Drescher P, Knes J M, Madsen P O
Department of Radiology, Medical College of Wisconsin, Milwaukee 53226, USA.
Acad Radiol. 1998 Nov;5(11):785-9. doi: 10.1016/s1076-6332(98)80263-8.
The authors' purpose was to investigate the role of histamine release causing renal vasoconstriction induced by application of contrast media, an important element in contrast medium-induced nephrotoxicity.
Isometric contractions in rabbit segmental renal arteries stimulated with KCl and increasing concentrations of the ionic contrast medium diatrizoate and the nonionic agents iomeprol and iodixanol were studied both with and without increasing concentrations of the histamine H1 and H2 blockers diphenhydramine and cimetidine. Histamine concentrations after contrast medium application were determined.
Contrast-induced, dose-dependent, reversible renal artery contractions of 27%, 4.5%, and 5% of the control KCl contraction were found for diatrizoate, iodixanol, and iomeprol respectively. Those induced by the ionic contrast medium were statistically significantly higher (P < .01). Contractions were partially inhibited by diphenhydramine (49%) but not by cimetidine. Significant elevation of histamine concentrations (P < .05) was detected only after stimulation with diatrizoate but not with nonionic agents.
Ionic contrast medium induces histamine release leading to renal vasoconstriction, which can be partly blocked by H1 blockers. Histamine has no effect on renal vasospasm induced by nonionic contrast media.
作者旨在研究组胺释放在此种造影剂诱导的肾毒性的一个重要因素即造影剂应用所引起的肾血管收缩中所起的作用。
研究在有无组胺H1和H2阻滞剂苯海拉明和西咪替丁浓度增加的情况下，氯化钾刺激兔肾节段动脉以及离子型造影剂泛影葡胺和非离子型造影剂碘美普尔及碘克沙醇浓度增加时的等长收缩。测定应用造影剂后的组胺浓度。
发现泛影葡胺、碘克沙醇和碘美普尔引起的造影剂诱导的、剂量依赖性、可逆性肾动脉收缩分别为对照氯化钾收缩的27%、4.5%和5%。离子型造影剂引起的收缩在统计学上显著更高（P < 0.01）。收缩被苯海拉明部分抑制（49%），但未被西咪替丁抑制。仅在泛影葡胺刺激后检测到组胺浓度显著升高（P < 0.05），而非离子型造影剂刺激后未检测到。
离子型造影剂诱导组胺释放导致肾血管收缩，这可被H1阻滞剂部分阻断。组胺对非离子型造影剂诱导的肾血管痉挛无作用。
