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对比剂肾病及其预防:基于循证研究结果我们究竟了解什么?

Contrast-induced nephropathy and its prevention: What do we really know from evidence-based findings?

作者信息

Reddan Donald, Laville Maurice, Garovic Vesna D

机构信息

University College Galway, Merlin Park Hospital, Galway - Ireland.

出版信息

J Nephrol. 2009 May-Jun;22(3):333-51.

Abstract

INTRODUCTION

Contrast-induced acute kidney injury, also referred to as contrast-induced nephropathy (CIN), is a potentially serious renal complication associated with the use of iodinated contrast media (CM) in patients at risk. With the dramatic growth in contrast-enhanced imaging services worldwide, including procedures involving exposure to iodinated CM, efforts to reduce the occurrence of CIN have received considerable attention in recent years. To date, these efforts have met with little success since the 12% prevalence of CIN today remains unchanged from 2 decades ago.

METHODS

We conducted a systematic literature review of the most recent evidence available from published reports of contemporary (2000-2008) prospective, randomized, controlled trials that have investigated CIN either by comparing CM or by comparing preventive strategies. The objective was to critically review the findings in light of several aspects of study design and then to establish a set of parameters for consideration in the planning of future CIN trials so as to optimize the strength of evidence obtained.

RESULTS

Whether future CIN trials are investigating comparative CM nephrotoxicity or dealing with prophylactic strategies for risk reduction, the complexities that must be addressed include a standardized definition of CIN, appropriate timing of SCr measurements with timing standardized for all subjects in a given study population, awareness of study population risk profile, hydration protocols, and pharmacological prophylactic strategies.

CONCLUSIONS

Large, well-designed trials (ideally with hard clinical outcome measures) that consider all the complexities involved in CIN and its prevention are needed before the clinical community has the evidence-based direction required for optimized patient care.

摘要

引言

对比剂诱导的急性肾损伤,也称为对比剂肾病(CIN),是一种潜在的严重肾脏并发症,与有风险的患者使用碘化对比剂(CM)有关。随着全球对比增强成像服务的急剧增长,包括涉及接触碘化CM的检查,近年来减少CIN发生的努力受到了相当大的关注。迄今为止,这些努力收效甚微,因为如今CIN 12%的患病率与20年前相比仍未改变。

方法

我们对当代(2000 - 2008年)前瞻性、随机、对照试验的已发表报告中的最新证据进行了系统的文献综述,这些试验通过比较CM或比较预防策略来研究CIN。目的是根据研究设计的几个方面严格审查研究结果,然后建立一套参数,供未来CIN试验规划时考虑,以优化所获得证据的强度。

结果

无论未来的CIN试验是研究对比剂肾毒性的比较还是处理降低风险的预防策略,必须解决的复杂性包括CIN的标准化定义、血清肌酐(SCr)测量的合适时间(在给定研究人群中对所有受试者的测量时间进行标准化)、对研究人群风险特征的认识、水化方案以及药物预防策略。

结论

在临床界获得优化患者护理所需的循证指导之前,需要进行大型、设计良好的试验(理想情况下采用严格的临床结局指标),这些试验要考虑到CIN及其预防中涉及的所有复杂性。

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