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Факторы риска и патофизиология контраст-индуцированной нефропатии после мультиспиральной компьютерной томографии с контрастным усилением

https://doi.org/10.24835/1607-0763-2017-1-103-115

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Аннотация

Введение. Количество МСКТ с контрастным усилением растет повсеместно, а вместе с ней растет риск развития побочных проявлений внутрисосудистого введения рентгеноконтрастных диагностических средств, в частности острого повреждения почек (известного в литературе как “контраст-индуцированная нефропатия – КИН”). Литературные данные часто противоречивы. Необходим объективный анализ информации о частоте КИН и оценке групп риска ее развития.

Цель исследования: изучение факторов, влияющих на развитие КИН, осмысление ее патофизиологии при выполнении МСКТ с контрастным усилением изображения, в том числе у пациентов с сахарным диабетом.

Материал и методы. Проанализированы 62 научные англоязычные публикации, полный текст которых и их библиография доступны в поисковой системе PubMed (2013–2016 гг.). Факторы патофизиологии КИН разделены на подгруппы и подвергнуты критическому анализу для осмысления противопоказаний к использованию МСКТ с контрастным усилением в диагностическом процессе.

Результаты. Возраст старше 65 лет, низкий базовый уровень расчетной скорости клубочковой фильтрации (рСКФ), сахарный диабет, низкий уровень сывороточного альбумина, гипертония предрасполагают пациентов к КИН чаще, чем измененный исходный уровень сывороточного креатинина (SCr). Внутривенное введение низкоосмолярных контрастных веществ не является фактором риска у пациентом с рСКФ ≥45 мл/кг/1,73 м2. Уровень SCr может колебаться до уровней, больше или меньше, чем 25% от базового уровня даже без введения йодсодержащих контрастных веществ, и не может считаться надежным диагностическим тестом.

Заключение. Введение в практику повседневной работы скрининга, основанного на изучении рСКФ (считая порогом риска развития КИН уровень ниже, чем 45 мл/мин/1,73 м2) приведет к сокращению неправильной идентификации риска КИН у большого числа взрослых стационарных больных с пороговым уровнем SCr >1,5 мг/дл.

Об авторах

Г. Г. Кармазановский
ФГБУ “Институт хирургии им. А.В. Вишневского” Минздрава России ФГБОУ ВО Первый МГМУ им. И.М. Сеченова ООО “Рэмси Диагностика Рус”
Россия

член-корр. РАН, профессор, заведующий отделом лучевой диагностики ФГБУ “Институт хирургии им. А.В. Вишневского” МЗ РФ; профессор кафедры лучевой диагностики ИПО ФГБОУ ВО Первый МГМУ им. И.М. Сеченова; главный специалист ООО “Рэмси Диагностика Рус”, Москва

117997, Россия, Москва, ул. Большая Серпуховская, 27, Институт хирургии им. А.В. Вишневского. Тел.: 8-499-237-37-64



А. Ш. Ревишвили
ФГБУ “Институт хирургии им. А.В. Вишневского” Минздрава России
Россия

академик РАН, профессор, директор ФГБУ “Институт хирургии им. А.В. Вишневского” МЗ РФ



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Для цитирования:


Кармазановский Г.Г., Ревишвили А.Ш. Факторы риска и патофизиология контраст-индуцированной нефропатии после мультиспиральной компьютерной томографии с контрастным усилением. Медицинская визуализация. 2017;(1):103-115. https://doi.org/10.24835/1607-0763-2017-1-103-115

For citation:


Karmazanovsky G.G., Revishvili A.S. Risk Factors and Pathophysiology of Contrast- Induced Nephropathy after Contrast Enhanced Multidetector Computed Tomography. Medical Visualization. 2017;(1):103-115. (In Russ.) https://doi.org/10.24835/1607-0763-2017-1-103-115

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