现在是时候为毒性辩论注入一些对比
Nans Florens1,2, Julien Demiselle3,4
1Nephrology, Dialysis and Transplantation Department, Strasbourg University Hospitals, 1 place de l'Hôpital, 67000 Strasbourg, France.
Kidney360
|October 2, 2025
概括
现代对比剂很少引起损伤,即使在高风险患者. 目前的证据表明,对比引起的AKI (急性损伤) 的恐惧往往被夸大了,支持基于证据的成像实践.
科学领域:
- 腎臟病學 (nephrology) 是一種醫學專業.
- 放射学 放射学是一门学科.
- 临床试验 临床试验
背景情况:
- 从历史上看,含的对比剂与对比诱导的AKI (CI-AKI) 有关,特别是高度的对比剂.
- 早期将对比介质与损伤联系起来的研究往往被患者的并发病和程序风险所混.
研究的目的:
- 为了评估CI-AKI的当代风险,使用现代的低和异色对比剂.
- 评估预防策略的有效性,并解决CI-AKI过度恐惧的临床影响.
主要方法:
- 审查当代的倾向匹配和受控分析.
- 对大型随机试验的分析,如PRESERVE试验,评估水分和N-乙半氨酸.
- 检查高风险人群 (CKD,AKI,严重疾病) 的临床结果.
主要成果:
- 现代的低和单色对比剂很少引起真正的毒性,即使在高风险患者中也是如此.
- 在大型试验中,诸如二碳酸,盐水和N-乙半氨酸等预防策略没有显示出显著的结果益处.
- 预防策略试验中强调了流体过载等风险.
结论:
- 持续对CI-AKI的恐惧,称为"renalism",可能导致延迟或避免必要的成像,对患者的结果产生负面影响.
- 目前的证据支持个性化方法,重点是避免低血压,限制对比剂量,并且仅在严重功能障碍的情况下保留毒素.
- 一个平衡的,基于证据的策略应该取代对比度介质使用的过时谨慎态度.
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