Idée Jean-Marc, Port Marc, Dencausse Anne, Lancelot Eric, Corot Claire
Guerbet, Research Division, BP 57400, 95943 Roissy Charles de Gaulle cedex, France.
Radiol Clin North Am. 2009 Sep;47(5):855-69, vii. doi: 10.1016/j.rcl.2009.06.006.
Nephrogenic systemic fibrosis (NSF) is a highly debilitating scleroderma-like disease occurring exclusively in patients with severe or end-stage renal failure. Since the recognition of a link between gadolinium chelates (GCs) used as contrast agents for MR imaging and NSF by two independent European teams in 2006, numerous studies have described the clinical issues and investigated the mechanism of this disease. So far the most commonly reported hypothesis is based on the in vivo dechelation of GCs. The physicochemical properties of GCs, especially their thermodynamic and kinetic stabilities, are described in the present article. High kinetic stability provided by the macrocyclic structure, combined with high thermodynamic stability, minimizes the amount of free gadolinium released in the body. The current hypotheses regarding the pathophysiologic mechanism are critically discussed.
肾源性系统性纤维化（NSF）是一种极具致残性的硬皮病样疾病，仅发生于严重或终末期肾衰竭患者。自2006年两个独立的欧洲研究团队发现用于磁共振成像的钆螯合物（GCs）与NSF之间存在关联以来，众多研究描述了该疾病的临床问题并对其发病机制进行了研究。迄今为止，最常报道的假说是基于GCs在体内的脱螯作用。本文描述了GCs的物理化学性质，尤其是它们的热力学和动力学稳定性。大环结构提供的高动力学稳定性，再加上高热力学稳定性，使体内释放的游离钆量降至最低。本文对目前关于病理生理机制的假说进行了批判性讨论。
