From the Department of Radiology, Research Institute of Radiological Science, Severance Hospital, Yonsei University College of Medicine.
Department of Radiology, Seoul National University Hospital, Seoul National University College of Medicine.
Invest Radiol. 2019 Sep;54(9):589-599. doi: 10.1097/RLI.0000000000000568.
We aimed to meta-analytically compare the incidence of acute adverse reactions (AARs) to nonionic iodinated contrast media (ICM) according to the type of ICM in patients who underwent radiologic examinations with administration of ICM via intravascular route.
A systematic literature search identified studies evaluating the incidence of AARs to 7 nonionic ICM (iobitridol, iohexol, iomeprol, iopamidol, iopromide, ioversol, and iodixanol) with extractable outcomes. These outcomes were pooled using a random-effects model, and the effect of ICM type on the incidence of overall and severe AARs was evaluated using meta-regression analysis.
Thirty studies with 1,360,488 exposures to ICM were included. The pooled incidences of overall and severe AARs to nonionic ICM were 1.03% (95% confidence interval [CI], 0.81%-1.30%; I = 0.99) and 0.0141% (95% CI, 0.0108%-0.0183%; I = 0.56), respectively. Iomeprol had the highest overall AAR incidence (1.74%; 95% CI, 0.79%-3.76%; I = 0.99), followed by iohexol (1.21%; 95% CI, 0.67%-2.17%; I = 0.99), iopamidol (1.10%; 95% CI, 0.60%-2.03%; I = 0.99), ioversol (0.88%; 95% CI, 0.43%-1.83%; I = 0.96), iodixanol (0.85%; 95% CI, 0.36%-1.95%; I = 0.99), iopromide (0.82%; 95% CI, 0.43%-1.55%; I = 0.99), and iobitridol (0.77%; 95% CI, 0.36%-1.62%; I = 0.99). Multivariable meta-regression analysis revealed that study design (P = 0.0014) and premedication (P = 0.0230) were statistically significant determinants affecting the incidence of overall AARs. Iodinated contrast media type did not affect the incidence of overall and severe AARs (P = 0.1453 and 0.4265, each).
The varying pooled incidences of overall and severe AARs to specific types of nonionic ICM do not remain as significant after adjusting confounders. Our results may support nonrestriction of certain types of nonionic ICM in the context of AAR avoidance.
我们旨在通过荟萃分析比较血管内途径给予非离子型碘造影剂（ICM）行影像学检查的患者中，不同类型 ICM 所致急性不良反应（AAR）的发生率。
系统文献检索确定了评估 7 种非离子型 ICM（碘比醇、碘海醇、碘美普尔、碘帕醇、碘普罗胺、碘佛醇和碘克沙醇）所致 AAR 发生率的研究，并提取了结局数据。使用随机效应模型汇总这些结局数据，并采用多元回归分析评估 ICM 类型对总体和严重 AAR 发生率的影响。
共纳入 30 项研究，涉及 1360488 例 ICM 暴露者。非离子型 ICM 所致总体和严重 AAR 的发生率分别为 1.03%（95%置信区间[CI]：0.81%-1.30%；I = 0.99）和 0.0141%（95%CI：0.0108%-0.0183%；I = 0.56）。总体 AAR 发生率最高的是碘美普尔（1.74%；95%CI：0.79%-3.76%；I = 0.99），其次是碘海醇（1.21%；95%CI：0.67%-2.17%；I = 0.99）、碘帕醇（1.10%；95%CI：0.60%-2.03%；I = 0.99）、碘佛醇（0.88%；95%CI：0.43%-1.83%；I = 0.96）、碘克沙醇（0.85%；95%CI：0.36%-1.95%；I = 0.99）、碘普罗胺（0.82%；95%CI：0.43%-1.55%；I = 0.99）和碘比醇（0.77%；95%CI：0.36%-1.62%；I = 0.99）。多变量回归分析显示，研究设计（P = 0.0014）和用药前准备（P = 0.0230）是影响总体 AAR 发生率的统计学显著决定因素。ICM 类型并未影响总体和严重 AAR 的发生率（P = 0.1453 和 0.4265，均）。
在调整混杂因素后，不同类型非离子型 ICM 所致总体和严重 AAR 的发生率差异不再显著。我们的研究结果可能支持在避免 AAR 的情况下不限制使用某些类型的非离子型 ICM。
