糖尿病患者急性脑梗死取栓术后发生对比剂肾病的影响因素及预测模型建立

doi:10.3877/cma.j.issn.2095-3216.2024.04.002

目的

探讨糖尿病患者急性脑梗死取栓术后发生对比剂肾病的影响因素，并建立预测模型。

方法

对2018年9月至2024年6月于徐州医科大学附属医院就诊的因急性脑梗死行机械取栓术的152例糖尿病患者进行回顾性分析。按照是否确诊对比剂肾病将其分为对比剂肾病组(37例)和非对比剂肾病组(115例)。采用Logistic回归方法分析影响对比剂肾病发生的影响因素。采用R语言方法构建预测模型列线图，构建临床决策曲线评估其临床应用价值。绘制受试者操作特征曲线以评价该列线图模型在对比剂肾病发生中的预测作用。

结果

单因素分析显示，两组患者在对比剂剂量、手术时长、白细胞计数、中性粒细胞计数、纤维蛋白原、甘油三酯-葡萄糖指数方面具有统计学差异(P均<0.05)。多因素Logistic回归分析显示，对比剂剂量(OR＝1.054，95%CI：1.014～1.096，P＝0.008)、甘油三酯-葡萄糖指数(OR＝3.554，95%CI：1.550～8.154，P＝0.003)、纤维蛋白原(OR＝3.358，95%CI：1.633～6.904，P＝0.001)是对比剂肾病的独立危险因素。受试者操作特征曲线分析显示，甘油三酯-葡萄糖指数、纤维蛋白原、对比剂剂量三者联合预测对比剂肾病时，曲线下面积为0.857、灵敏度为86.5%、特异性为77.4%。

结论

对比剂剂量、甘油三酯-葡萄糖指数及纤维蛋白原是糖尿病患者急性脑梗死取栓术后发生对比剂肾病的独立危险因素。构建的列线图模型对糖尿病患者急性脑梗死取栓术后发生对比剂肾病有一定的预测价值。

关键词: 急性脑梗死, 糖尿病, 取栓术, 对比剂肾病, 甘油三酯-葡萄糖指数, 纤维蛋白原

Objective

To investigate the influencing factors and prediction modeling of contrast-induced nephropathy (CIN) after thrombectomy in diabetic patients with acute cerebral infarction.

Methods

A retrospective analysis was performed on 152 diabetic patients who underwent mechanical thrombectomy for acute cerebral infarction in the Affiliated Hospital of Xuzhou Medical University from September 2018 to June 2024. The patients were divided into CIN group (37 cases) and non-CIN group (115 cases) according to whether CIN was confirmed. Logistic regression method was used to analyze the influencing factors of CIN development. R language method was used to construct the prediction model nomogram, and clinical decision curve was constructed to evaluate its clinical application value. The receiver operating characteristic curve was drawn to evaluate the predictive role of the model in the development of CIN.

Results

Univariate analysis showed that there were statistically significant differences in contrast dose, operation duration, white blood cell count, neutrophil count, fibrinogen, and triglyceride-glucose index between the two groups (P<0.05). Multivariate logistic regression analysis showed that the dose of contrast (OR=1.054, 95%CI: 1.014-1.096, P=0.008), triglyceride-glucose index (OR=3.554, 95%CI: 1.550-8.154, P=0.003), and fibrinogen (OR=3.358, 95%CI: 1.633-6.904, P=0.001) were independent risk factors for CIN. The receiver operating characteristic curve analysis showed that when triglyceride-glucose index, fibrinogen, and contrast dose were combined to predict CIN, the area under the curve was 0.857, with the sensitivity being 86.5%, and the specificity 77.4%.

Conclusion

The contrast dose, triglyceride-glucose index, and fibrinogen were the independent risk factors for CIN after thrombectomy in the diabetic patients with acute cerebral infarction. The nomogram model constructed had a certain value in predicting the occurrence of CIN after thrombectomy in the diabetic patients with acute cerebral infarction.

Key words: Acute cerebral infarction, Diabetes, Thrombectomy, Contrast-induced nephropathy, Triglyceride-glucose index, Fibrinogen

表1 糖尿病患者急性脑梗死取栓术后两组一般资料及临床资料比较

项目	CIN组(37例)	非CIN组(115例)	χ²/t/z值	P值
年龄(岁)	68.54±11.98	67.57±10.97	0.460	0.646
性别(男)[例(%)]	24(64.9)	71(61.7)	0.117	0.733
高血压[例(%)]	25(67.6)	68(59.1)	0.839	0.360
心房颤动[例(%)]	14(37.8)	31(27.0)	1.590	0.207
服用二甲双胍[例(%)]	23(62.2)	58(50.4)	1.547	0.214
取栓部位[例(%)]			3.889	0.274
颈内动脉	9(24.3)	19(16.52)
大脑中动脉	11(29.7)	53(46.1)
椎动脉	9(24.3)	18(15.7)
基底动脉	8(21.6)	25(21.7)
手术时间(min)	125.24±56.74	94.65±35.14	3.094	0.003
对比剂剂量(ml)	110.00±24.26	90.70±19.10	4.418	<0.001
白细胞计数(×10⁹/L)	10.30±3.48	8.38±2.76	3.435	0.001
血小板计数(×10⁹/L)	218.78±71.46	200.64±55.47	1.608	0.110
中性粒细胞计数(×10⁹/L)	8.24±3.69	6.45±2.74	2.715	0.009
FIB(g/L)	3.56±0.88	2.76±0.65	5.999	<0.001
空腹血糖(mmol/L)	10.64±3.35	7.93±2.54	4.510	<0.001
甘油三酯(mmol/L)	1.28(1.12，1.73)	1.17(0.81，1.51)	－2.202	0.043
术前肌酐(μmol/L)	76.86±36.44	66.86±23.99	1.925	0.056
术前eGFR(ml/min·1.73 m²)	97.90±28.70	103.46±19.13	－1.224	0.227
术后血清肌酐(μmol/L)	134.73±52.75	69.40±22.40	7.325	<0.001
术后eGFR(mL/min·1.73 m²)	56.83±22.18	99.68±16.67	－10.497	<0.001
TyG指数	8.38±1.59	7.85±1.43	4.283	<0.001

表1 糖尿病患者急性脑梗死取栓术后两组一般资料及临床资料比较

项目	CIN组(37例)	非CIN组(115例)	χ²/t/z值	P值
年龄(岁)	68.54±11.98	67.57±10.97	0.460	0.646
性别(男)[例(%)]	24(64.9)	71(61.7)	0.117	0.733
高血压[例(%)]	25(67.6)	68(59.1)	0.839	0.360
心房颤动[例(%)]	14(37.8)	31(27.0)	1.590	0.207
服用二甲双胍[例(%)]	23(62.2)	58(50.4)	1.547	0.214
取栓部位[例(%)]			3.889	0.274
颈内动脉	9(24.3)	19(16.52)
大脑中动脉	11(29.7)	53(46.1)
椎动脉	9(24.3)	18(15.7)
基底动脉	8(21.6)	25(21.7)
手术时间(min)	125.24±56.74	94.65±35.14	3.094	0.003
对比剂剂量(ml)	110.00±24.26	90.70±19.10	4.418	<0.001
白细胞计数(×10⁹/L)	10.30±3.48	8.38±2.76	3.435	0.001
血小板计数(×10⁹/L)	218.78±71.46	200.64±55.47	1.608	0.110
中性粒细胞计数(×10⁹/L)	8.24±3.69	6.45±2.74	2.715	0.009
FIB(g/L)	3.56±0.88	2.76±0.65	5.999	<0.001
空腹血糖(mmol/L)	10.64±3.35	7.93±2.54	4.510	<0.001
甘油三酯(mmol/L)	1.28(1.12，1.73)	1.17(0.81，1.51)	－2.202	0.043
术前肌酐(μmol/L)	76.86±36.44	66.86±23.99	1.925	0.056
术前eGFR(ml/min·1.73 m²)	97.90±28.70	103.46±19.13	－1.224	0.227
术后血清肌酐(μmol/L)	134.73±52.75	69.40±22.40	7.325	<0.001
术后eGFR(mL/min·1.73 m²)	56.83±22.18	99.68±16.67	－10.497	<0.001
TyG指数	8.38±1.59	7.85±1.43	4.283	<0.001

表2 单因素Logistic回归分析糖尿病患者急性脑梗死取栓术后发生对比剂肾病的相关因素

项目	回归系数	标准误差	瓦尔德值	OR(95%CI)	P值
TyG指数	1.307	0.342	14.628	3.696(1.892～7.223)	<0.001
白细胞计数(×10⁹/L)	0.200	0.063	10.049	1.222(1.079～1.383)	0.002
中性粒细胞计数(×10⁹/L)	0.182	0.062	8.676	1.200(1.063～1.354)	0.003
FIB(g/L)	1.431	0.317	20.366	4.183(2.247～7.788)	<0.001
手术时间(min)	0.016	0.005	10.995	1.016(1.007～1.026)	0.001
对比剂剂量(ml)	0.042	0.010	18.165	1.043(1.023～1.063)	<0.001

表2 单因素Logistic回归分析糖尿病患者急性脑梗死取栓术后发生对比剂肾病的相关因素

项目	回归系数	标准误差	瓦尔德值	OR(95%CI)	P值
TyG指数	1.307	0.342	14.628	3.696(1.892～7.223)	<0.001
白细胞计数(×10⁹/L)	0.200	0.063	10.049	1.222(1.079～1.383)	0.002
中性粒细胞计数(×10⁹/L)	0.182	0.062	8.676	1.200(1.063～1.354)	0.003
FIB(g/L)	1.431	0.317	20.366	4.183(2.247～7.788)	<0.001
手术时间(min)	0.016	0.005	10.995	1.016(1.007～1.026)	0.001
对比剂剂量(ml)	0.042	0.010	18.165	1.043(1.023～1.063)	<0.001

表3 多因素Logistic回归分析糖尿病患者急性脑梗死取栓术后发生对比剂肾病的相关因素

项目	回归系数	标准误差	瓦尔德值	OR(95%CI)	P值
TyG指数	1.268	0.424	8.963	3.554(1.550～8.154)	0.003
FIB(g/L)	1.211	0.368	10.852	3.358(1.633～6.904)	0.001
对比剂剂量(ml)	0.053	0.020	7.128	1.054(1.014～1.096)	0.008

表3 多因素Logistic回归分析糖尿病患者急性脑梗死取栓术后发生对比剂肾病的相关因素

项目	回归系数	标准误差	瓦尔德值	OR(95%CI)	P值
TyG指数	1.268	0.424	8.963	3.554(1.550～8.154)	0.003
FIB(g/L)	1.211	0.368	10.852	3.358(1.633～6.904)	0.001
对比剂剂量(ml)	0.053	0.020	7.128	1.054(1.014～1.096)	0.008

图1 甘油三酯-葡萄糖指数、纤维蛋白原、对比剂剂量及三者联合对糖尿病患者取栓术后发生对比剂肾病预测价值的受试者操作特征曲线注：TyG指数：甘油三酯-葡萄糖指数；Nomogram：列线图；AUC：曲线下面积

表4 受试者操作特征曲线分析结果

项目	最佳截断值	灵敏度(%)	特异度(%)	约登指数	曲线下面积(95%CI)	P值
TyG指数	>8.83	86.5	53.9	0.404	0.724(0.630～0.819)	<0.001
FIB(g/L)	>2.98	86.5	71.3	0.578	0.799(0.721～0.877)	<0.001
对比剂剂量(ml)	>105.00	48.6	85.2	0.338	0.729(0.634～0.824)	<0.001
三者联合	>0.20	86.5	77.4	0.639	0.857(0.786～0.928)	<0.001

表4 受试者操作特征曲线分析结果

项目	最佳截断值	灵敏度(%)	特异度(%)	约登指数	曲线下面积(95%CI)	P值
TyG指数	>8.83	86.5	53.9	0.404	0.724(0.630～0.819)	<0.001
FIB(g/L)	>2.98	86.5	71.3	0.578	0.799(0.721～0.877)	<0.001
对比剂剂量(ml)	>105.00	48.6	85.2	0.338	0.729(0.634～0.824)	<0.001
三者联合	>0.20	86.5	77.4	0.639	0.857(0.786～0.928)	<0.001

图2 基于Logistic回归分析预测对比剂肾病的列线图模型注：TyG指数：甘油三酯-葡萄糖指数；CIN：对比剂肾病

图3 列线图模型的校准曲线

图4 列线图模型的临床决策曲线注：TyG指数：甘油三酯-葡萄糖指数；Nomogram：列线图；None：为水平等于0的线条，是所有患者均不进行治疗时的收益曲线，表示所有患者均不进行干预净收益为0；ALL：对所有患者均进行干预的临床净收益曲线

[20]	Luyendyk J, Schoenecker J, Flick M. The multifaceted role of fibrinogen in tissue injury and inflammation [J]. Blood, 2019, 133(6): 511-520.
[21]	Vlachopoulos C, Terentes-Printzios D, Laurent S, et al. Association of estimated pulse wave velocity with survival: a secondary analysis of SPRINT [J]. JAMA Netw Open, 2019, 2(10): e1912831.
[22]	Cheng HT, Huang JW, Chiang CK, et al. Metabolic syndrome and insulin resistance as risk factors for development of chronic kidney disease and rapid decline in renal function in elderly [J]. J Clin Endocrinol Metab, 2012, 97(4): 1268-1276.
[23]	Rosovsky M, Rusinek H, Berenstein A, et al. High-dose administration of nonionic contrast media: a retrospective review [J]. Radiology, 1996, 200(1): 119-122.
[24]	黄炜超，李递通，陈锦俭，等. 脑血管病患者全脑血管造影术后致造影剂肾病相关危险因素研究[J]. 脑与神经疾病杂志，2023, 31(11): 669-672.
[25]	张红梅. 脑血管介入诊疗术后对比剂肾病的危险因素分析[J]. 中国实用医刊，2016, 43(7): 98-99.
[26]	张绪吉，王辉霞，刘翔宇. 造影剂滥用导致造影剂肾病的相关因素分析[J]. 中国药物滥用防治杂志，2021, 27(2): 207-210.
[27]	Cichoń M, Wybraniec MT, Okoń O, et al. Repeated dose of contrast media and the risk of contrast-induced acute kidney injury in a broad population of patients hospitalized in cardiology department [J]. J Clin Med, 2023, 12(6): 2166.
[1]	Dong Y, Qu J, Zhang Z, et al. Human urinary kallidinogenase in treating acute ischemic stroke patients: analyses of pooled data from a randomized double-blind placebo-controlled phase IIb and phase Ⅲ clinical trial [J]. NEUROL RES, 2020, 42(4): 286-290.
[2]	Sun G, Chen JY, Liu Y. Contrast-induced nephropathy: further investigations about risk factors are required [J]. Angiology, 2019, 70(8): 784-785.
[3]	Qin Y, Tang H, Yan G, et al. A high triglyceride-glucose index is associated with contrast-induced acute kidney injury in Chinese patients with type 2 diabetes mellitus [J]. Front Endocrinol (Lausanne), 2021, 11: 522883.
[4]	Zheng L, Wang Z, Liu J, et al. Association between admission blood fibrinogen-to-albumin ratio and clinical outcomes after acute lacunar stroke [J]. Biomark Med, 2021, 15(2): 87-96.
[5]	Celik IE, Kurtul A, Duran M, et al. Elevated serum fibrinogen levels and risk of contrast-induced acute kidney injury in patients undergoing a percutaneous coronary intervention for the treatment of acute coronary syndrome [J]. Coron Artery Dis, 2016, 27(1): 13-18.
[6]	提拉柯孜·图尔荪，魏海燕，努尔巴哈尔·热木图拉，等. 血清NLRP3水平和造影剂用量在急性ST段抬高型心肌梗死患者经皮冠状动脉介入治疗术后造影剂肾病的诊断价值研究[J]. 中国全科医学，2024, 27(27): 3378-3382.
[7]	Liang J, Zhang L, Huang Z, et al. Implications of malnutrition on contrast-associated acute kidney injury in young and old patients undergoing percutaneous coronary intervention: a multicenter prospective cohort [J]. Front Nutr, 2022, 8: 795068.
[8]	Kellum JA, Lameire N. Diagnosis, evaluation, and management of acute kidney injury: a KDIGO summary (Part 1) [J]. Crit Care, 2013, 17(1): 204.
[9]	孙晓琳，董得时，杨世磊. 碘造影剂肾病的损伤机制和预防策略[J]. 中国现代应用药学，2022, 39(2): 261-268.
[10]	Aksu U, Gulcu O, Aksakal E, et al. Long-term mortality and contrast-induced nephropathy [J]. Angiology, 2019, 70(8): 783.
[11]	Saeed F, Adil MM, Khursheed F, et al. Acute renal failure is associated with higher death and disability in patients with acute ischemic stroke: analysis of nationwide inpatient sample [J]. Stroke, 2014, 45(5): 1478-1480.
[12]	Rudnick MR, Leonberg-Yoo AK, Litt HI, et al. The controversy of contrast-induced nephropathy with intravenous contrast: what is the risk? [J]. Am J Kidney Dis, 2020, 75(1): 105-113.
[13]	Nikolsky E, Aymong ED, Dangas G, et al. Radiocontrast nephropathy: identifying the high-risk patient and the implications of exacerbating renal function [J]. Rev Cardiovasc Med, 2003, 4(Suppl 1): S7-S14.
[14]	Tumlin JA, Wang A, Murray PT, et al. Fenoldopam mesylate blocks reductions in renal plasma flow after radiocontrast dye infusion: a pilot trial in the prevention of contrast nephropathy [J]. Am Heart J, 2002, 143(5): 894-903.
[15]	Wi J, Ko YG, Kim JS, et al. Impact of contrast-induced acute kidney injury with transient or persistent renal dysfunction on long-term outcomes of patients with acute myocardial infarction undergoing percutaneous coronary intervention [J]. Heart, 2011, 97(21): 1753-1757.
[16]	Heyman SN, Rosenberger C, Rosen S, et al. Why is diabetes mellitus a risk factor for contrast-induced nephropathy? [J]. Biomed Res Int, 2013, 2013: 123589.
[17]	Khan SH, Sobia F, Niazi NK, et al. Metabolic clustering of risk factors: evaluation of triglyceride-glucose index (TyG index) for evaluation of insulin resistance [J]. Diabetol Metab Syndr, 2018, 10: 74.
[18]	Lee M, Kim CH, Kim Y, et al. High triglyceride-glucose index is associated with poor outcomes in ischemic stroke patients after reperfusion therapy [J]. Cerebrovasc Dis, 2021, 50(6): 691-699.
[19]	Sörensen I, Susnik N, Inhester T, et al. Fibrinogen, acting as a mitogen for tubulointerstitial fibroblasts, promotes renal fibrosis [J]. Kidney Int, 2011, 80(10): 1035-1044.

[1]	曹雯佳, 刘学兵, 罗安果, 钟释敏, 邓岚, 王玉琳, 李赵欢. 超声矢量血流成像对2型糖尿病患者颈动脉壁剪切应力的研究[J/OL]. 中华医学超声杂志（电子版）, 2024, 21(07): 709-717.
[2]	刘子洋, 崔俭俭, 赵茵. 产科弥散性血管内凝血及其评分系统的研究现状[J/OL]. 中华妇幼临床医学杂志(电子版), 2024, 20(05): 511-518.
[3]	王杰, 袁泉, 王玥琦, 乔佳君, 谭春丽, 夏仲元, 刘守尧. 溃疡油在糖尿病足溃疡治疗中的应用效果及安全性观察[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 480-484.
[4]	徐志刚, 曹涛, 何亭, 李博奥, 魏婧韬, 张栋梁, 官浩, 杨薛康. 采用抗生素骨水泥治疗糖尿病患者心脏术后胸骨骨髓炎的临床效果观察[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(06): 498-502.
[5]	姜珊, 李湘燕, 田硕涵, 温冰, 何睿, 齐心. 采用优化抗感染治疗模式改善糖尿病足感染预后的临床观察[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 398-403.
[6]	别瑶, 曹志斌, 辛静, 王健楠, 惠宗光. 应用基质血管成分细胞治疗糖尿病足溃疡的研究进展[J/OL]. 中华损伤与修复杂志(电子版), 2024, 19(05): 453-456.
[7]	孟令凯, 李大勇, 王宁, 王桂明, 张炳南, 李若彤, 潘立峰. 袖状胃切除术对肥胖伴2型糖尿病大鼠的作用及机制研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(06): 638-642.
[8]	李猛, 姜腊, 董磊, 吴情, 贾犇黎. 腹腔镜胃袖状切除术治疗肥胖合并2型糖尿病及脂肪胰的临床研究[J/OL]. 中华普外科手术学杂志(电子版), 2024, 18(05): 554-557.
[9]	李鑫钊, 张廷涛, 朱峰, 刘金山, 刘大闯. 血纤维蛋白原、D-二聚体及碱性磷酸酶诊断前列腺癌骨转移的价值分析[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2024, 18(05): 459-463.
[10]	伍细蓉, 徐立文, 陈亚琼. 基于LPR和FARI构建肝衰竭患者生存预后模型[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(05): 675-681.
[11]	严虹霞, 王晓娟, 张毅勋. 2 型糖尿病对结直肠癌患者肿瘤标记物、临床病理及预后的影响[J/OL]. 中华结直肠疾病电子杂志, 2024, 13(06): 483-487.
[12]	周学锋, 董哲毅, 冯哲, 蔡广研, 陈香美. 糖尿病肾脏疾病中西医结合诊疗指南计划书[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 301-305.
[13]	杜军霞, 赵小淋, 王浩然, 高志远, 王曼茜, 万楠熙, 张冬, 丁潇楠, 任琴琴, 段颖洁, 汤力, 朱晗玉. 2 型糖尿病的血液透析患者肠道微生物组学高通量测序分析[J/OL]. 中华肾病研究电子杂志, 2024, 13(06): 313-320.
[14]	孙文恺, 沈青, 杭丽, 张迎春. 纤维蛋白原与清蛋白比值、中性粒细胞与白蛋白比值、C反应蛋白与溃疡性结肠炎病情评估和预后的关系[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 426-431.
[15]	邱岭, 朱旭丽, 浦坚, 邢苗苗, 吴佳玲. 糖尿病肾病患者肠道菌群生态特点与胃肠道功能障碍的关联性研究[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 453-458.

阅读次数

全文

摘要

选择文件类型/文献管理软件名称

选择包含的内容

Influencing factors and prediction modeling of contrast-induced nephropathy after thrombectomy in diabetic patients with acute cerebral infarction

模态框（Modal）标题

选择文件类型/文献管理软件名称

选择包含的内容

Influencing factors and prediction modeling of contrast-induced nephropathy after thrombectomy in diabetic patients with acute cerebral infarction