在对比剂诱导肾损伤高危患者中，尿流率指导（UFR）与左室舒张末压指导（LVEDP）水合作用的随机试验发现，UFR引导技术在预防急性肾损伤和/或急性肺水肿等并发症方面更有效。

 

 

 

　　在第三十一届经导管心血管治疗（TCT）学术会议上发表了研究结果。TCT是世界上最重要的心血管介入医学教育会议，由心血管研究基金会（CRF）赞助。

 

　　慢性肾脏病患者在服用用于诊断和介入治疗的造影剂后有急性肾损伤的危险。REMEDIAL III是一项随机、多中心、旨在比较两种补水策略降低急性肾损伤风险的试验。共有708名肾小球滤过率≤45 ml·min-1·1.73 m-2 和/或 Mehran评分≥11和/或Gurm评分＞7的患者入选。将患者按1:1的比例随机分为LVEDP指导下的生理盐水水化（LVEDP指导组；n=355）和UFR指导下的肾保护系统控制的水化（UFR指导组；n=353）。在所有病例中，均使用碘比醇（一种低渗透、非离子造影剂）。

 

　　主要终点是对比剂诱导的急性肾损伤（定义为血清肌酐从基线到48小时增加≥25%和/或≥0.5 mg/dl）和/或急性肺水肿的复合物。主要终点发生在UFR引导组的5.7%（n=20/351）和LVEDP引导组的10.3%（n=36/351）（RR=0.56；95%CI：0.39~0.79；P=0.036）。

 

　　意大利那不勒斯Mediterranea心脏中心介入性心脏病实验室主任Carlo Briguori医学博士说：“急性肾损伤可能是一种严重的并发症，因为在侵入性诊断或介入治疗过程中接受了对比剂。水合作用是防止这种并发症的基石。然而，不受控制的水合作用可导致急性肺水肿。REMEDIAL III试验比较两种量身定制的补水方案，以降低高危患者的整体风险。研究发现，UFR指导的水化治疗急性肾损伤和急性肺水肿优于LVEDP指导的水化治疗。使用RenalGuard系统预防一次事件所需的治疗次数为22次。”

 

 

 

 

 

 

　　Carlo Briguori was born in Catanzaro (Italy)， on June 28， 1967. In 1991 he had his bachelor degree in Medicine and Surgery at the “Federico II” University School of Medicine in Naples. In 1995 he had his Board Certification in Cardiology at the “Federico II” University School of Medicine in Naples. In 2000 he had his PhD in Pathophysiology of Cardiovascular System at the University School of Modena (Italy).

 

　　From 1999 to 2002 he was research fellow in Interventional Cardiology， at the Laboratory of Interventional Cardiology in San Raffaele Hospital in Milan， under the guidance of Antonio Colombo. Since 2002 he has been chief of the Laboratory of Interventional Cardiology at the Clinica Mediterranea in Naples， Italy. At present Dr. Briguori his also consultant and co-director of clinical research at the Laboratory of Interventional Cardiology， “Vita e Salute” University， San Raffaele Hospital， Milan (Italy).

 

　　Dr. Briguori is fellow of the Society for Cardiac Angiography and Interventions and member of the Working Group on Interventional Cardiology & Coronary Pathophysiology of the European Society of Cardiology， Italian Society of Cardiology， and Italian Society of Interventional Cardiology. He is referee of some of the most prestigious international journals in the field of cardiovascular disease (New England Journal of Medicine， Annals of Internal Medicine， Lancet， Circulation， Journal of the American College of Cardiology， American Journal of Cardiology， European Heart Journal and Heart).

 

　　Dr. Briguori is author and co-author of more than 200 studies published on some of the most prestigious international journals in the field of cardiovascular disease. The principal fields of interest are 1) contrast agent associated nephrotoxicity， 2) prevention periprocedural complications during coronary angioplasty/stenting; 3) percutaneous revascularization in patients with diabetes mellitus， and 3) therapeutic myocardial angiogenesis.

 

　　About CRF and TCT

 

　　The Cardiovascular Research Foundation (CRF) is one of the world’s leading nonprofit organizations specializing in interventional cardiology innovation， research， and education. CRF is dedicated to helping doctors improve survival and quality of life for people suffering from heart and vascular disease. For nearly 30 years， CRF has helped pioneer medical advances and educated doctors on the latest treatments for heart disease. CRF is comprised of the CRF Skirball Center for Innovation， CRF Clinical Trials Center， CRF Center for Education， CRF Digital， TCTMD， and Structural Heart: The Journal of the Heart Team.Transcatheter Cardiovascular Therapeutics (TCT) is the annual scientific symposium of CRF and the premier educational meeting specializing in interventional cardiovascular medicine. Now in its 31st year， TCT features major medical research breakthroughs and gathers leading researchers and clinicians from around the world to present and discuss the latest evidence-based research in the field. TCT also includes interactive training pavilions where clinicians can gain vital skills to apply immediately to their practices.

 

　　For more information，

　　visit www.crf.org and www.tctconference.com.