Endocrinology and Metabolism Research Center, Tehran University of Medical Sciences, Tehran, Iran.
Med Hypotheses. 2013 Nov;81(5):898-900. doi: 10.1016/j.mehy.2013.08.001. Epub 2013 Aug 11.
Compared to the normal population, patients with congestive heart failure are at higher risk for contrast-induced nephropathy. A variety of interventions are suggested to reduce the risk for contrast-induced nephropathy. Unfortunately results of none of current protective treatments are satisfactory. Apelin a vasodilator adipocytokine, positively inotropic agent, and free radical scavenger has been recently introduced. It has been shown that endogenous apelin levels are decreased in patients with congestive heart failure. Two major mechanisms have been suggested for pathophysiology of contrast induced nephropathy including reactive oxygen species production and impaired renal perfusion due to vasoconstriction. Pretreatment with recombinant apelin (exogenous apelin-13), could compensate decreased endogenous apelin serum levels of congestive heart failure patients. Its antioxidant and cell-protective properties, decrease nephrotoxicity of contrast agent; additionally impaired renal perfusion due to malfunction of cardiac pump will refurbish, because of positively inotropic property of apelin plus its vasodilatation effect in renal arteries. We believe that the triangle of increased contractility, decreased vascular resistance and decreased contrast agent nephrotoxicity could significantly reduce risk of contrast-induced nephropathy in patients with congestive heart failure.
与正常人群相比，充血性心力衰竭患者发生造影剂肾病的风险更高。有多种干预措施被建议用于降低造影剂肾病的风险。然而，目前没有任何一种保护治疗的效果令人满意。Apelin 是一种血管舒张性脂肪细胞因子、正性肌力药和自由基清除剂，最近已被引入。研究表明，充血性心力衰竭患者的内源性 Apelin 水平降低。造影剂诱导的肾病的病理生理学有两种主要机制，包括活性氧的产生和由于血管收缩导致的肾灌注受损。用重组 Apelin（外源性 Apelin-13）预处理可补偿充血性心力衰竭患者内源性 Apelin 血清水平的降低。其抗氧化和细胞保护特性可降低造影剂的肾毒性；此外，由于 Apelin 的正性肌力作用及其对肾动脉的血管舒张作用，心脏泵功能障碍导致的肾灌注受损将得到修复。我们相信，收缩力增加、血管阻力降低和造影剂肾毒性降低的三角关系可显著降低充血性心力衰竭患者造影剂肾病的风险。
