预防对比剂相关性急性肾损伤的研究进展

doi:10.11958/20230617

天津医药 ›› 2024, Vol. 52 ›› Issue (3): 327-330.doi: 10.11958/20230617

预防对比剂相关性急性肾损伤的研究进展

樊汇¹(), 马宇², 李曦铭²^,³^,^△()

1.天津医科大学（邮编300070）
2.天津大学胸科医院心血管内科
3.天津市心血管急危重症重点实验室

收稿日期:2023-04-22 修回日期:2023-08-08 出版日期:2024-03-15 发布日期:2024-03-13
通讯作者: ^△E-mail：ljsunlight@126.com
作者简介:樊汇（1997），女，硕士在读，主要从事对比剂相关性急性肾损伤方面研究。E-mail：15947617054@163.com
基金资助:
天津市卫生健康科技项目青年人才项目(TJWJ2021QN056)

Research progress in the prevention of contrast-related acute kidney injury

FAN Hui¹(), MA Yu², LI Ximing²^,³^,^△()

1. Tianjin Medical University, Tianjin 300070, China
2. Department of Cardiology, Chest Hospital of Tianjin University
3. Tianjin Key Laboratory of Cardiovascular Emergency and Critical Care

Received:2023-04-22 Revised:2023-08-08 Published:2024-03-15 Online:2024-03-13
Contact: ^△E-mail: ljsunlight@126.com

樊汇, 马宇, 李曦铭. 预防对比剂相关性急性肾损伤的研究进展[J]. 天津医药, 2024, 52(3): 327-330.

FAN Hui, MA Yu, LI Ximing. Research progress in the prevention of contrast-related acute kidney injury[J]. Tianjin Medical Journal, 2024, 52(3): 327-330.

摘要/Abstract

摘要：

对比剂相关性急性肾损伤（CA-AKI）是在诊断或介入手术中使用对比剂所引起的一种严重并发症，目前已成为住院患者新发急性肾功能不全的主要原因之一。选择相对低毒的对比剂，减少对比剂暴露的时间和剂量对CA-AKI有一定的预防作用，他汀等药物以及术前术后的水化能够降低CA-AKI的风险，目前纳米药物已被证明在动物模型中获益。该文就当前CA-AKI的防治进行综述，为进一步深入研究新的干预措施奠定基础，并为临床治疗提供理论依据。

关键词: 造影剂, 急性肾损伤, 羟甲基戊二酰基CoA还原酶抑制剂, 纳米粒子, 补液疗法

Abstract:

Contrast-associated acute kidney injury (CA-AKI) is an important complication caused by the use of contrast medium (CM) in diagnostic or interventional surgery. At present, it has become one of the major causes of acute renal insufficiency in hospitalized patients. Choosing a relatively low toxic CM and reducing the exposure time and dose of CM can prevent CA-AKI occurrence to some extent. Drugs such as statins and postoperative hydration can reduce the risk of CA-AKI. In addition, nanomedicine has shown a benefit in animal models. This paper reviews the current prevention and treatment of CA-AKI to lay the foundation for further study of new interventions and provide a theoretical basis for clinical treatment.

Key words: contrast media, acute kidney injury, hydroxymethylglutaryl-CoA reductase inhibitors, nanoparticles, fluid therapy

中图分类号:

R692

图/表 2

参考文献 26

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纳米颗粒类型	特性
壳聚糖纳米颗粒
硫酸化壳聚糖	Fe²⁺螯合能力和抗氧化活性
含有姜黄素的壳聚糖纳米颗粒	姜黄素具有肾保护作用；抑制氧化损伤
负载芒果苷的壳聚糖纳米颗粒	增强药物溶解度，提高生物利用度，清除氧自由基，与过氧化氢酶和过氧化物酶等抗氧化酶协同作用，保护肾上皮细胞免受氟化钠诱导的氧化损伤
SS31^①偶联L-丝氨酸修饰壳聚糖前药	具有肾脏靶性和触发的药物释放，以保护线粒体免受损伤，减少氧化应激、炎症反应和细胞凋亡
负载SS31的pH响应性纳米颗粒	抑制氧化应激、炎症反应，保护线粒体结构；壳聚糖具有pH敏感性，能够在溶酶体中释放SS31，SS31具有线粒体靶向
pH响应性含氮氧化物自由基的纳米颗粒	清除ROS和肾脏保护作用；抑制ROS生成，脂质过氧化和促炎细胞因子生成
无机纳米颗粒
苯二铵基碳纳米点	AKI肾脏特异性被动靶向和通过清除ROS的抗氧化治疗
金纳米颗粒	抗氧化、抗炎和抗血管生成能力
氧化钌纳米颗粒	多酶样抗氧化活性（例如过氧化氢酶、过氧化物酶，超氧化物歧化酶和谷胱甘肽过氧化物酶）
脂质基纳米颗粒
负载地塞米松的唾液酸修饰脂质磷酸钙纳米颗粒	有效积累在AKI损伤的肾脏中；改善肾功能，降低促炎细胞因子水平、氧化应激和细胞凋亡
泼尼松龙负载脂质体	聚集在发炎的肾组织发挥抗炎作用
水凝胶
负载生长因子的注射水凝胶	促进肾小管再生
肿瘤坏死因子-α中和抗体和肝细胞生长因子共载水凝胶	改善血清生物标志物，肾小管再生，减少肾组织中促炎细胞和巨噬细胞浸润

纳米颗粒类型	特性
壳聚糖纳米颗粒
硫酸化壳聚糖	Fe²⁺螯合能力和抗氧化活性
含有姜黄素的壳聚糖纳米颗粒	姜黄素具有肾保护作用；抑制氧化损伤
负载芒果苷的壳聚糖纳米颗粒	增强药物溶解度，提高生物利用度，清除氧自由基，与过氧化氢酶和过氧化物酶等抗氧化酶协同作用，保护肾上皮细胞免受氟化钠诱导的氧化损伤
SS31^①偶联L-丝氨酸修饰壳聚糖前药	具有肾脏靶性和触发的药物释放，以保护线粒体免受损伤，减少氧化应激、炎症反应和细胞凋亡
负载SS31的pH响应性纳米颗粒	抑制氧化应激、炎症反应，保护线粒体结构；壳聚糖具有pH敏感性，能够在溶酶体中释放SS31，SS31具有线粒体靶向
pH响应性含氮氧化物自由基的纳米颗粒	清除ROS和肾脏保护作用；抑制ROS生成，脂质过氧化和促炎细胞因子生成
无机纳米颗粒
苯二铵基碳纳米点	AKI肾脏特异性被动靶向和通过清除ROS的抗氧化治疗
金纳米颗粒	抗氧化、抗炎和抗血管生成能力
氧化钌纳米颗粒	多酶样抗氧化活性（例如过氧化氢酶、过氧化物酶，超氧化物歧化酶和谷胱甘肽过氧化物酶）
脂质基纳米颗粒
负载地塞米松的唾液酸修饰脂质磷酸钙纳米颗粒	有效积累在AKI损伤的肾脏中；改善肾功能，降低促炎细胞因子水平、氧化应激和细胞凋亡
泼尼松龙负载脂质体	聚集在发炎的肾组织发挥抗炎作用
水凝胶
负载生长因子的注射水凝胶	促进肾小管再生
肿瘤坏死因子-α中和抗体和肝细胞生长因子共载水凝胶	改善血清生物标志物，肾小管再生，减少肾组织中促炎细胞和巨噬细胞浸润

预防对比剂相关性急性肾损伤的研究进展

Research progress in the prevention of contrast-related acute kidney injury

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