目的 探討不同程度碘對比劑后急性腎損傷的危險因素及其轉(zhuǎn)歸預(yù)后。方法 篩選2016年4月1日至2019年8月31日于重慶醫(yī)科大學(xué)附屬第三醫(yī)院住院期間發(fā)生碘對比劑后急性腎損傷（PC-AKI）的患者，按照急性腎損傷分層標準將其分為非嚴重損傷組（A組）和嚴重損傷組（B組），從基本人口學(xué)資料、基礎(chǔ)疾病、藥物使用情況、轉(zhuǎn)歸預(yù)后等方面分析兩組患者的特點及差異。結(jié)果 1 920例患者中發(fā)生PC-AKI者90例，其中A組72例（80.00%），B組18例（20.00%），B組中最終需腎臟替代治療（血液透析）干預(yù)者11例（12.22%）。A組與B組間一般情況、基礎(chǔ)腎功能、碘對比劑的使用以及聯(lián)用腎毒性藥物、靜脈水化量等觀察指標無統(tǒng)計學(xué)差異。B組合并慢性疾病者更多，其中冠心病（55.56% vs 29.17%）、心肌梗死（27.78% vs 5.56%）患病率差異具有統(tǒng)計學(xué)意義（P<0.05），行血液透析的患者第一診斷為心肌梗死者占45.45%。65.85%的患者在使用對比劑后10 d內(nèi)肌酐仍高于基線，54.54%的透析患者在出院時仍需透析治療，81.81%的透析患者出院時死亡或放棄治療。結(jié)論 合并冠心病、心肌梗死的患者更容易發(fā)生嚴重PC-AKI，當合并這些疾病的患者使用碘對比劑時，臨床醫(yī)師應(yīng)密切關(guān)注其腎功能的變化。PC-AKI的腎功轉(zhuǎn)歸較差，發(fā)生PC-AKI后需透析治療的患者往往預(yù)后不良。

Objective To investigate the risk factors and prognosis of different degrees of post-contrast acute kidney injury. Methods A retrospective analysis was performed for the patients admitted to The Third Affiliated Hospital of Chongqing Medical University from April 2016 to August 2019, the patients who met the diagnostic criteria of post-contrast acute kidney injury (PC-AKI) were divided into without serious injury group (group A) and serious injury group (group B), the characteristics and differences between two groups were analyzed by collecting the medical records of basic demographic datas, diseases, drugs and outcomes. Results 90 patients were diagnosed with PC-AKI among the 1 920 patients, including 72 patients (80.00%) in group A and 18 patients (20.00%) in group B, 11 patients in group B were treated with renal replacement therapy (hemodialysis) after useing iodine contrast agent. There were no significant differences in general information, basic renal function, use of iodine contrast agent, nephrotoxic drug and intravenous hydration between two groups. Patients in group B had the higher prevalence of chronic diseases, especially the coronary heart disease (55.56% vs 29.17%) and myocardial infarction (27.78% vs 5.56%) (P<0.05), myocardial infarction was the first diagnosis in 45.45% of the patients requiring hemodialysis. 65.85% of patients had a creatinine above baseline within 10 days after using contrast agent, 54.54% of the patients requiring hemodialysis couldn't stop receiving hemodialysis prior to discharge, 81.81% of the patients requiring hemodialysis died or gave up the treatment prior to discharge. Conclusion Patients with coronary heart disease or myocardial infarction were more likely to have severe PC-AKI. Doctors should pay close attention to patients' renal function after using contrast agent, especially when they had these dieases. The renal function of most patients with PC-AKI didn't return to baseline, the patients requiring hemodialysis after PC-AKI usually had poor outcomes.

R969

中國健康促進基金會醫(yī)藥知識管理專項基金（KNKT-ZX-1601）