下肢动脉硬化闭塞症介入后PC-AKI发生及影响因素分析

doi:10.3877/cma.j.issn.2095-5782.2025.04.005

目的

分析下肢动脉硬化闭塞症（lower extremity arteriosclerosis obliterans, LEASO）介入后对比剂后急性肾损伤（post-contrast acute kidney injury, PC-AKI）发生率及其影响因素。

方法

回顾性分析2023年1月至2024年12月于浙江省人民医院行介入治疗的LEASO患者550例，根据是否发生PC-AKI分为PC-AKI组和非PC-AKI组，比较2组临床特征。采用Cochran-Armitage趋势检验法分析PC-AKI发生率随慢性肾脏病（chronic kidney disease, CKD）分期进展的变化趋势。采用多因素Logistic回归方法分析PC-AKI发生的影响因素。

结果

发生PC-AKI的患者42例（7.64%）。随着CKD分期进展，PC-AKI发生率逐渐升高（趋势检验P<0.001）。多因素Logistic回归分析结果显示，心力衰竭（OR=5.63，95% CI：1.58~20.00，P=0.008）、急性下肢缺血（ALI）（OR=5.53，95% CI：1.91~16.01，P=0.002）、估算肾小球滤过率（estimated glomerular filtration rate, eGFR）<60 mL/(min·1.73 m²)（OR=2.81，95% CI：1.08~7.32，P=0.035）、对比剂使用剂量与eGFR比值（CGR）≥3（OR=4.03，95% CI：1.61~10.09，P=0.003）是LEASO介入治疗后PC-AKI的影响因素。

结论

LEASO介入治疗后PC-AKI并不少见，随着CKD分期进展，PC-AKI发生率逐渐升高。心力衰竭、ALI、eGFR<60 mL/(min·1.73 m²)、CGR≥3是LEASO介入治疗后PC-AKI的影响因素。

关键词: 下肢动脉硬化闭塞症, 介入治疗, 对比剂后急性肾损伤, 慢性肾脏病

Objective

To explore the prevalence and influencing factors of post-contrast acute kidney injury (PC-AKI) in patients with lower extremity arteriosclerosis obliterans (LEASO) after interventional therapy.

Methods

A retrospective analysis was conducted on 550 patients with LEASO who underwent interventional therapy at Zhejiang Provincial People's Hospital between January 1, 2023 and December 31, 2024. Patients were categorized into PC-AKI and non-PC-AKI groups based on the occurrence of PC-AKI. Clinical data were collected and compared. The Cochran-Armitage trend test was applied to assess the relationship between PC-AKI incidence and chronic kidney disease (CKD) stage. Multivariate logistic regression analysis was performed to identify independent predictors of PC-AKI.

Results

PC-AKI occurred in 42 patients (7.64%). The incidence of PC-AKI increased significantly with advancing CKD stage (trend P<0.001). Multivariate logistic regression analysis identified heart failure (OR=5.63, 95% CI：1.58~20.00, P=0.008), acute limb ischemia (ALI) (OR=5.53, 95% CI：1.91~16.01, P=0.002), baseline eGFR<60 mL·min^-1·(1.73 m²)^-1 (OR=2.81, 95% CI：1.08~7.32, P=0.035), and a contrast medium volume-to-eGFR ratio (CGR)≥3 (OR=4.03, 95% CI：1.61~10.09, P=0.003) as independent factors associated with PC-AKI.

Conclusion

PC-AKI is a relatively common complication in LEASO patients after interventional therapy, with incidence increasing in parallel with CKD stage progression. Heart failure, ALI, impaired baseline renal function [eGFR< 60 mL/(min·1.73 m²)], and CGR≥3 are independent predictors of PC-AKI in this population.

Key words: Lower extremity arteriosclerosis obliterans, Interventional therapy, Post-contrast acute kidney injury, Chronic kidney disease

表1 PC-AKI组与非PC-AKI组患者临床特征比较

临床资料	总体（550例）(n=550)	非PC-AKI组（508例）(n=508)	PC-AKI组（42例）(n=42)	统计值	P值
性别[男性,例(%)]	402 (73.09)	374 (73.62)	28 (66.67)	0.63	0.426
年龄[岁，M(Q₁, Q₃)]	75.00 (68.00, 82.00)	75.00 (68.00, 82.00)	74.50 (67.25, 82.00)	10 999.00	0.738
BMI[kg/m²，M(Q₁, Q₃)]	22.03 (19.61, 24.16)	22.04 (19.69, 24.18)	21.54 (19.55, 23.99)	10 881.00	0.83
吸烟史[例(%)]	247 (44.91)	233 (45.87)	14 (33.33)	1.98	0.159
合并疾病[例(%)]
高血压	404 (73.45)	366 (72.05)	38 (90.48)		0.010 ^a
糖尿病	273 (49.64)	249 (49.02)	24 (57.14)	0.73	0.394
冠心病	100 (18.18)	86 (16.93)	14 (33.33)	5.96	0.015
心力衰竭	16 (2.91)	10 (1.97)	6 (14.29)	16.7	<0.001
血脂异常	507 (92.18)	470 (92.52)	37 (88.10)	0.53	0.467
CLI[例(%)]	167 (30.36)	153 (30.12)	14 (33.33)	0.07	0.794
ALI[例(%)]	24 (4.36)	14 (2.76)	10 (23.81)	36.31	<0.001
血红蛋白(g/L， $x ¯$ ±s)	125.11±21.35	126.10±21.35	113.19±17.60	14 533.50	<0.001
血肌酐[μmol/L, M(Q₁, Q₃)]	82.45 (68.35, 107.40)	80.80 (67.10,101.13)	130.15 (102.15, 269.43)	4 201.00	<0.001
eGFR[ml/(min·1.73 m²), M(Q₁, Q₃)]	75.99 (53.34, 88.14)	77.62 (55.68, 89.59)	34.49 (16.75, 60.14)	17 196.00	<0.001
术后72 h内血肌酐[μmol/L, M(Q₁, Q₃)]	83.50 (68.50, 111.88)	80.60 (67.68, 100.63)	187.00 (145.03, 363.75)	1 497.50	<0.001
CKD分期[例(%)]				68.48	<0.001
正常/G1~2期	374 (68.00)	363 (71.46)	11 (26.19)
G3a期	90 (16.36)	81 (15.94)	9 (21.43)
G3b期	39 (7.09)	34 (6.69)	5 (11.90)
G4期	18 (3.27)	12 (2.36)	6 (14.29)
G5期	29 (5.27)	18 (3.54)	11 (26.19)
院内用药[例(%)]
ACEI/ARB	158 (28.73)	142 (27.95)	16 (38.10)	1.49	0.223
非甾体类抗炎药物	262 (47.64)	237 (46.65)	25 (59.52)	2.09	0.149
CGR≥3[例(%)]	72 (13.09)	50 (9.84)	22 (52.38)	58.02	<0.001
住院时间[d, M(Q₁, Q₃)]	6.00 (5.00, 8.00)	6.00 (5.00, 8.00)	8.00 (6.00, 12.00)	7 206.00	<0.001
术后30 d死亡[例(%)]	5 (0.91)	2 (0.39)	3 (7.14)		0.004^a

表1 PC-AKI组与非PC-AKI组患者临床特征比较

临床资料	总体（550例）(n=550)	非PC-AKI组（508例）(n=508)	PC-AKI组（42例）(n=42)	统计值	P值
性别[男性,例(%)]	402 (73.09)	374 (73.62)	28 (66.67)	0.63	0.426
年龄[岁，M(Q₁, Q₃)]	75.00 (68.00, 82.00)	75.00 (68.00, 82.00)	74.50 (67.25, 82.00)	10 999.00	0.738
BMI[kg/m²，M(Q₁, Q₃)]	22.03 (19.61, 24.16)	22.04 (19.69, 24.18)	21.54 (19.55, 23.99)	10 881.00	0.83
吸烟史[例(%)]	247 (44.91)	233 (45.87)	14 (33.33)	1.98	0.159
合并疾病[例(%)]
高血压	404 (73.45)	366 (72.05)	38 (90.48)		0.010 ^a
糖尿病	273 (49.64)	249 (49.02)	24 (57.14)	0.73	0.394
冠心病	100 (18.18)	86 (16.93)	14 (33.33)	5.96	0.015
心力衰竭	16 (2.91)	10 (1.97)	6 (14.29)	16.7	<0.001
血脂异常	507 (92.18)	470 (92.52)	37 (88.10)	0.53	0.467
CLI[例(%)]	167 (30.36)	153 (30.12)	14 (33.33)	0.07	0.794
ALI[例(%)]	24 (4.36)	14 (2.76)	10 (23.81)	36.31	<0.001
血红蛋白(g/L， $x ¯$ ±s)	125.11±21.35	126.10±21.35	113.19±17.60	14 533.50	<0.001
血肌酐[μmol/L, M(Q₁, Q₃)]	82.45 (68.35, 107.40)	80.80 (67.10,101.13)	130.15 (102.15, 269.43)	4 201.00	<0.001
eGFR[ml/(min·1.73 m²), M(Q₁, Q₃)]	75.99 (53.34, 88.14)	77.62 (55.68, 89.59)	34.49 (16.75, 60.14)	17 196.00	<0.001
术后72 h内血肌酐[μmol/L, M(Q₁, Q₃)]	83.50 (68.50, 111.88)	80.60 (67.68, 100.63)	187.00 (145.03, 363.75)	1 497.50	<0.001
CKD分期[例(%)]				68.48	<0.001
正常/G1~2期	374 (68.00)	363 (71.46)	11 (26.19)
G3a期	90 (16.36)	81 (15.94)	9 (21.43)
G3b期	39 (7.09)	34 (6.69)	5 (11.90)
G4期	18 (3.27)	12 (2.36)	6 (14.29)
G5期	29 (5.27)	18 (3.54)	11 (26.19)
院内用药[例(%)]
ACEI/ARB	158 (28.73)	142 (27.95)	16 (38.10)	1.49	0.223
非甾体类抗炎药物	262 (47.64)	237 (46.65)	25 (59.52)	2.09	0.149
CGR≥3[例(%)]	72 (13.09)	50 (9.84)	22 (52.38)	58.02	<0.001
住院时间[d, M(Q₁, Q₃)]	6.00 (5.00, 8.00)	6.00 (5.00, 8.00)	8.00 (6.00, 12.00)	7 206.00	<0.001
术后30 d死亡[例(%)]	5 (0.91)	2 (0.39)	3 (7.14)		0.004^a

表2 不同CKD分期组别PC-AKI发生率变化趋势[例(%)]

CKD分期	例数	总体	男性	女性
正常/G1	126	1 (0.79)	0 (0.00)	1 (3.70)
G2	248	10 (4.03)	9 (4.79)	1 (1.67)
G3a	90	9 (10.00)	7 (11.11)	2 (7.41)
G3b	39	5 (12.82)	2 (10.00)	3 (15.79)
G4	18	6 (33.33)	3 (25.00)	3 (50.00)
G5	29	11 (37.93)	7 (35.00)	4 (44.44)
Z值^a		7.94	6.18	4.84
P值		<0.001	<0.001	<0.001

表2 不同CKD分期组别PC-AKI发生率变化趋势[例(%)]

CKD分期	例数	总体	男性	女性
正常/G1	126	1 (0.79)	0 (0.00)	1 (3.70)
G2	248	10 (4.03)	9 (4.79)	1 (1.67)
G3a	90	9 (10.00)	7 (11.11)	2 (7.41)
G3b	39	5 (12.82)	2 (10.00)	3 (15.79)
G4	18	6 (33.33)	3 (25.00)	3 (50.00)
G5	29	11 (37.93)	7 (35.00)	4 (44.44)
Z值^a		7.94	6.18	4.84
P值		<0.001	<0.001	<0.001

表3 LEASO介入治疗后PC-AKI的单因素及多因素分析Logistic回归分析结果

变量	单因素分析			多因素分析
变量	OR值	95% CI	P值^a	OR值	95% CI	P值^a
女性	1.40	0.71~2.73	0.330
年龄≥60岁	1.48	0.44~4.97	0.523
BMI分类
偏低	参照
正常	1.45	0.49~4.28	0.503
超重	0.94	0.27~3.33	0.924
肥胖	3.42	0.78~14.99	0.103
吸烟史	0.59	0.30~1.15	0.120
高血压	3.69	1.29~10.52	0.015	2.40	0.77~7.48	0.132
糖尿病	1.39	0.73~2.62	0.313
冠心病	2.45	1.24~4.85	0.010	2.18	0.98~4.87	0.057
心力衰竭	8.30	2.86~24.13	<0.001	5.63	1.58~20.00	0.008
血脂异常	0.60	0.22~1.61	0.309
CLI	1.16	0.59~2.26	0.663
ALI	11.03	4.54~26.76	<0.001	5.53	1.91~16.01	0.002
血红蛋白≥110 g/L	0.63	0.32~1.25	0.189
eGFR< 60 mL/(min·1.73m²)	7.06	3.45~14.41	<0.001	2.81	1.08~7.32	0.035
ACEI/ARB	1.59	0.83~3.05	0.166
非甾体类抗炎药物	1.68	0.89~3.19	0.112
CGR≥3	10.08	5.14~19.73	<0.001	4.03	1.61~10.09	0.003

表3 LEASO介入治疗后PC-AKI的单因素及多因素分析Logistic回归分析结果

变量	单因素分析			多因素分析
变量	OR值	95% CI	P值^a	OR值	95% CI	P值^a
女性	1.40	0.71~2.73	0.330
年龄≥60岁	1.48	0.44~4.97	0.523
BMI分类
偏低	参照
正常	1.45	0.49~4.28	0.503
超重	0.94	0.27~3.33	0.924
肥胖	3.42	0.78~14.99	0.103
吸烟史	0.59	0.30~1.15	0.120
高血压	3.69	1.29~10.52	0.015	2.40	0.77~7.48	0.132
糖尿病	1.39	0.73~2.62	0.313
冠心病	2.45	1.24~4.85	0.010	2.18	0.98~4.87	0.057
心力衰竭	8.30	2.86~24.13	<0.001	5.63	1.58~20.00	0.008
血脂异常	0.60	0.22~1.61	0.309
CLI	1.16	0.59~2.26	0.663
ALI	11.03	4.54~26.76	<0.001	5.53	1.91~16.01	0.002
血红蛋白≥110 g/L	0.63	0.32~1.25	0.189
eGFR< 60 mL/(min·1.73m²)	7.06	3.45~14.41	<0.001	2.81	1.08~7.32	0.035
ACEI/ARB	1.59	0.83~3.05	0.166
非甾体类抗炎药物	1.68	0.89~3.19	0.112
CGR≥3	10.08	5.14~19.73	<0.001	4.03	1.61~10.09	0.003

[1]	Safley D M, Salisbury A C, Tsai T T, et al. Acute kidney injury following in-patient lower extremity vascular intervention: from the national cardiovascular data registry[J]. JACC Cardiovasc Interv, 2021, 14(3): 333-341.
[2]	Van der Molen A J, Reimer P, Dekkers I A, et al. Post-contrast acute kidney injury-Part 1: definition, clinical features, incidence, role of contrast medium and risk factors: recommendations for updated ESUR contrast medium safety committee guidelines[J]. Eur Radiol, 2018, 28(7): 2845-2855.
[3]	Suva M, Kala P, Poloczek M, et al. Contrast-induced acute kidney injury and its contemporary prevention[J]. Front Cardiovasc Med, 2022, 9: 1073072.
[4]	Liu Z, Shang A, Chen Z, et al. Neutrophil gelatinase-associated lipocalin as an early predictor of contrast-induced nephropathy following endovascular therapy for arteriosclerosis obliterans[J].Medicine (Baltimore), 2020, 99(37): e21386.
[5]	卢冉, 余朝文, 聂中林, 等. 下肢动脉硬化闭塞症腔内治疗的效果及术后再狭窄的影响因素分析[J]. 中华解剖与临床杂志, 2024, 29(4): 216-221.
[6]	Consultation W H O E. Appropriate body-mass index for Asian populations and its implications for policy and intervention strategies[J]. Lancet, 2004, 363(9403): 157-163.
[7]	上海市肾内科临床质量控制中心专家组. 慢性肾脏病早期筛查、诊断及防治指南(2022年版)[J]. 中华肾脏病杂志, 2022, 38(5): 453-464.
[8]	Kidney Disease: Improving Global Outcomes CKDWG. KDIGO 2024 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease[J]. Kidney Int, 2024, 105(4S): S117-S314.
[9]	Lun Z, Liu L, Chen G, et al. The global incidence and mortality of contrast-associated acute kidney injury following coronary angiography: a meta-analysis of 1. 2 million patients[J]. J Nephrol, 2021, 34(5): 1479-1489.
[10]	Lee S R, Zhuo H, Zhang Y, et al. Risk factors and safe contrast volume thresholds for postcontrast acute kidney injury after peripheral vascular interventions[J]. J Vasc Surg, 2020, 72(2): 603-610.
[11]	高长乐. 对比剂对下肢动脉硬化闭塞症合并糖尿病患者肾功能影响及相关因素分析[J]. 中国中西医结合外科杂志, 2014(6): 648-651.
[12]	母海蕾, 刘亚军, 刘阳, 等. 循证护理结合水化疗法对下肢动脉硬化闭塞症患者介入术后对比剂肾病的预防效果[J]. 临床与病理杂志, 2021, 41(1): 133-139.
[13]	Kusirisin P, Chattipakorn S C, Chattipakorn N. Contrast-induced nephropathy and oxidative stress: mechanistic insights for better interventional approaches[J]. J Transl Med, 2020, 18(1): 400.
[14]	Li Y, Wang J. Contrast-induced acute kidney injury: a review of definition, pathogenesis, risk factors, prevention and treatment[J]. BMC Nephrol, 2024, 25(1): 140.
[15]	徐雪蕾, 宋小军, 顾光超, 等. 下肢动脉硬化闭塞症造影后急性肾损伤的预防进展[J]. 血管与腔内血管外科杂志, 2022, 8(7): 825-828.
[16]	姚强, 郝斌, 杨涛, 等. 周围血管疾病介入诊疗致对比剂肾病影响因素分析[J]. 中国药物与临床, 2014, 14(4): 513-516.
[17]	Liu W T, Liu X Q, Jiang T T, et al. Using a machine learning model to predict the development of acute kidney injury in patients with heart failure[J]. Front Cardiovasc Med, 2022, 9: 911987.
[18]	Chen Z, Mao Q, Xiang L, et al. Iodixanol-associated acute kidney injury and prognosis in patients undergoing elective percutaneous coronary intervention: a prospective, multi-center study[J]. Eur Radiol, 2023, 33(12): 9444-9454.
[19]	Huang Y, Zhang S, Liu M, et al. Impact of RAAS Blockers on contrast-induced nephropathy in patients with renal insufficiency: a meta-analysis[J]. J Cardiovasc Pharmacol, 2020, 76(6): 692-697.
[20]	Van der Molen A J, Reimer P, Dekkers I A, et al. Post-contrast acute kidney injury. Part 2: risk stratification, role of hydration and other prophylactic measures, patients taking metformin and chronic dialysis patients : Recommendations for updated ESUR Contrast Medium Safety Committee guidelines[J]. Eur Radiol, 2018, 28(7): 2856-2869.
[21]	Rozenbaum Z, Chang M F, Wiley J, et al. Safety of ultra-low contrast coronary angiography in patients with acute kidney injury[J]. Clin Cardiol, 2024, 47(5): e24282.
[22]	Lee S R, Ali S, Cardella J, et al. Carbon dioxide angiography during peripheral vascular interventions is associated with decreased cardiac and renal complications in patients with chronic kidney disease[J]. J Vasc Surg, 2023, 78(1): 201-208.
[23]	Tran Duc M, Nguyen Quoc T, Nguyen B Y T, et al. Acute kidney injury after percutaneous coronary intervention guided by intravascular ultrasound[J]. Cureus, 2024, 16(3): e57164.

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The occurrence and influencing factors of post-contrast acute kidney injury in patients with lower extremity arteriosclerosis obliterans after interventional therapy

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The occurrence and influencing factors of post-contrast acute kidney injury in patients with lower extremity arteriosclerosis obliterans after interventional therapy