对比剂肾病的防治进展

Progress in the treatment of contrast nephropathy

对比剂肾病(CIN)是临床实践中常见的一种可逆转的急性肾功能衰竭。伴随着当前各种血管造影(如冠脉造影、脑血管造影等)或其他医学相关的造影(如尿路造影、胆道造影等)中对比剂的广泛使用,CIN的发病率呈逐年升高的趋势,已作为继缺血和药物损伤后患者急性肾损伤的重要病因。当前,对比剂诱导CIN发生的机理尚不完全清晰,主要包括氧化应激和细胞凋亡等。此外,众多研究也发现肾缺血性及肾小管毒性损伤也是CIN发生的关键病理机制。CIN的发生不仅与升高的医疗费用相关,而且也导致患者发生不良结局(如急性心肌梗死、急性心力衰竭、透析及死亡等)的风险显著增加。因此,早期识别CIN发生的危险因素,并给予恰当的临床干预,有助于高危CIN患者获益于早期的肾脏保护的策略,改善预后。本次研究从CIN的诊断以及当前防治措施的进展进行综述,为临床提供依据。

Contrast-induced nephropathy(CIN)is a common reversible acute renal failure in clinical practice.The incidence rate of CIN is increasing annually with the widely use of contrast agents such as angiography,coronary angiography,cerebral angiography,or other medical related radiography(urography and cholangiography).It has been an important cause of acute kidney injury after ischemia and drug injury.Nowadays,the mechanism of CIN induced by contrast agent is not completely clear,mainly including oxidative stress and apoptosis.In addition,many studies have also found that renal ischemia and tubular toxic injury are also the key pathological mechanisms of CIN.The occurrence of CIN is not only related to the increased medical expenses,but also leads to a significant increase in the risk of adverse outcomes(such as acute myocardial infarction,acute heart failure,dialysis and death).Therefore,early identification of risk factors for CIN and appropriate clinical intervention will help high-risk CIN patients benefit from early renal protection strategies and improve prognosis.This study reviews the diagnosis of CIN and the progress of current treatment measures,so as to provide basis for clinical practice.