对比剂肾病发病机制研究进展
Progress in Mechanisms of Contrast-Induced Nephropathy

DOI: 10.12677/ACM.2014.44011, PP. 58-63

Keywords: 造影剂肾病，危险因素，发病机制，综述
Contrast-Induced Nephropathy, Risk Factor, Mechanism, Review

Full-Text   Cite this paper   Add to My Lib

Abstract:

造影剂肾病(contrast-induced nephropathy, CIN)是造影剂的使用中最为严重的并发症，是院内发生急性肾功能不全的常见病因，严重威胁患者的健康。CIN常见的危险因素主要包括慢性肾功能不全、糖尿病及高龄等。CIN发病机制复杂，主要包括肾脏血流动力学改变、造影剂的直接肾毒性、肾小管阻塞以及免疫因素等，其中肾脏血流动力学改变和造影剂的直接肾毒性是CIN发生的关键因素。研究CIN发病的危险因素和病理生理机制，可为CIN的预防和治疗提供理论基础，开辟新途径和新方向，并减少介入诊断与治疗的副作用。本文旨在综述这些最新进展。
Contrast-induced nephropathy (CIN), one of the most severe complications after using contrast agent, is a common reason of acute renal insufficiency which occurs in hospital and a severe threat to human health. Common risk factors of CIN include chronic renal insufficiency, diabetes, age and else. The mechanisms of CIN are complex, including the change of haemodynamics of renal, direct renal toxicity of contrast agent, obstruction of kidney tubules and immunological factors. The changes of renal hemodynamic and direct renal toxicity of contrast agent are critical factors in the development of CIN. Studies on risk factors and mechanism of CIN provide theoretical basis for the prevention and treatment of CIN, indicate new direction, and help to reduce adverse effects after using contrast agent for diagnosis and treatment. The current paper is to review the most recent development.

References

[1]	Manabe, K., Kamihata, H., Motohiro, M., et al. (2012) Urinary liver-type fatty acid-binding protein level as a predictive biomarker of contrast-induced acute kidney injury. European Journal of Clinical Investigation, 42, 557-563.
[2]	李雪梅 (2010) 药物导致的急性肾损伤. 中华医学会、中华医学会肾脏病学分会, 中华医学会肾脏病学分会2010学术年会专题讲座汇编, 中华医学会、中华医学会肾脏病学分会, 1.
[3]	Briguori, C., Visconti, G., Rivera, N.V., et al. (2010) Cystatin C and contrast-induced acute kidney injury. Circulation, 121, 2117-2122.
[4]	Stacul, F., Van der Molen, A.J., Reimer, P., et al. (2011) Contrast induced nephropathy: Updated ESUR Contrast Media Safety Committee guidelines. European Radiology, 21, 2527-2541.
[5]	Khwaja, A. (2012) KDIGO clinical practice guidelines for acute kidney injury. Nephron Clinical Practice, 120, c179- c184.
[6]	张翩, 倪兆慧, 王玲, 等 (2010) 冠状动脉介入术患者造影剂肾病的危险因素多中心调查. 中国中西医结合肾病杂志, 11, 214-218.
[7]	Wong, P.C., Li, Z., Guo, J., et al. (2012) Pathophysiology of contrast-induced nephropathy. International Journal of Cardiology, 158, 186-192.
[8]	刘毅, 林凡, 郑尘飞, 袁谦, 王禄萍, 许菲菲, 徐玉兰 (2002) 内皮素与糖尿病造影剂肾病发生的关系研究. 中国现代医学杂志, 20, 7-9.
[9]	曹宪英, 解忠伟, 赵昱星 (2010) 造影剂肾病与血、尿内皮素水平相关性的研究及护理要点. 黑龙江医学, 12, 950.
[10]	Nough, H., Eghbal, F., Soltani, M., et al. (2013) Incidence and main determinants of contrast-induced nephropathy following coronary angiography or subsequent balloon angioplasty. CardioRenal Medicine, 3, 128-135.
[11]	Malhis, M., Al-Bitar, S. and Al-Deen Zaiat, K. (2010) The role of theophylline inprevention of radiocontrast media- induced nephropathy. Saudi Journal of Kidney Diseases and Transplantation, 21, 276-283.
[12]	Bilasy, M.E., Oraby, M.A., Ismail, H.M., et al. (2012) Effectiveness of theophyl-line in preventing contrast-induced nephropathy after coronary angio-graphic procedures. Journal of Interventional Cardiology, 25, 404-410.
[13]	Teplan, V. (2012) Contrast Nephropathy and Prevention. Vnitr Lek., 58, 553-556.
[14]	Spargias, K., Adreanides, E., Demerouti, E., et al. (2009) Iloprost prevents contrast-induced nephropathy in patients with renal dys-function un-dergoing coronary angiography or intervention. Circulation, 120, 1793-1799.
[15]	Herts, B.R., Schneider, E., Obuchowski, N., et al. (2009) Probability of reduced renal function after contrast-enhanced CT: A model based on serum creatinine level, patient age, and estimated glomerular filtration rate. American Journal of Roentgenology, 193, 494-500.
[16]	Seeliger, E., Flemming, B., Wronski, T., et al. (2007) Viscosity of contrast media perturbs renal hemo-dynamics. Journal of the American Society of Nephrology, 18, 2912-2920.
[17]	Fishbane, S., Durham, J.H., Marzo, K., et al. (2004) N-acetylcysteine in the prevention of radiocontrast-induced nephropathy. Journal of the American Society of Nephrology, 15, 251-260.
[18]	Zager, R.A., Johnson, A.C. and Hanson, S.Y. (2003) Radiographic contrast me-dia-induced tubular injury: Evaluation of oxidant stress and plasma membrane integrity. Kidney International, 64, 128-139.
[19]	Persson, P.B., Hansell, P. and Liss, P. (2005) Pathophysiology of contrast medium-induced nephropathy. Kidney International, 68, 14-22.
[20]	Trivedi, H., Daram, S., Szabo, A., et al. (2009) High-dose N-acetylcysteine for the prevention of contrast-induced nephropathy. American Journal of Medicine, 122, 874.e9-e15.
[21]	Stewart, J.D., Hengstler, J.G. and Bolt, H.M. (2011) Contrastagent-induced nephrotoxicity: Role of oxidative stress and apoptosis through the mitochondrial pathway. Archives of Toxicology, 85, 163-164.
[22]	Lee, H.C., Sheu, S.H., Yen, H.W., et al. (2010) JNK/ATF2 pathway is involved in iodinated contrast media-induced apoptosis. American Journal of Nephrology, 31, 125-133.
[23]	Nikolsky, E., Aymong, E.D. and Dangas, G. (2003) Radiocontrast nephropathy: Identifying the high-risk patient and the implications of exacerbating renal function. Reviews in Cardiovascular Medicine, 4, S7-S14.

Full-Text