对比剂肾病的中西医防治新进展
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摘要
随着近年来经皮冠脉介入治疗数量的增加,对比剂肾病的发病率逐年增高,已成为最主要的医源性肾功能衰竭的原因之一。对比剂肾病可以增加患者的住院费用,延长患者住院时间,增加患者的近期及远期死亡率。对比剂肾病的发病机制较为复杂,目前尚不明确,水化是临床指南推荐预防对比剂肾病发生的重要手段。目前关于对比剂肾病防治的研究多以西医为主,中医防治方法尚在起步阶段。一些临床研究显示,中医药在对比剂肾病的防治中也有一定的作用,故旨在总结近年来西医、中医防治对比剂肾病方面的新进展,从不同的角度探讨对比剂肾病的发病机制和防治方法,并为进一步开发中医药预防对比剂肾病启迪新的研究思路。
The incidence of contrast-induced nephropathy( CIN) is increasing owing to the increasing use of contrast media in percutaneous coronary intervention. CIN has come to be one of the major causes of hospital-acquired acute renal failure. CIN may increase health care costs,prolongs hospital length of stay,and increases both short-and long-term morbidity and mortality. The pathophysiological mechanism of CIN is too complicated,and remains unknown as far as we know. The clinical guidelines recommended that hydration status optimization is the effective proven strategy to prevent CIN. At present,the research on the prevention of CIN is mainly based on western medicine,and the Traditional Chinese medicine( TCM) is still in its infancy stage. In recent years,there have been some clinical trials to evaluate the role of TCM in preventing patients from CIN. This paper aimed at summarizing new progress of TCM and western medicine in preventing of CIN from different perspectives,in order to provide reference for clinical medication and enlighten new research ideas in TCM treatment of CIN.
The incidence of contrast-induced nephropathy( CIN) is increasing owing to the increasing use of contrast media in percutaneous coronary intervention. CIN has come to be one of the major causes of hospital-acquired acute renal failure. CIN may increase health care costs,prolongs hospital length of stay,and increases both short-and long-term morbidity and mortality. The pathophysiological mechanism of CIN is too complicated,and remains unknown as far as we know. The clinical guidelines recommended that hydration status optimization is the effective proven strategy to prevent CIN. At present,the research on the prevention of CIN is mainly based on western medicine,and the Traditional Chinese medicine( TCM) is still in its infancy stage. In recent years,there have been some clinical trials to evaluate the role of TCM in preventing patients from CIN. This paper aimed at summarizing new progress of TCM and western medicine in preventing of CIN from different perspectives,in order to provide reference for clinical medication and enlighten new research ideas in TCM treatment of CIN.
引文
[1]MCCULLOUGH PA,ADAM A,BECKER CR,et al.Epidemiology and prognostic implications of contrast-induced nephropathy[J].Am J Cardiol,2006,98(6A):5K-13K.
[2]SN SQ,ZHANG T,DING D,et al.Circulating MicroRNA-188,-30a,and-30e as Early Biomarkers for Contrast-Induced Acute Kidney Injury[J].J Am Heart Assoc,2016,5(8)pii:e004138.
[3]GEENEN RW,KINGMA HJ,VAN DER MOLEN AJ.Contrastinduced nephropathy:pharmacology,pathophysiology and prevention[J].Insights Imaging,2013,4(6):811-820.
[4]AZZALINI L,SPAGNOLI V,LY HQ.Contrast-Induced Nephropathy:From Pathophysiology to Preventive Strategies[J].Can J Cardiol,2016,32(2):247-255.
[5]GOLSHAHI J,NASRI H,GHARIPOUR M.Contrast-induced nephropathy;A literature review[J].J Nephropathol,2014,3(2):51-56.
[6]YUAN Y,QIU H.TCT-378 The Relationship between Endothelin and Contrast-induced Acute Kidney Injury in Patients underwent Emergency Intervention Therapy[J].J Am Coll Cardiol,2016,68(18S):B154.
[7]GONG X,CELSI G,CARLSSON K,et al.N-acetylcysteine amide protects renal proximal tubular epithelial cells against iohexol-induced apoptosis by blocking p38 MAPK and i NOSsignaling[J].Am J Nephrol,2010,31(2):178-188.
[8]MACCARIELLO E.Contrast induced nephropathy[J].J Bras Nefrol,2016,38(4):388-389.
[9]OKOYE O,OJOGWU L,UNUIGBE E,et al.Frequency and risk factors of contrast-induced nephropathy after contrast procedures in a nigerian tertiary centre[J].West Afr J Med,2013,32(1):19-25.
[10]ZHAO K,LI YJ,GAO QY.Role of red blood cell distribution width in predicting contrast induced nephropathy in patients with stable angina pectoris undergoing percutaneous coronary intervention[J].Int J Cardiol,2015,197:276-278.
[11]QIAO B,DENG J,LI Y,et al.Rosuvastatin attenuated contrastinduced nephropathy in diabetes patients with renal dysfunction[J].Int J Clin Exp Med,2015,8(2):2342-2349.
[12]赵凯,李永健.普罗布考对老年不稳定型心绞痛患者对比剂肾损害的预防作用[J].重庆医学,2013,42(14):1593-1594.
[13]YE Z,LU H,GUO W,et al.The effect of alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention in diabetic patients:A systematic review and meta-analysis[J].Medicine(Baltimore),2016,95(46):e5306.
[14]GENG W,FU XH,GU XS,et al.Preventive effects of anisodamine against contrast-induced nephropathy in type 2diabetics with renal insufficiency undergoing coronary angiography or angioplasty[J].Chin Med J,2012,125(19):3368-3372.
[15]SUBRAMANIAM RM,SUAREZ-CUERVO C,WILSON RF,et al.Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy:A Systematic Review and Meta-analysis[J].Ann Intern Med,2016,164(6):406-416.
[16]ZHAO K,LI YJ,ZHANG H.Role of Dongchongxiacao(Cordyceps)in prevention of contrast-induced nephropathy in patients with stable angina pectoris[J].J Tradit Chin Med,2013,33(3):283-286.
[17]陈鹏,牛琳琳,朱明军,等.中药对冠脉介入术后造影剂肾病防治的作用机制浅析[J].中国中西医结合杂志,2016,36(8):991-993.
[18]KAI Z,YONGJIAN L,SHENG G,et al.Effect of Dongchongxiacao(Cordyceps)therapy on contrast-induced nephropathy in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography[J].J Tradit Chin Med,2015,35(4):422-427.
[19]黄仁发,康雷,程新,等.冬虫夏草对肾缺血-再灌注大鼠尿IL-18水平的影响[J].中国中医基础医学杂志,2012,18(7):739-740.
[20]ZHAO K,LIN Y,LI YJ,et al.Efficacy of short-term cordyceps sinensis for prevention of contrast-induced nephropathy in patients with acute coronary syndrome undergoing elective percutaneous coronary intervention[J].Int J Clin Exp Med,2014,7(12):5758-5764.
[21]赵凯,高晟,李永健,等.冬虫夏草预防2型糖尿病肾功能不全患者对比剂肾病的作用[J].中国老年学杂志,2017,37(4):886-888.
[22]龚学忠,王骞,符丹,等.制大黄-川芎“药对”抑制造影剂肾病大鼠肾小管上皮细胞凋亡信号通路的机制研究[J].上海中医药杂志,2013,47(8):69-71.
[23]GONG X,WANG Q,TANG X,et al.Tetramethylpyrazine prevents contrast-induced nephropathy by inhibiting p38 MAPKand Fox O1 signaling pathways[J].Am J Nephrol,2013,37(3):199-207.
[24]丁文飞,钟爱民,王金艳,等.尿毒清颗粒对造影剂肾病的实验研究[J].中国中西医结合肾病杂志,2014,15(7):612-615.
[25]牛哲莉,李明明,杨洪娟,等.丹红注射液对造影剂肾病的预防作用[J].河北中医,2015,37(5):747-749.
[26]陈海威,张津津,熊丹,等.肾康注射液对老年慢性肾病患者造影剂肾病的防治作用[J].中国中西医结合杂志,2016,36(7):792-796.
[27]张成果,扈晓霞,孙少卿,等.红花黄色素对造影剂肾病的预防作用[J].中国中西医结合杂志,2015,35(3):368-370.
[29]王婷,钟丽娟,何紫阳,等.慢性肾功能衰竭中医外治法的研究概况[J].中医药通报,2016,15(3):57-60.
[29]于浩.针灸治疗对慢性肾炎患者血液流变学的影响[J].山东医药,2009,49(41):77.
[30]吴平路,王维武.行气利水针刺法联合依那普利片对肾小球肾炎蛋白尿的影响[J].中国中医药科技,2010,17(5):469.
[31]高晟.对比剂肾病的中医治疗[M]//党群,李永健,高晟,等.冠状动脉介入并发症中西医治疗.北京:人民军医出版社,2012:7-11.
[32]马晓伟,孙伟.中药外治法在慢性肾功能不全治疗中的应用[J].长春中医药大学学报,2013,29(3):445-446.
[33]葛玉英,程亚菲,王秋妹.中药灌肠结合血液透析治疗慢性肾功能不全疗效及对血清CRP、脂联素水平影响[J].中华中医药学刊,2016,34(12):3025-3027.
[34]温宪春,徐磊,夏美莹,等.玉米须水提物对2型糖尿病肾病大鼠转化生长因子-β1和纤维连接蛋白表达的影响[J].中国现代医学杂志,2015,25(13):8-12.
[2]SN SQ,ZHANG T,DING D,et al.Circulating MicroRNA-188,-30a,and-30e as Early Biomarkers for Contrast-Induced Acute Kidney Injury[J].J Am Heart Assoc,2016,5(8)pii:e004138.
[3]GEENEN RW,KINGMA HJ,VAN DER MOLEN AJ.Contrastinduced nephropathy:pharmacology,pathophysiology and prevention[J].Insights Imaging,2013,4(6):811-820.
[4]AZZALINI L,SPAGNOLI V,LY HQ.Contrast-Induced Nephropathy:From Pathophysiology to Preventive Strategies[J].Can J Cardiol,2016,32(2):247-255.
[5]GOLSHAHI J,NASRI H,GHARIPOUR M.Contrast-induced nephropathy;A literature review[J].J Nephropathol,2014,3(2):51-56.
[6]YUAN Y,QIU H.TCT-378 The Relationship between Endothelin and Contrast-induced Acute Kidney Injury in Patients underwent Emergency Intervention Therapy[J].J Am Coll Cardiol,2016,68(18S):B154.
[7]GONG X,CELSI G,CARLSSON K,et al.N-acetylcysteine amide protects renal proximal tubular epithelial cells against iohexol-induced apoptosis by blocking p38 MAPK and i NOSsignaling[J].Am J Nephrol,2010,31(2):178-188.
[8]MACCARIELLO E.Contrast induced nephropathy[J].J Bras Nefrol,2016,38(4):388-389.
[9]OKOYE O,OJOGWU L,UNUIGBE E,et al.Frequency and risk factors of contrast-induced nephropathy after contrast procedures in a nigerian tertiary centre[J].West Afr J Med,2013,32(1):19-25.
[10]ZHAO K,LI YJ,GAO QY.Role of red blood cell distribution width in predicting contrast induced nephropathy in patients with stable angina pectoris undergoing percutaneous coronary intervention[J].Int J Cardiol,2015,197:276-278.
[11]QIAO B,DENG J,LI Y,et al.Rosuvastatin attenuated contrastinduced nephropathy in diabetes patients with renal dysfunction[J].Int J Clin Exp Med,2015,8(2):2342-2349.
[12]赵凯,李永健.普罗布考对老年不稳定型心绞痛患者对比剂肾损害的预防作用[J].重庆医学,2013,42(14):1593-1594.
[13]YE Z,LU H,GUO W,et al.The effect of alprostadil on preventing contrast-induced nephropathy for percutaneous coronary intervention in diabetic patients:A systematic review and meta-analysis[J].Medicine(Baltimore),2016,95(46):e5306.
[14]GENG W,FU XH,GU XS,et al.Preventive effects of anisodamine against contrast-induced nephropathy in type 2diabetics with renal insufficiency undergoing coronary angiography or angioplasty[J].Chin Med J,2012,125(19):3368-3372.
[15]SUBRAMANIAM RM,SUAREZ-CUERVO C,WILSON RF,et al.Effectiveness of Prevention Strategies for Contrast-Induced Nephropathy:A Systematic Review and Meta-analysis[J].Ann Intern Med,2016,164(6):406-416.
[16]ZHAO K,LI YJ,ZHANG H.Role of Dongchongxiacao(Cordyceps)in prevention of contrast-induced nephropathy in patients with stable angina pectoris[J].J Tradit Chin Med,2013,33(3):283-286.
[17]陈鹏,牛琳琳,朱明军,等.中药对冠脉介入术后造影剂肾病防治的作用机制浅析[J].中国中西医结合杂志,2016,36(8):991-993.
[18]KAI Z,YONGJIAN L,SHENG G,et al.Effect of Dongchongxiacao(Cordyceps)therapy on contrast-induced nephropathy in patients with type 2 diabetes and renal insufficiency undergoing coronary angiography[J].J Tradit Chin Med,2015,35(4):422-427.
[19]黄仁发,康雷,程新,等.冬虫夏草对肾缺血-再灌注大鼠尿IL-18水平的影响[J].中国中医基础医学杂志,2012,18(7):739-740.
[20]ZHAO K,LIN Y,LI YJ,et al.Efficacy of short-term cordyceps sinensis for prevention of contrast-induced nephropathy in patients with acute coronary syndrome undergoing elective percutaneous coronary intervention[J].Int J Clin Exp Med,2014,7(12):5758-5764.
[21]赵凯,高晟,李永健,等.冬虫夏草预防2型糖尿病肾功能不全患者对比剂肾病的作用[J].中国老年学杂志,2017,37(4):886-888.
[22]龚学忠,王骞,符丹,等.制大黄-川芎“药对”抑制造影剂肾病大鼠肾小管上皮细胞凋亡信号通路的机制研究[J].上海中医药杂志,2013,47(8):69-71.
[23]GONG X,WANG Q,TANG X,et al.Tetramethylpyrazine prevents contrast-induced nephropathy by inhibiting p38 MAPKand Fox O1 signaling pathways[J].Am J Nephrol,2013,37(3):199-207.
[24]丁文飞,钟爱民,王金艳,等.尿毒清颗粒对造影剂肾病的实验研究[J].中国中西医结合肾病杂志,2014,15(7):612-615.
[25]牛哲莉,李明明,杨洪娟,等.丹红注射液对造影剂肾病的预防作用[J].河北中医,2015,37(5):747-749.
[26]陈海威,张津津,熊丹,等.肾康注射液对老年慢性肾病患者造影剂肾病的防治作用[J].中国中西医结合杂志,2016,36(7):792-796.
[27]张成果,扈晓霞,孙少卿,等.红花黄色素对造影剂肾病的预防作用[J].中国中西医结合杂志,2015,35(3):368-370.
[29]王婷,钟丽娟,何紫阳,等.慢性肾功能衰竭中医外治法的研究概况[J].中医药通报,2016,15(3):57-60.
[29]于浩.针灸治疗对慢性肾炎患者血液流变学的影响[J].山东医药,2009,49(41):77.
[30]吴平路,王维武.行气利水针刺法联合依那普利片对肾小球肾炎蛋白尿的影响[J].中国中医药科技,2010,17(5):469.
[31]高晟.对比剂肾病的中医治疗[M]//党群,李永健,高晟,等.冠状动脉介入并发症中西医治疗.北京:人民军医出版社,2012:7-11.
[32]马晓伟,孙伟.中药外治法在慢性肾功能不全治疗中的应用[J].长春中医药大学学报,2013,29(3):445-446.
[33]葛玉英,程亚菲,王秋妹.中药灌肠结合血液透析治疗慢性肾功能不全疗效及对血清CRP、脂联素水平影响[J].中华中医药学刊,2016,34(12):3025-3027.
[34]温宪春,徐磊,夏美莹,等.玉米须水提物对2型糖尿病肾病大鼠转化生长因子-β1和纤维连接蛋白表达的影响[J].中国现代医学杂志,2015,25(13):8-12.