专家共识
ENGLISH ABSTRACT
碘对比剂诱导的急性肾损伤防治的专家共识
中华医学会临床药学分会
中国药学会医院药学专业委员会
中华医学会肾脏病学分会
作者及单位信息
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DOI: 10.3760/cma.j.cn441217-20210909-00041
Expert consensus on prevention and treatment of iodine contrast media-induced acute kidney injury
Chinese Society of Clinical Pharmacy
Hospital Pharmacy Professional Committee of Chinese Pharmaceutical Association
Chinese Society of Nephrology
Zuo Xiaocong
Zhao Jie
Zhang Yu
Chen Jianghua
Authors Info & Affiliations
Chinese Society of Clinical Pharmacy
Hospital Pharmacy Professional Committee of Chinese Pharmaceutical Association
Chinese Society of Nephrology
Zuo Xiaocong
Department of Pharmacy, the Third Xiangya Hospital, Central South University, Changsha 410013, China
Zhao Jie
National Engineering Laboratory for Internet Medical Systems and Applications, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
Zhang Yu
Department of Pharmacy, Hubei Province Clinical Research Center for Precision Medicine for Critical Illness, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430022, China
Chen Jianghua
Kidney Disease Center, the First Affiliated Hospital, Zhejiang University School of Medicine; Institute of Nephrology, Zhejiang University; Key Laboratory of Kidney Disease Prevention and Control Technology, Zhejiang Province, Hangzhou 310003
·
DOI: 10.3760/cma.j.cn441217-20210909-00041
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摘要

随着影像技术的不断发展,碘对比剂在介入治疗、血管造影等领域的应用日益增多。虽然碘对比剂的临床应用大大提高了疾病的诊疗水平,但其引起的急性肾损伤不容忽视。为降低碘对比剂诱导的急性肾损伤的发生率,中华医学会临床药学分会、中国药学会医院药学专业委员会和中华医学会肾脏病学分会组织国内专家,成立《碘对比剂诱导的急性肾损伤防治的专家共识》编写委员会,在参考国内外相关指南、共识及研究进展的基础上,结合我国的实际情况,针对碘对比剂的结构和分类、已上市的碘对比剂品种及理化性质、碘对比剂的应用现状、碘对比剂诱导的急性肾损伤的定义、流行病学、生物标志物、病理特征、危险因素与风险评估、预防措施和治疗手段等方面进行证据检索和评价,并充分讨论,制定了本共识,为临床医、药、护、技更有效、更安全地合理使用碘对比剂提供指导建议。

造影剂;碘;急性肾损伤;对比剂肾病;防治;共识
引用本文

中华医学会临床药学分会,中国药学会医院药学专业委员会,中华医学会肾脏病学分会. 碘对比剂诱导的急性肾损伤防治的专家共识[J]. 中华肾脏病杂志,2022,38(03):265-288.

DOI:10.3760/cma.j.cn441217-20210909-00041

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前言
为增强显影效果,提高疾病诊疗水平,碘对比剂(iodine contrast media,又称碘造影剂,简称对比剂)广泛应用于临床。然而,流行病学调查显示,11%~40%的患者在应用碘对比剂后出现急性肾损伤(acute kidney injury,AKI),即碘对比剂诱导的AKI(iodine contrast media-induced acute kidney injury),也称对比剂诱导的AKI(contrast-induced acute kidney injury,CI-AKI)或对比剂肾病(contrast-induced nephropathy,CIN) [ 1 , 2 , 3 , 4 ]。慢性肾脏病(chronic kidney disease,CKD)患者接受碘对比剂后CI-AKI发病率高达40%,在这些患者中,CI-AKI与住院透析需求、长期肾衰竭和总死亡率(7%~31%)相关,且需要住院透析的患者中有13%可能永久依赖透析,因而CI-AKI与更长的住院时间和更高的成本相关 [ 2 ],已成为影响我国居民健康的重要疾病。因此,为了提高医务人员对CI-AKI的认识,规范碘对比剂的临床应用,降低CI-AKI的发生率,中华医学会临床药学分会、中国药学会医院药学专业委员会和中华医学会肾脏病学分会组织专家制定《CI-AKI防治的专家共识》。本共识在已有国内外相关指南和专家共识的基础上,结合CI-AKI的新证据,同时考虑我国的实际情况,参照 表1 中的证据水平及推荐等级,介绍了碘对比剂的结构和分类、已上市的碘对比剂品种及理化性质、碘对比剂的应用现状、CI-AKI的定义、流行病学、生物标志物、病理特征、危险因素与风险评估、预防措施和治疗手段等内容。本共识是我国最新的CI-AKI防治共识,以期为临床CI-AKI的规范防治提供参考。
级别 说明
证据水平  
  A 资料来源于多项随机临床试验或荟萃分析
  B 资料来源于单项随机临床试验或多项大规模非随机对照研究
  C 资料来源于专家共识和/或小型临床试验、回顾性研究或注册登记
推荐等级  
  已证实和/或一致公认某治疗措施或操作有益、有效,应该采用
  某治疗措施或操作的有效性尚有争论
    Ⅱa 指有关证据和/或观点倾向于有效,应用该治疗措施或操作是适当的
    Ⅱb 指有关证据和/或观点尚不能充分证明有效,需进一步研究
  已证实和/或一致公认某治疗措施或操作无用和/或无效,并对某些病例可能有害,不推荐使用
本专家共识的证据水平及推荐等级
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备注信息
A
左笑丛:中南大学湘雅三医院药学部,长沙 410013,Email: mocdef.6ab2180cxouz
B
赵杰:郑州大学第一附属医院互联网医疗系统与应用国家工程实验室,郑州 450052,Email: nc.defudabe.uzzeijoahz
C
张玉:华中科技大学同济医学院附属协和医院药学部,湖北省重大疾病精准用药医学研究中心,武汉 430022,Email: mocdef.3ab61yzhxhw
D
陈江华:浙江大学医学院附属第一医院肾脏病中心,浙江大学肾脏病研究所,浙江省肾脏病防治技术研究重点实验室,杭州 310003,Email: nc.defudabe.ujzauhgnaijnehc
E
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