Yang Yongfeng, Liu Fangyi, Yu Jie, Cheng Zhigang, Han Zhiyu, Dou Jianping, Hu Jie, Wang Ze, Gao Haigang, Yang Qiao, Tian Jing, Xu Yongjie, Bai Xiaoli, Lu Liping, Liang Ping
Department of Interventional Ultrasound, Chinese PLA General Hospital, Beijing, China.
Special Clinic Department, The 985th Hospital of Chinese People's Liberation Army Joint Logistic Support Force, Taiyuan, China.
Front Oncol. 2020 Sep 4;10:1408. doi: 10.3389/fonc.2020.01408. eCollection 2020.
Acute kidney injury (AKI) is a recently observed side effect in patients after microwave ablation (MWA) of hepatocellular carcinoma (HCC) and is associated with negative outcomes. The aim of this study is to explore the risk factors of affecting the occurrence of AKI (stages 1b, 2, and 3), because they have a higher mortality rate than patients with AKI (stage 1a) and without AKI. In this retrospective study, a total of 1,214 patients with HCC who were treated with MWA under ultrasound (US) guidance in our department between January 2005 and November 2017 were enrolled. We evaluated the influence of 20 risk factors. Univariate and multivariate analysis were used for statistical analysis. The possible risk factors of AKI after MWA for HCC were summarized. AKI, AKI (stage 1a), and AKI (stages 1b, 2, and 3) after MWA were found in 34, 15, and 19 patients (2.80, 1.24, and 1.57%), respectively. Among 34 patients with AKI, 10 cases with AKI (stage 1a) and 6 cases with AKI (stages 1b, 2, and 3) recovered before their discharge without any treatment for AKI and 9 cases with AKI (stages 1b, 2, and 3) with further treatment. Four cases who had chronic renal failure before MWA of liver accepted renal dialysis. By univariate analysis, the number of antenna insertions ( = 0.027, OR = 3.3), MWA time ≥20 min ( = 0.029, OR = 4.3), creatinine (Cr)-pre above the upper limit of the reference value ( < 0.001, OR = 35.5), albumin (Alb)-pre ( = 0.030, OR = 0.9), and red blood cell (RBC)-pre ( < 0.001, OR = 0.3) were significant risk factors. By multivariate analysis, Cr-pre ≥ 110 μmol/L ( < 0.001, OR = 31.4) and MWA time ≥20 min ( = 0.043 OR = 9.9) were the independent risk factors. AKI (stages 1b, 2, and 3) is a relatively serious complication after MWA for HCC, which is related to MWA time and Cr-pre. It requires attention by clinicians. So it is of great necessity to assess the Cr-pre level and reduce the MWA time to <20 min to minimize the risk of AKI after MWA for HCC.
急性肾损伤（AKI）是最近在肝细胞癌（HCC）患者接受微波消融（MWA）后观察到的一种副作用，且与不良预后相关。本研究的目的是探讨影响AKI（1b期、2期和3期）发生的危险因素，因为这些患者的死亡率高于AKI（1a期）患者和无AKI患者。在这项回顾性研究中，纳入了2005年1月至2017年11月期间在我科接受超声（US）引导下MWA治疗的1214例HCC患者。我们评估了20个危险因素的影响。采用单因素和多因素分析进行统计学分析。总结了HCC患者MWA术后AKI的可能危险因素。MWA术后AKI、AKI（1a期）和AKI（1b期、2期和3期）分别在34例、15例和19例患者中发现（2.80%、1.24%和1.57%）。在34例AKI患者中，10例AKI（1a期）患者和6例AKI（1b期、2期和3期）患者在出院前未经任何AKI治疗即康复，9例AKI（1b期、2期和3期）患者接受了进一步治疗。4例在肝脏MWA术前患有慢性肾衰竭的患者接受了肾透析。单因素分析显示，天线插入次数（P = 0.027，OR = 3.3）、MWA时间≥20分钟（P = 0.029，OR = 4.3）、术前肌酐（Cr）高于参考值上限（P < 0.001，OR = 35.5）、术前白蛋白（Alb）（P = 0.030，OR = 0.9）和术前红细胞（RBC）（P < 0.001，OR = 0.3）是显著危险因素。多因素分析显示，术前Cr≥110 μmol/L（P < 0.001，OR = 31.4）和MWA时间≥20分钟（P = 0.043，OR = 9.9）是独立危险因素。AKI（1b期、2期和3期）是HCC患者MWA术后相对严重的并发症，与MWA时间和术前Cr有关。需要临床医生关注。因此，评估术前Cr水平并将MWA时间缩短至<20分钟以尽量降低HCC患者MWA术后AKI的风险非常必要。
