Department of Interventional Radiology II, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
Clin Invest Med. 2021 Oct 3;44(3):E19-24. doi: 10.25011/cim.v44i3.36961.
Incidence of contrast induced nephropathy (CIN) and related risk factors in patients with liver cancer and chronic kidney disease after trans-catheter arterial chemoembolization (TACE) is higher. The purpose of this study was to investigate the feasibility and safety of TACE therapy in such patients.
A retrospective analysis was performed on 103 patients with liver cancer and chronic kidney disease who underwent TACE treatments. TACE was performed according to Seldinger's technique of arterial embolization with minor modifications. Based on CIN diagnostic criteria, patients were divided into non-CIN (n=89) and CIN (n=14) groups. Multiple clinical parameters were assessed for the two groups after TACE. Serum creatinine levels were measured 48-72 h after TACE.
Tumor size (>5 cm), TACE frequency, contrast agent dosage, solitary kidney, volume of iodized oil used in the TACE (ml) and urea levels were significantly higher in CIN group in comparison with the non-CIN group, while serum albumin and haemoglobin levels were significantly lower. Multivariate logistic regression analysis confirmed that the volume of iodized oil and TACE frequency were significantly positively correlated, and serum albumin level was negatively correlated in the CIN group.
Volume of iodized oil, TACE frequency and low serum albumin levels were found to be independent risk factors for CIN after TACE. Thus, it is safe and feasible for hepatocellular carcinoma patients with chronic kidney disease to receive TACE treatment, but adverse events management after TACE needs to be addressed.
肝癌合并慢性肾脏病患者经导管动脉化疗栓塞术（TACE）后发生对比剂肾病（CIN）及相关危险因素的发生率较高。本研究旨在探讨此类患者行 TACE 治疗的可行性和安全性。
回顾性分析 103 例行 TACE 治疗的肝癌合并慢性肾脏病患者的临床资料。TACE 采用改良 Seldinger 动脉栓塞技术进行。根据 CIN 诊断标准，将患者分为 CIN 组（n=14）和非 CIN 组（n=89）。比较两组患者 TACE 治疗后的多项临床参数。TACE 后 48-72 小时测量血清肌酐水平。
CIN 组肿瘤直径（>5cm）、TACE 频率、造影剂用量、孤立肾、TACE 中碘油用量（ml）及尿素水平均显著高于非 CIN 组，而血清白蛋白及血红蛋白水平显著低于非 CIN 组。多因素 logistic 回归分析证实，CIN 组中碘油用量与 TACE 频率呈显著正相关，血清白蛋白水平呈显著负相关。
TACE 后碘油用量、TACE 频率和低血清白蛋白水平是 CIN 的独立危险因素。因此，慢性肾脏病肝癌患者行 TACE 治疗是安全可行的，但 TACE 后不良事件的管理仍需关注。
