慢性肾脏病并发结核病患者行CT和MRI增强检查的安全性研究进展

doi:10.3969/j.issn.1000-6621.2018.03.019

摘要/Abstract

摘要：

近年来,慢性肾脏病并发结核病(或疑似结核病)和肺癌患者越来越多,在接受CT或MRI增强检查时会出现一些特殊的不良反应,需要临床医生引起重视。CT增强检查需要使用含碘对比剂,最严重的不良反应是对比剂肾病,对比剂肾病可防可治,选择合适的对比剂品种和剂量,停用肾毒性药物并在增强检查前后进行水化治疗可最大程度地减少慢性肾脏病等高危人群的对比剂肾病发生率。MRI增强检查需使用钆对比剂,最严重的不良反应是肾原性系统性纤维化,肾原性系统性纤维化可防难治;对于慢性肾脏病处于4、5期的患者、急性肾损伤或正在进行透析治疗的患者应避免使用钆对比剂。

关键词: 肾机能不全,慢性, 结核, 造影剂, 药物毒性, 体层摄影术,X线计算机, 磁共振成像, 预防和防护用药, 综述

Abstract:

Patients with tuberculosis (or suspected tuberculosis) or lung cancer complicated with chronic kidney disease (CKD) are increasing. Some special adverse reactions may appear during enhanced CT or MRI scanning, which require clinicians’ attention. Contrast-induced nephropathy (CIN) is the most serious adverse reaction by iodine contrast medium that is used during enhanced CT scanning. CIN can be prevented and treated. Properly selecting appropriate contrast medium type and dosage, discontinuing nephrotoxic drugs, and receiving hydration therapy before and after examination can minimize the occurrence of CIN in CKD and other high risk patients. Nephropathy systemic fibrosis (NSF) is the most serious adverse reaction by gadolinium contrast medium that is used during enhanced MRI scanning. NSF can be prevented but is difficult to be treated. Patients with stage 4 or 5 CKD, acute kidney injury or undergoing dialysis should avoid the use of gadolinium contrast medium.

Key words: Renal insufficiency,chronic, Tuberculosis, Contrast media, Drug toxicity, Tomography,X-ray computed, Magnetic resonance imaging, Protective agents, Review

金弢. 慢性肾脏病并发结核病患者行CT和MRI增强检查的安全性研究进展[J]. 中国防痨杂志, 2018, 40(3): 315-319. doi: 10.3969/j.issn.1000-6621.2018.03.019

Tao JIN. Advances in safety assessment of enhanced CT and MRI scanning in tuberculosis patients complicated with chronic kidney disease[J]. Chinese Journal of Antituberculosis, 2018, 40(3): 315-319. doi: 10.3969/j.issn.1000-6621.2018.03.019

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