论文部分内容阅读
目的影像学检查时静脉注射(IV)对比剂的病人与曾经做过影像学检查但未使用过对比剂或从未做过检查(对照组)共两组病人,对两组间急性肾损伤(AKI)的发生率和其他风险的对照研究进行系统回顾和Meta分析。材料与方法在MEDLINE、EMBASE、Scopus以及CochraneLibrary检索2011年9月前发表的含有静脉注射对比剂后肾毒性相关检索词的所有文章。两名独立的研究员通过分析病人进行影像学检查或入院后48~72h血清肌酐水平或肾小球滤过率的变化分别研究使用IV对比剂病人和未使用对比剂病人AKI的发生率。应用标准方法得出:研究特征、AKI发生结果、透析率和死亡率。通过随机效应模型计算相对危险度(RR);并在不同病人并发症、对比剂类型和AKI诊断标准的亚组中检验RR。RR值小于1.00提示在未使用对比剂组(非对比剂组)这些结果有较高的发生率。结果在最初确定的1489项研究中,13项包括25950例病人的非随机研究(0.9%)符合纳入标准。接受对比剂组(对比剂组)AKI风险[RR=0.79;95%CI:0.62~1.02;P=0.07]、死亡风险(RR=0.95;95%CI:0.55~1.67;P=0.87)、透析风险(RR=0.88;95%CI:0.23~3.43;P=0.85)与非对比剂组AKI风险比较是相似的。这个结果不受IV对比剂类型、AKI的诊断标准或者病人是否有糖尿病或肾功能不全的影响。结论对比剂诱发肾病的对照研究表明在对比剂组和对照组之间,两者有类似的AKI发生率、透析率和死亡率。
Aim To compare the effects of intravenous (IV) contrast agent in patients with those who had undergone radiological examination but not contrast or who had never been examined (control group) for acute renal injury AKI) and other risks of controlled study for systematic review and meta-analysis. MATERIALS AND METHODS All articles containing nephrotoxic related terms after intravenous contrast agent published before September 2011 were searched MEDLINE, EMBASE, Scopus and Cochrane Library. Two independent investigators studied the incidence of AKI in patients with IV contrast and unused contrast agents, respectively, by analyzing the changes in serum creatinine or GFR 48 to 72 hours after imaging or on admission. Standard methods were used: study characteristics, outcome of AKI, dialysis and mortality. Relative risk (RR) was calculated by random effects model; RR was examined in subgroups with different patient complications, contrast media type, and AKI diagnostic criteria. An RR of less than 1.00 suggests a higher incidence of these results in the unused contrast group (non-contrast group). Results Of the initially identified 1489 studies, 13 non-randomized studies (0.9%), including 25,950 patients, met the inclusion criteria. The risk of AKI in the comparator (comparator) group (RR = 0.79; 95% CI: 0.62-1.02; P = 0.07), risk of death (RR = 0.95; 95% CI: 0.55-1.67; Risk (RR = 0.88; 95% CI: 0.23 to 3.43; P = 0.85) was similar to the risk of AKI in the non-contrast group. This result is not affected by the type of IV contrast media, the diagnostic criteria of AKI, or whether the patient has diabetes or renal insufficiency. Conclusions A controlled study of contrast-induced nephropathy showed a similar incidence of AKI, dialysis, and mortality between the comparator and control groups.