Vercellino M, Bezante G P, Balbi M
Cardiology Unit - Department of Internal Medicine, University of Genova, Genova, Italy.
Cardiovasc Hematol Agents Med Chem. 2009 Apr;7(2):166-80. doi: 10.2174/187152509787847083.
Diagnostic and interventional cardiac imaging modalities employing contrast media (CMs) have become increasingly widespread in the recent years, especially multi-slice coronary computed tomography (MSCCT) and percutaneous coronary intervention (PCI). Contrast medium induced nephropathy (CIN), defined as impairment of renal function within 48-72 hours after administering CM, is one of the most common causes of hospital acquired renal insufficiency. The overall incidence of CIN in the general population is low (0.6-2.3%), but it may become remarkably elevated in patients with pre-existing renal failure, diabetes mellitus and in the elderly, all of whom represent a large cohort of patients undergoing cardiac studies. Calculating a simple risk score that is based on readily available information can assess the overall risk of CIN in each individual patient. Volume supplementation in moderate-high risk patients remains the cornerstone for preventing CIN. The combination of oral volume overload and intravenous (i.v.) hydration with normal saline (NS) or bicarbonate significantly reduces the risk. Since no ideal CM exists, preventing CIN involves reducing the given volume, avoiding the use of high osmolality or high viscosity CM, and limiting repeated exposure. Several vasodilators have been tested and controversial results have been observed. Recently, considerable interest has arisen due to the initial positive data on the effectiveness of antioxidant agents in reducing CIN incidence. In this review, we focus on the current strategies in the risk management of CIN and on the effectiveness of new preventive pharmacological therapies.
近年来，使用造影剂（CMs）的诊断性和介入性心脏成像技术越来越普遍，尤其是多层螺旋冠状动脉计算机断层扫描（MSCCT）和经皮冠状动脉介入治疗（PCI）。造影剂诱发的肾病（CIN）定义为在使用CM后48 - 72小时内肾功能受损，是医院获得性肾功能不全最常见的原因之一。普通人群中CIN的总体发病率较低（0.6 - 2.3%），但在已有肾功能衰竭、糖尿病患者以及老年人中，其发病率可能会显著升高，而这些人群正是接受心脏检查的大量患者群体。基于易于获取的信息计算一个简单的风险评分，可以评估每个患者发生CIN的总体风险。对中高危患者进行容量补充仍然是预防CIN的基石。口服容量超负荷与静脉输注生理盐水（NS）或碳酸氢盐联合补液可显著降低风险。由于不存在理想的CM，预防CIN涉及减少给药量、避免使用高渗或高粘度CM以及限制重复暴露。已经对几种血管扩张剂进行了测试，观察到了有争议的结果。最近，由于抗氧化剂在降低CIN发病率方面有效性的初步阳性数据，引起了相当大的关注。在这篇综述中，我们重点关注CIN风险管理的当前策略以及新的预防性药物治疗的有效性。
