碘造影剂肾病的损伤机制和预防策略

Damage Mechanism and Prevention Strategy of Iodine Contrast-induced Nephropathy

关键词:  碘造影剂  肾脏毒性  水化  氧化应激

Key words:  iodine contrast media  nephrotoxicity  hydration  oxidative stress

摘要:

随着医学影像学技术的广泛应用，碘造影剂肾病的发生日益增多，已成为导致急性肾衰竭的第3位致病因素。目前碘造影剂肾病的损伤机制并未完全明确，既往研究表明碘造影剂对肾小管上皮细胞的毒性作用、肾小管血流动力学改变以及氧化应激等机制参与造影剂肾病的发病过程。目前碘造影剂肾病防治方案主要有水化疗法、血液净化治疗、相关药物预防，如尼可地尔、前列地尔、普罗布考、枸橼酸钠/钾、硝酸异山梨酯、辅酶Q10、曲美他嗪、N-乙酰半胱氨酸、余甘子提取物、丹酚酸B、川芎嗪等，这些方案的预防效果及机制还有待进一步研究探讨。本文就碘造影剂肾病的损伤机制和预防策略予以综述，为其研究与治疗提供参考。

Abstract:

As the extensive development of contrast technology, the incidence of iodine contrast-induced nephropathy(CIN) is increasing, which become the third pathogenic factor leading to acute renal failure. However, up to now, the pathogenesis of CIN is not completely clear yet. Previous studies have shown that toxicity of contrast agents to the renal tubular cells, changes in hemodynamics and oxidative stress are involved in the pathogenesis of CIN. Nowadays, the prevention of CIN mainly concentrate on the hydrated therapy, blood purification treatment, related drug prevention such as nicorandil, alprostadil, probucol, sodium/potassium citrate, isosorbide dinitrate, coenzyme Q10 and trimetazidine, N-acetylcysteine, phyllanthus emblica extract, salvianolic acid B, ligustrazine, etc. Their preventive effects and mechanism need to be further research. This paper through reviewing the pathogenesis and prevention of CIN, provides reference basis for the research and treatment of CIN.