造影剂肾病的分子影像学诊断和防治进展

Progresses in molecular imaging diagnosis,prevention and treatment for contrast-induced nephropathy

随着造影剂在现代医学的广泛应用,造影剂肾病(CIN)也引起临床上更多关注。造影剂肾病是指在血管造影或是其他医疗过程中使用碘造影剂引起的急性肾损伤,是仅次于肾灌注不足和肾毒性药物所致肾损伤的医源性急性肾损害的第3大病因。CIN可产生延长住院时间、造成慢性肾功能不全、引起其他血管事件、增加病死率等后果,目前CIN尚无有效的治疗方案,防治重点在于早期评估及预防。本文综述了2014年以来CIN发生的病理生理机制、早期诊断分子标志物、分子影像学诊断、危险因素以及风险预测、造影剂选择、造影剂代谢监测、药物联合水化疗法、基因治疗、中医药治疗、中西医结合治疗等方面的防治进展,以期为CIN的精准诊断和治疗提供参考。

With the widespread application of contrast agents in modern medicine,contrast induced nephropathy(CIN)has received more attention.As the third most common cause of iatrogenic acute kidney injury after renal hypoperfusion and nephrotoxic medications,CIN refers to acute renal failure due to the administration of the iodinated contrast agents in angiography or other medical procedures.Patients with CIN show prolonged hospitalization,chronic renal insufficiency,other vascular events and higher mortality.At present,there is no effective treatment for CIN and therefor early evaluation and prevention have been the leading focus of CIN treatment.This article reviews the progress in prevention and treatment of CIN since 2014,including pathophysiological mechanisms,molecular markers for early diagnosis,molecular imaging diagnosis,risk factors and risk prediction,contrast agent selection,contrast agent metabolism monitoring,drug combination hydration therapy,gene therapy,traditional Chinese medicine and integrated traditional Chinese medicine andWestern medicine.