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频繁使用造影剂进行计算机断层扫描检查对口腔鳞状细胞癌患者肾功能的影响及术后慢性肾脏病危险因素评估

Effect of Frequent Computed Tomography Examinations with Contrast Media on the Renal Function of Patients with Oral Squamous Cell Cancer and an Evaluation of Risk Factors for Post-Operative Chronic Kidney Disease.

作者信息

Hasegawa Takumi, Matsuda Aya, Amano Rika, Saito Izumi, Takeda Daisuke, Kakei Yasumasa, Kimoto Akira, Sakakibara Akiko, Akashi Masaya

机构信息

Department of Oral and Maxillofacial Surgery, Kobe University Graduate School of Medicine, 7-5-1, Kusunoki-Cho, Chuo-Ku, Kobe, 650-0017 Japan.

出版信息

J Maxillofac Oral Surg. 2024 Aug;23(4):824-830. doi: 10.1007/s12663-023-02015-1. Epub 2023 Sep 27.

Abstract

PURPOSE

This retrospective study aimed to investigate the effect of frequent computed tomography (CT) examinations with contrast media on the renal function of patients with oral squamous cell cancer (OSCC) that underwent radical surgery, by using estimated glomerular filtration rate (eGFR); to identify risk factors of occurrence of post-operative chronic kidney disease (CKD) in these patients; and to explore the relationship between risk factors and occurrence of postoperative CKD during follow-up.

METHODS

Herein, 188 patients (107 male; 81 female) who underwent radical surgery for OSCC were included. We evaluated the risk factors for postoperative CKD after treatment, including demographic, perioperative, and postoperative factors by univariate and multivariate analyses. Patients were divided into post-operative CKD and control groups based on eGFR evaluation. Overall survival (OS) rates were compared between the groups.

RESULTS

eGFR decreased over time after treatment in both patient groups. Postoperative CKD was diagnosed in 56 (29.8%) patients. The average number of contrast-enhanced CT examinations was not an independent risk factor for postoperative CKD. However, lower hemoglobin on hospital discharge [odds ratio (OR) = 0.53], lower eGFR on hospital discharge (OR = 0.84), and common use of nonsteroidal anti-inflammatory drugs (OR = 48.79) were significant risk factors associated with postoperative CKD. The control group was associated with a better OS than the postoperative CKD group; however, this difference was not significant.

CONCLUSIONS

Clinicians should pay close attention to these risk factor of post-operative CKD during the management of patients with OSCC that undergo radical surgery and frequent follow-up CT examinations with contrast media.

摘要

目的

本回顾性研究旨在通过估算肾小球滤过率(eGFR),调查接受根治性手术的口腔鳞状细胞癌(OSCC)患者频繁进行含造影剂的计算机断层扫描(CT)检查对其肾功能的影响;确定这些患者术后发生慢性肾脏病(CKD)的危险因素;并探讨危险因素与随访期间术后CKD发生之间的关系。

方法

纳入188例行OSCC根治性手术的患者(男性107例;女性81例)。我们通过单因素和多因素分析评估了治疗后术后CKD的危险因素,包括人口统计学、围手术期和术后因素。根据eGFR评估将患者分为术后CKD组和对照组。比较两组的总生存率(OS)。

结果

两组患者治疗后eGFR均随时间下降。56例(29.8%)患者被诊断为术后CKD。增强CT检查的平均次数不是术后CKD的独立危险因素。然而,出院时血红蛋白水平较低[比值比(OR)=0.53]、出院时eGFR较低(OR=0.84)以及常用非甾体抗炎药(OR=48.79)是与术后CKD相关的显著危险因素。对照组的OS优于术后CKD组;然而,这种差异并不显著。

结论

临床医生在管理接受根治性手术且频繁进行含造影剂的随访CT检查的OSCC患者时,应密切关注这些术后CKD的危险因素。

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