A Review of the Use of Iloprost, A Synthetic Prostacyclin, in the Prevention of Radiocontrast Nephropathy in Patients Undergoing Coronary Angiography and Intervention.
A Review of the Use of Iloprost, A Synthetic Prostacyclin, in the Prevention of Radiocontrast Nephropathy in Patients Undergoing Coronary Angiography and Intervention.
复制标题
伊洛前列素（一种合成前列环素）在预防冠状动脉造影和介入治疗患者放射性对比肾病中的应用综述。
DOI：
10.1002/clc.22407
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发表时间：
2015
影响因子：
2.7
通讯作者：
Brown,JeremiahR
中科院分区：
文献类型：
--
作者：
Kassis,HayahM;Minsinger,KristopherD;McCullough,PeterA;Block,ClayA;Sidhu,MandeepS;Brown,JeremiahR
伊洛前列素是一种前列环素类似物，可有效预防移植患者肾功能不全。我们假设伊洛前列素在不同的环境中对肾功能障碍有保护作用，在这些环境中发生类似的潜在肾毒性机制。我们进行了文献综述，并讨论了伊洛前列素在降低急性肾功能不全中的应用以及造影剂肾病（CIN）的病理生理机制。一种被提出的CIN机制是延长肾动脉血管收缩，导致肾灌注不足、缺血和自由基释放。Iloprost是血管扩张性前列腺素PGI2的类似物。它通过抑制溶酶体降解和自由基释放，使膜稳定，在肾移植人群中显示出细胞保护特性。两项关于伊洛前列素和CIN的高质量研究报道。5项研究报道了伊洛前列素在肾移植中的保护作用，1项研究报道了在冠状动脉旁路移植术中的保护作用。发现伊洛前列素对基线肾功能不全因CIN接受冠状动脉造影的患者具有肾保护作用（风险比[RR] = 0.32, 95%可信区间[CI]: 0.16‐0.67），并增加肌酐清除率的加权平均差异改善（RR = 4.56, 95% CI: 1.82‐7.30）。CIN与主要心脏不良事件有关。预防CIN对患者安全和减轻疾病负担非常重要。依洛前列素可使CIN降低68%。伊洛前列素在急性肾移植术后和体外循环中抑制移植物功能障碍的相同机制也可能有助于预防CIN。大型随机对照试验是必要的，以确定伊洛前列素在血管造影术中的临床疗效。
Iloprost, a prostacyclin analogue, has been effective in preventing renal dysfunction among transplant patients. We hypothesized that iloprost is protective against renal dysfunction in different settings, in which similar underlying mechanisms of nephrotoxicity occur. We conducted a literature review, and discuss the application of iloprost in reducing acute renal insufficiency and the pathophysiological mechanisms of contrast‐induced nephropathy (CIN). One proposed mechanism of CIN is prolonged renal arterial vasoconstriction, causing renal hypoperfusion, ischemia, and release of free radicals. Iloprost is an analogue of the vasodilatory prostaglandin PGI2. It has demonstrated cytoprotective properties in the renal transplant population by inhibiting lysosomal degradation and release of free radicals, allowing membrane stabilization. Two good‐quality studies reported on iloprost and CIN. Five studies reported protective effects of iloprost in renal transplantation and 1 in coronary artery bypass grafting. Iloprost was found to be renoprotective in patients with baseline renal insufficiency who underwent coronary angiography for CIN (risk ratio [RR] = 0.32, 95% confidence interval [CI]: 0.16‐0.67) and increases the weighted mean difference improvement in creatinine clearance (RR = 4.56, 95% CI: 1.82‐7.30). CIN is associated with major adverse cardiac events. Preventing CIN is important for patient safety and reducing disease burden. Iloprost may reduce CIN by up to 68%. The same mechanisms of iloprost that inhibit graft dysfunction in the acute post–renal transplant and cardiopulmonary bypass setting may also contribute to preventing CIN. Large randomized controlled trials are necessary to determine the clinical efficacy of iloprost in the angiography setting.