造影剂急性肾损伤的风险评估模型

Risk assessment model of contrast-induced acute kidney injury

造影剂急性肾损伤(CI-AKI)是冠状动脉造影术(CAG)和经皮冠状动脉介入治疗(PCI)的严重并发症。本文介绍了4种CI-AKI风险评估模型,分别是Mehran CI-AKI风险评估系统、Maioli CI-AKI风险评估模型、Chen CI-AKI风险评估模型和Duan CI-AKI风险评估模型。这4个模型涉及的预测因子包括低血压、主动脉内球囊反博术、充血性心力衰竭、高龄、贫血、糖尿病、造影剂剂量、肾功能、心肌梗死、左心室射血分数、高密度脂蛋白、急诊PCI、72 h内进行过1次PCI或CAG、直接PCI、N-末端脑钠肽前体(NT-proBNP)和超敏C反应蛋白(Hs-CRP)。除Mehran CI-AKI风险评估系统为术后风险评估外,其他3个模型均为术前CI-AKI风险评估。Mehran CI-AKI风险评估系统是目前较有影响力的CI-AKI风险评估模型,已有对其进行外部验证和推广的报道;Maioli CI-AKI风险估评模型对肾损伤患者也具有预测价值;Chen CI-AKI风险评估模型的评估对象为亚洲人群;Duan CI-AKI风险评估模型纳入了CI-AKI高敏感生物标志物NT-proBNP和Hs-CRP。上述模型均存在一定的局限性,均无临床应用证据。

Contrast-induced acute kidney injury (CI-AKI) is a serious complication of coronary angiography (CAG) and percutaneous coronary intervention (PCI). Four risk assessment models of CI-AKI are introduced here, including Mehran CI-AKI risk assessment system, Chen CI-AKI risk assessment system, Maioli CI-AKI risk assessment system, and Duan CI-AKI risk assessment system. The predictive factors involved in the 4 models include hypotension, intra-aortic balloon pump, congestive heart-failure, advanced age, anemia, diabetes mellitus, volume of contrast, renal function, myocardial infarction, left ventricular ejection fraction, high density lipoprotein, emergency PCI, PCI or CAG procedure performed within the past 72 h, primary PCI, N-terminal pro-B-type natriuretic peptide, and high-sensitivity C-reactive protein. Mehran CI-AKI risk assessment system is used postoperatively, while the other 3 models are used preoperatively. Mehran CI-AKI risk assessment system is more influential at present. And there are already some reports on its external validation and promotion. Maioli CI-AKI risk assessment system has predictive value for patients with renal injury, additionally. The Chen CI-AKI risk assessment system is applied to the patients in Asian population. Duan CI-AKI risk assessment system incorporates 2 highly sensitive biomarkers of CI-AKI, N-terminal pro-B-type natriuretic peptide and high-sensitivity C-reactive protein. All of the above 4 models have certain limitations, and they all have no clinical practical evidences.