冠脉造影术后对比剂肾病的研究进展

随着人口老龄化以及饮食结构的改变,冠心病发病率逐年升高。冠状动脉造影技术在临床中广泛开展,导致对比剂肾病(contrast-induced nephropathy,CIN)的发病率不断上升。CIN的发生与患者本身的基础肾脏疾病及术前血糖水平等危险因素密切相关。对比剂会影响肾脏血流动力学,同时对肾小管有直接毒性作用,最新研究显示炎症反应参与了CIN的发生,但其具体发病机制尚未完全阐明。在CIN的早期诊断中,新的生化指标较血肌酐值可更早反应对比剂使用后肾功能的损害。除静脉水化疗法外,新型的药物在防治CIN中起到一定作用。CIN对患者的预后有重要影响,认识和熟悉CIN的高危因素、发病机制及早期诊断方法,对预防冠脉造影术后引发的肾脏损害尤为重要。该文就CIN的发病机制、高危因素、早期诊断、防治方法等方面的研究进展进行综述。

Progress in Contrast-induced Nephropathy after Coronary Angiography

With the aging population and the change of dietary structure, the incidence of coronary heart disease has increasedyear by year. Application of coronary angiography is increasingly widespread. Therefore, contrast-induced nephropathy (contrast-inducednephropathy, CIN) incidence is rising. Risk factors of CIN include the basis of kidney disease and the preoperative blood glucose levels,etc. Contrast agent can affect renal hemodynamics, and has a direct toxic effect on the renal tubules. But its specific pathogenesis has notbeen fully elucidated. The latest study shows that inflammation is involved in the occurrence of CIN. In the early diagnosis of CIN, thenew biochemical markers can earlier response the renal injury after the use of contrast agent than serum creatinine level. In addition tointravenous hydration therapy, some new drugs play a role in the prevention and treatment of CIN. CIN has a major impact on theprognosis of patients. Understanding of the risk factors, pathogenesis and early diagnosis of CIN is very important to the prevention of thedisease. This paper studies the progress of the pathogenesis, risk factors, early diagnosis, prevention and treatment of CIN.