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目的对欧洲泌尿生殖放射学会(ESUR)制定的对比剂肾病(CIN)诊断标准缺陷进行分析,并提出改进建议。方法文章收集2005、2006年及2010年3—7月于首都医科大学附属北京安贞医院接受冠状动脉介入术的患者,应用ESUR制定的标准(标准1)及文内修订的ESUR标准(标准2)对CIN进行诊断,通过两个标准诊断结果的对比分析,找出ESUR诊断标准的缺陷、成因及改进方法。结果 (1)用标准1、2诊断的CIN发病率分别为11.6%及4.2%,相差2.8倍(P<0.01)。(2)用标准2进行诊断时,CIN组与非CIN组的SCr中位数值分别为85.0μmol/L及77.8μmol/L(P<0.01);用标准1诊断时分别为65.5μmol/L及79.6μmol/L(P<0.001)。(3)CIN组基线SCr值与CIN发病率的关系,用标准2进行诊断时近似线形,而用标准1诊断时呈“U”型。(4)基线SCr正常组用标准2的SCr上升绝对值及相对值指标进行诊断时,CIN发病率分别为1.3%及3.4%;用标准1的上述指标进行诊断时,分别为1.4%及12.1%。结论用ESUR标准诊断CIN会造成过度诊断,此过度诊断主要发生在基线SCr正常人群及应用SCr上升相对值指标进行诊断时。应用文内修订的标准可以克服上述缺陷。
OBJECTIVE: To analyze the diagnostic criteria of Contrast-induced nephropathy (CIN) developed by European Genitourinary Society (ESUR) and to provide suggestions for improvement. METHODS: Patients with coronary artery disease undergoing coronary angioplasty at Beijing Anzhen Hospital affiliated to Capital Medical University from March to July in 2005, 2006 and 2010 were enrolled in this study. ESUR criteria (Standard 1) and the revised version of ESUR (Standard 2 ) CIN diagnosis, through the comparison of two standard diagnostic results to identify the defects of ESUR diagnostic criteria, causes and improvement methods. Results (1) The incidences of CIN diagnosed with standard 1 and 2 were 11.6% and 4.2%, respectively, a difference of 2.8 times (P <0.01). (2) The SCr median of CIN group and non-CIN group were 85.0μmol / L and 77.8μmol / L respectively (P <0.01) when diagnosed by standard 2, 65.5μmol / L and 79.6 μmol / L (P <0.001). (3) The baseline SCr value in CIN group was positively correlated with the incidence of CIN, which was approximately linear when diagnosed with standard 2 and “U” with standard 1. (4) The incidence of CIN was 1.3% and 3.4% respectively in the baseline SCr normal group and the standard SCr ascending absolute value and relative value in the baseline SCr group, 1.4% and 12.1 %. Conclusions The diagnosis of CIN using the ESUR standard can cause overdiagnosis. This overdiagnosis mainly occurs when the baseline SCr normal population and the relative value of SCr rise are used for diagnosis. The application of the revised standards can overcome the above shortcomings.