慢性肾脏病患者计算机断层扫描期间的造影剂暴露与终末期肾病发生风险：一项基于全国人口的倾向评分匹配纵向随访研究
Contrast Medium Exposure During Computed Tomography and Risk of Development of End-Stage Renal Disease in Patients With Chronic Kidney Disease: A Nationwide Population-Based, Propensity Score-Matched, Longitudinal Follow-Up Study.
作者信息
Hsieh Ming-Shun, Chiu Chien-Shan, How Chorng-Kuang, Chiang Jen-Huai, Sheu Meei-Ling, Chen Wen-Chi, Lin Hsuan-Jen, Hsieh Vivian Chia-Rong, Hu Sung-Yuan
机构信息
From the Department of Emergency Medicine (M-SH), Taipei Veterans General Hospital, Taoyuan Branch, Taoyuan; Department of Emergency Medicine (M-SH), Taipei Veterans General Hospital; Institute of Occupational Medicine and Industrial Hygiene (M-SH), National Taiwan University College of Public Health; School of Medicine (M-SH, C-SC, C-KH), National Yang-Ming University, Taipei; Department of Dermatology (C-SC), Taichung Veterans General Hospital; Institute of Biomedical Sciences (C-SC, M-LS), National Chung Hsing University; Management Office for Health Data (J-HC); College of Medicine (J-HC); Graduate Institute of Integrated Medicine (J-HC, W-CC), College of Chinese Medicine, Research Center for Chinese Medicine & Acupuncture, China Medical University; Sex Hormone Research Center (W-CC), Departments of Obstetrics and Gynecology, Urology, and Medical Research; Department of Medical Research (W-CC), Obstetrics and Gynecology, Dermatology, and Urology; Kidney Institute and Division of Nephrology (H-JL), Department of internal medicine; Department of Health Services Administration (VC-RH), China Medical University; Department of Emergency Medicine (S-YH), Taichung Veterans General Hospital; Institute of Medicine (S-YH), Chung Shan Medical University; and Department of Nursing (S-YH), College of Health, National Taichung University of Science and Technology, Taichung, Taiwan.
出版信息
Medicine (Baltimore). 2016 Apr;95(16):e3388. doi: 10.1097/MD.0000000000003388.
The aim of the study was to investigate the long-term association between contrast medium exposure during computed tomography (CT) and the subsequent development of end-stage renal disease (ESRD) in patients with chronic kidney disease (CKD). We conducted a population-based cohort study using Taiwan's National Health Insurance Research Database. A total of 7100 patients with nonadvanced CKD who underwent contrast medium-enhanced CT were identified and served as the study cohort. To avoid selection bias, we used the propensity score to match 7100 nonadvanced CKD patients, who underwent noncontrast medium-enhanced CT to serve as the comparison cohort. The age, sex, index year, and frequency of undergoing CTs were also matched between the study and comparison cohorts. Participants were followed until a new diagnosis of ESRD or December 31, 2011. Hazard ratios (HRs) with 95% confidence interval (95% CI) were calculated using the Cox proportional hazards regression. Contrast medium exposure was not identified as a risk factor for developing ESRD in nonadvanced CKD patients after confounders adjustment (adjusted HR = 0.91; 95% CI, 0.66-1.26; P = 0.580). We further divided the patients who underwent CTs with contrast medium use into ≤1 exposure per year on average, >1 and <2 exposure per year on average, and ≥2 exposure per year on average. After adjusting for confounders, we identified a much higher risk for developing ESRD in the 2 groups of >1 and <2 exposure per year on average and ≥2 exposure per year on average (adjusted HR = 8.13; 95% CI, 5.57-11.87 and adjusted HR = 12.08; 95% CI, 7.39-19.75, respectively) compared with the patients who underwent CTs without contrast medium use. This long-term follow-up study demonstrated that contrast medium exposure was not associated with an increased risk of ESRD development in nonadvanced CKD patients.
本研究的目的是调查慢性肾脏病（CKD）患者在计算机断层扫描（CT）期间的造影剂暴露与终末期肾病（ESRD）后续发生之间的长期关联。我们使用台湾全民健康保险研究数据库进行了一项基于人群的队列研究。共识别出7100例接受造影剂增强CT的非晚期CKD患者，并将其作为研究队列。为避免选择偏倚，我们使用倾向评分匹配7100例接受非造影剂增强CT的非晚期CKD患者作为对照队列。研究队列和对照队列在年龄、性别、索引年份以及接受CT检查的频率方面也进行了匹配。对参与者进行随访，直至新诊断出ESRD或2011年12月31日。使用Cox比例风险回归计算风险比（HR）及95%置信区间（95%CI）。在调整混杂因素后，造影剂暴露未被确定为非晚期CKD患者发生ESRD的危险因素（调整后HR = 0.91；95%CI，0.66 - 1.26；P = 0.580）。我们进一步将使用造影剂进行CT检查的患者分为平均每年≤1次暴露、平均每年>1次且<2次暴露以及平均每年≥2次暴露。在调整混杂因素后，我们发现平均每年>1次且<2次暴露以及平均每年≥2次暴露的两组患者发生ESRD的风险比未使用造影剂进行CT检查的患者高得多（调整后HR分别为8.13；95%CI，5.57 - 11.87和调整后HR为12.08；95%CI，7.39 - 19.75）。这项长期随访研究表明，造影剂暴露与非晚期CKD患者发生ESRD的风险增加无关。
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