摘要
多年来,临床医生一直在寻找“肾肌钙蛋白”——一种评估急性肾损伤(AKI)风险的简单诊断工具。近来,造影剂相关手术(造影剂计算机断层扫描(CT),经皮冠状动脉介入(PCI)和血管造影剂)的增多导致造影剂引起的急性肾损伤(CI-AKI)的增加。CIAKI仍然是总体死亡率、住院时间延长和增加治疗总费用的一个重要原因。肾功能不全的后果影响生活质量,并可能导致残疾。目前国内外对CI-AKI的预测研究较多,但还没有敏感可靠的方法。肾损伤分子1 (KIM-1)和中性粒细胞明胶酶脂蛋白(NGAL)被认为是肾特异性分子。在实施与对比相关的程序之前,这些物质的高浓度被建议用于评估肾脏对CI-AKI的易感性,它们似乎具有心血管事件和总体死亡率的预测潜力。根据其他作者,常规测定已知的炎症因子(如CRP, WBC和中性粒细胞计数)可能有助于预测CIAKI。然而,临床试验的结果提供了截然不同的结果。造影剂肾病的病理机制尚不清楚。由于其流行,急性肾损伤的风险评估仍然是一个严重的问题有待解决。本文回顾了病理生理学,并提出了促进造影剂诱导急性肾损伤预测的最佳标记物。
关键词: 造影剂诱导的急性肾损伤,造影剂CT,经皮冠状动脉成形术,肾损伤分子1 (KIM-1),中性粒细胞明胶酶脂蛋白(NGAL),经皮冠状动脉介入治疗(PCI)
[PMID: 28303073]
[http://dx.doi.org/10.4103/1319-2442.202758] [PMID: 28352014]
[http://dx.doi.org/10.1038/kisup.2012.1]
[http://dx.doi.org/10.21037/jtd.2019.06.53] [PMID: 31463094]
[http://dx.doi.org/10.1186/s13613-018-0373-y] [PMID: 29445884]
[http://dx.doi.org/10.5527/wjn.v6.i3.86] [PMID: 28540198]
[http://dx.doi.org/10.1093/eurheartj/ehr494] [PMID: 22267241]
[http://dx.doi.org/10.1016/j.ijcard.2018.06.013] [PMID: 29937300]
[http://dx.doi.org/10.1002/ccd.26548] [PMID: 27083771]
[http://dx.doi.org/10.2215/CJN.01260308] [PMID: 18463172]
[http://dx.doi.org/10.1097/01.rli.0000242807.01818.24] [PMID: 17035872]
[http://dx.doi.org/10.1155/2014/358136] [PMID: 24707482]
[http://dx.doi.org/10.1155/2014/362725] [PMID: 25197639]
[http://dx.doi.org/10.1016/j.jvs.2006.04.036] [PMID: 16890873]
[http://dx.doi.org/10.1002/cmmi.1468] [PMID: 22649048]
[http://dx.doi.org/10.1159/000480340] [PMID: 28854431]
[http://dx.doi.org/10.1016/j.bcp.2006.08.008] [PMID: 16989777]
[http://dx.doi.org/10.1159/000146075] [PMID: 18635927]
[http://dx.doi.org/10.1016/j.semnephrol.2005.09.003] [PMID: 16530603]
[http://dx.doi.org/10.1161/CIRCINTERVENTIONS.114.002475] [PMID: 26198286]
[http://dx.doi.org/10.1161/JAHA.117.005715] [PMID: 28647690]
[http://dx.doi.org/10.1016/j.ijcard.2018.08.097] [PMID: 30196995]
[http://dx.doi.org/10.1007/s00330-015-3624-4] [PMID: 25773936]
[http://dx.doi.org/10.2214/AJR.07.3280] [PMID: 18647905]
[http://dx.doi.org/10.1006/geno.1997.4896] [PMID: 9339356]
[http://dx.doi.org/10.1016/j.jacc.2011.10.854] [PMID: 22240130]
[http://dx.doi.org/10.1016/j.jacc.2010.11.051] [PMID: 21511111]
[http://dx.doi.org/10.1038/nm.2290] [PMID: 21240264]
[http://dx.doi.org/10.1016/j.jacc.2007.12.035] [PMID: 18402894]
[http://dx.doi.org/10.1093/eurheartj/ehn197] [PMID: 18468994]
[http://dx.doi.org/10.1161/CIRCINTERVENTIONS.115.002673] [PMID: 26333343]
[http://dx.doi.org/10.1371/journal.pone.0197833] [PMID: 29791495]
[http://dx.doi.org/10.1186/1471-2369-14-270] [PMID: 24305547]
[http://dx.doi.org/10.1002/clc.22551] [PMID: 27175937]
[http://dx.doi.org/10.1038/srep41300] [PMID: 28128223]
[http://dx.doi.org/10.2147/IJNRD.S105124] [PMID: 27672338]
[http://dx.doi.org/10.1172/JCI34487] [PMID: 18414680]
[PMID: 25125746]
[http://dx.doi.org/10.1093/ndt/gfu025] [PMID: 24578471]
[http://dx.doi.org/10.1093/ndt/gfp010] [PMID: 19318357]
[http://dx.doi.org/10.1046/j.1523-1755.2002.00433.x] [PMID: 12081583]
[http://dx.doi.org/10.3892/br.2015.449] [PMID: 26171157]
[http://dx.doi.org/10.1681/ASN.2013070758] [PMID: 24904085]
[http://dx.doi.org/10.1681/ASN.2006030221] [PMID: 17267747]
[http://dx.doi.org/10.2215/CJN.04810908] [PMID: 19406962]
[http://dx.doi.org/10.1111/imr.12616] [PMID: 29247988]
[http://dx.doi.org/10.1159/000319319] [PMID: 20664297]
[http://dx.doi.org/10.3892/etm.2014.1898] [PMID: 25187836]
[http://dx.doi.org/10.1007/s40620-014-0113-9] [PMID: 24899123]
[http://dx.doi.org/10.1159/000117814] [PMID: 18287807]
[http://dx.doi.org/10.1038/sj.ki.5001527] [PMID: 16710348]
[http://dx.doi.org/10.1053/j.ajkd.2013.05.014] [PMID: 23830182]
[http://dx.doi.org/10.1016/j.clinbiochem.2008.01.002] [PMID: 18237555]
[http://dx.doi.org/10.1093/ckj/sfs008] [PMID: 22833807]
[http://dx.doi.org/10.1038/ki.2009.422] [PMID: 19940842]
[http://dx.doi.org/10.1681/ASN.2007010097] [PMID: 17942962]
[http://dx.doi.org/10.1186/1471-2261-14-117] [PMID: 25212385]
[http://dx.doi.org/10.1111/j.1365-2362.2011.02620.x] [PMID: 22070248]
[http://dx.doi.org/10.1038/sj.ki.5002721] [PMID: 18094680]
[http://dx.doi.org/10.1016/j.athoracsur.2011.10.048] [PMID: 22269724]
[http://dx.doi.org/10.2478/v10039-009-0036-1] [PMID: 19875355]
[http://dx.doi.org/10.3109/1354750X.2012.672458] [PMID: 22455661]
[http://dx.doi.org/10.1002/clc.22722] [PMID: 28543803]
[http://dx.doi.org/10.1016/j.jcin.2014.06.023] [PMID: 25523533]
[http://dx.doi.org/10.1042/CS20160669] [PMID: 28424376]
[http://dx.doi.org/10.1159/000487499] [PMID: 29466798]
[http://dx.doi.org/10.1111/jcmm.13261] [PMID: 28767184]
[http://dx.doi.org/10.1590/1516-3180.2016.0099220516] [PMID: 27759760]
[http://dx.doi.org/10.1097/ACI.0b013e3283306533] [PMID: 19644363]
[http://dx.doi.org/10.1681/ASN.2012060579] [PMID: 23291472]
[http://dx.doi.org/10.1084/jem.20081271] [PMID: 19414556]
[http://dx.doi.org/10.1186/1471-2369-15-133] [PMID: 25128003]
[http://dx.doi.org/10.1186/s13054-016-1192-x] [PMID: 26864834]
[http://dx.doi.org/10.1053/j.ajkd.2019.06.011]] [PMID: 31547939]
[http://dx.doi.org/10.1371/journal.pone.0218574] [PMID: 31306435]
[http://dx.doi.org/10.1038/nrg2455] [PMID: 18852696]
[http://dx.doi.org/10.1093/toxsci/kfs210] [PMID: 22705808]
[http://dx.doi.org/10.1681/ASN.2016010045] [PMID: 27444565]
[http://dx.doi.org/10.1681/ASN.2012050438] [PMID: 23160513]
[http://dx.doi.org/10.2119/molmed.2010.00002] [PMID: 20386864]
[http://dx.doi.org/10.2215/CJN.10971012] [PMID: 23599408]
[http://dx.doi.org/10.1177/1740774517723588] [PMID: 28795578]
[http://dx.doi.org/10.1159/000142938] [PMID: 18802377]
[http://dx.doi.org/10.1681/ASN.2006030301] [PMID: 16928802]
[http://dx.doi.org/10.1161/JAHA.116.004138] [PMID: 27528406]
[http://dx.doi.org/10.1016/j.amjmed.2014.05.011] [PMID: 24852935]
[http://dx.doi.org/10.1016/j.ajem.2012.04.011] [PMID: 22795418]
[http://dx.doi.org/10.5152/akd.2011.164] [PMID: 21959875]
[http://dx.doi.org/10.1159/000368529] [PMID: 26496491]
[http://dx.doi.org/10.1161/CIRCULATIONAHA.108.814145] [PMID: 19380620]
[http://dx.doi.org/10.1038/nature07511] [PMID: 19043405]
[http://dx.doi.org/10.1073/pnas.0912701107] [PMID: 20651252]
[http://dx.doi.org/10.2215/CJN.00430111] [PMID: 21700819]
[http://dx.doi.org/10.1016/j.jcin.2019.04.055] [PMID: 31521648]
[http://dx.doi.org/10.1001/archinte.162.3.329] [PMID: 11822926]
[http://dx.doi.org/10.1093/ndt/gfp389] [PMID: 19703838]
[http://dx.doi.org/10.1253/circj.CJ-13-0171] [PMID: 23986081]
[http://dx.doi.org/10.21037/jtd.2019.04.65] [PMID: 31179103]
[http://dx.doi.org/10.1161/CIRCULATIONAHA.112.096370] [PMID: 22735306]