钆对比剂沉积机制与不良反应

Mechanism and adverse reactions of gadolinium contrast agent deposition

钆对比剂广泛应用于磁共振成像中,是公认的安全性及耐受性良好的对比剂。然而最近有不少研究发现,在严重肾损害患者中,钆对比剂的使用与肾源性系统纤维化的发展存在一定关系。本研究综述了钆对比剂毒性的生化机制和分子基础以及限制钆人体负荷的方法。应用PubMed及中国知网、万方等数据库,以'钆''钆对比剂''钆毒性''磁共振成像''生化机制'为关键词,检索2008-2018年的相关文献,共检索到98篇文献。纳入标准:(1)钆对比剂的分子基础及成像原理。(2)钆对比剂在组织中沉积的不良影响。(3)钆的生化和毒理学机制。(4)钆组织沉积不良反应的治疗和预防措施。根据纳入标准,最后分析28篇高度相关的文献。无论肾功能是否损害,钆都能在组织中沉积,并对神经系统、骨肌系统及皮肤等产生一定的不良反应。钆毒性反应与细胞凋亡、氧化应激、金属转移以及Gd3+与Ca2+在细胞生物过程中的竞争作用有关。关于多次接受钆对比剂造影检查对健康影响的研究较为有限,目前已明确钆对比剂在组织沉积中会产生不良反应,为明确更多钆潜在毒性方面的问题,需进一步研究。

Gadolinium contrast agent is widely used in magnetic resonance imaging and is recognized as a safe and well-tolerated contrast agent.However,many recent studies have found that the use of gadolinium contrast agent has a certain relationship with the development of renal systemic fibrosis in patients with severe renal damage.This article reviews the biochemical mechanism and molecular basis of gadolinium contrast agent toxicity and the methods to limit gadolinium human load.PubMed,CNKI,Wanfang and other databases were used to search the relevant literatures from 2008 to2018,with'gadolinium''gadolinium contrast agent''gadolinium toxicity''magnetic resonance imaging''biochemical mechanism'and other key words.A total of 98 literatures were retrieved.Inclusion criteria included:(1)molecular basis and imaging principle of gadolinium contrast agent;(2)adverse effects of gadolinium contrast agent deposition in tissues;(3)biochemical and toxicological mechanisms of gadolinium;(4)treatment and prevention of gadolinium tissue deposition adverse reactions.According to the inclusion criteria,28 highly relevant documents were finally analyzed.Gadolinium can be deposited in tissues regardless of renal function damage and has certain adverse effects on nervous system,musculoskeletal system and skin.Gadolinium toxicity reaction is related to cell apoptosis,oxidative stress,metal transfer and the competitive effects of Gd3+and Ca2+in cell biological processes.Research on the health effects of multiple gadolinium contrast media contrast examinations is relatively limited.It has been confirmed that gadolinium contrast media will produce adverse reactions in tissue deposition.Further research is needed to clarify more potential toxicity problems of gadolinium.