钆对比剂安全性评价

Safety Evaluation of Gadolinium-based Contrast Agents

钆对比剂是含有顺磁性金属离子Gd^(3+)的螯合物,能够通过增强T1加权像上的信号强度,提高病灶与正常组织的对比度及显示病灶的血流动力学特征,对磁共振成像技术的革新和发展有很大的帮助,近年来使用率呈逐年增加的趋势。自1987年首个钆对比剂被FDA批准上市,目前共9种钆对比剂投入临床使用,不同种类的钆对比剂的稳定性主要取决于各种类型分子结构的热力学常数、动力学稳定常数和条件稳定常数,动物实验及临床研究均证实了使用钆对比剂后钆在体内各组织器官的沉积。尽管目前临床普遍认为钆对比剂是安全的,但仍有部分患者发生不良反应,头痛、恶心、味觉改变和荨麻疹是最常见的不良反应,极少数患者可能发生过敏性休克或远期发生肾源性系统性纤维化。本文旨在通过对大量文献进行回顾分析及本院数据总结,对钆对比剂的主要特征和不良反应进行了详细的介绍,以利于将钆对比剂更安全地应用于临床。

Gadolinium-based contrast agents （GBCAs） are composed of gadolinium ion Gd3＋ and chelates. Through signal enhancement on Tl-weighted imaging, the contrast between normal tissues and lesions could be increased, and their hemodynamic property could be demonstrated. In recent years, the usage of GBCAs is increasing gradually all over the world. Since the first GBCA was approved by FDA in 1987, there are 9 GBCAs available for clinical practice now. The stability of each GBCAs is determined by their thermodynamic, kinetic and conditional stability constants. Animal studies and clinical researches have demonstrated the gadolinium deposition in different tissues and organs after the injection of GBCAs. Despite the fact that GBCAs are considered safe, some patients do have adverse reactions. Headache, nausea, taste change and urticarial are the most common adverse reactions, and very few patients suffer anaphylactic shock and nephrogenic systemic fibrosis. The review aimed to give detailed introduction of the main characteristics and adverse reactions of GBCAs through literature review and data analysis from our hospital and contribute to safer GBCAs application in clinical practice.