| In recent years, with the development of medicine, the contrast medium (contrast media, CM) is widely used to assist diagnosis and treatment of diseases in clinical, it plays a pivotal role. However, the issue that contrast can impacts nephropathy also will be prominent, the contrast medium can cause acute renal failure by poisoning, only second to antibiotics, ranking No.2, contrast induced nephropathy (CIN) has become the third largest cause of acute renal failure which occours in the hospital.in view of the above, During the 20th Great Wall International Cardiology Conference, the expert team which is led by the Professor Hu Dayi issued the "the experts consensus of contrast nephropathy",they are in the fields of Cardiology, Nephrology and so on. It proposed:(1) hierarchical; (2) hydration; (3) Limited; (4) isotonic four principles to prevent contrast induced nephropathy. Once the CIN happends, in addition to the hydration therapy,,the.effective treatmen is lack,Therefore, how to prevent CIN is an important issue currently which the cardiology intervention need to solve.contrast induced nephropathy (CIN) is the of acute renal dysfunction only because of the application of contrast agent, The diagnostic criteria which CIN is commonly used are as follows:before the use of the contrast agent,Scr <1.5mg/dl,48 hours later, elevated levels of Scr> 25%; or before the application of contrast agent, Scr> 1.5mg/dl, after the application of contrast agent,48 hours later Scr levels> lmg/dl, the two conditins can be diagnosed as CIN.. CIN medullary pathology showed vacuolar degeneration of renal tubular epithelial cells, some can cause apoptosis, or necrosis, loss to the tubular lumen, tubular collapse, we can see tubular compensatory expansion,it is visible that varying degrees of interstitial inflammation cell infiltration; under the electron microscope, the results changes in renal tubular epithelial cells in AMD, such as nuclear condensation and fragmentation, mitochondrial swelling, calcification within the cytoplasm and cell damage, p pathological changes in the outer medulla are articularly severe. In the pathogenesis of CIN, the incidence of renal medullary ischemia is a key factor. Which is mainly due to ET, NO, adenosine and other mediators involved in blood vessel expansion and contraction and the breaking of this balance, results in the blood flowing to the cortex, the direct and indirect effects of Contrast media on renal tubular toxicity, the damage of oxygen free radical, apoptosis, immune factors and the occurrence of renal tubular obstruction are all play an important role in CIN Physical and chemical properties of contrast agents themselves, including osmotic pressure, viscosity and direct toxic effects of molecules, also play an important role in the occurance and development of the contrast agent nephropathy [16]。In hypertension, atherosclerosis and other groups, due to the common pathological changes that the endothelial cell dysfunction, they are more sensitive in the response of the contrast agent, more easier to cause CIN.There are clinical studies using antioxidants to combat CIN, but there are different views about the results.Oral cysteine, vitamin E, antioxidant drugs statin therapy to prevent CIN in clinical practice in the country been widely studied, and some research results have confirmed the antioxidant protection of renal tubular function of endothelial cells, from oxidative to shock damage. However, the results of the study of antioxidants are not uniform, therefore, these antioxidants will not independently to prevent CIN.Probucol is the antagonists of Reaetive oxygen speeies, low-dose dopamine can expand the renal artery and improve renal ischemia, we can infer that probucol combined with low dose dopamine can more effectively inhibit the contrast agent on renal function injury. By the joint detection of serum creatinine,and the electron microscopy ultrastructure of renal unit test the expected results, it can prove that renal ischemia and oxygen free radicals play a role in the contrast agents in renal injury It provides a clinical support of actively control the feasibility of contrast inducednephropathy.In addition, whether the contrast agent cause acute damage on the liver cells and myocardial cells, currently lacks a rational system, this preliminary study involved in this study, in the application of contrast agent,48 hours later,we can observe the pathology of the liver and heart.In summary, we believe that laboratory experiments with animals in this experiment and the necessary test equipment, this study fully possible.Methods:1.subjects:Select 2 months of age, body weight of 2 kg, homogeneous rabbits with normal renal function 25.2.experimental animals were randomly divided into 5 groups of grouping:group A:5 rabbits, Determination of blood creatinine, Then, the intraperitoneal injection of iopromide (Ultravist 370), volume 5ml/kg,48 hours after the re-venous serum creatinine, make the rabbits death suddenly, Separate the kidney, liver and heart, making biopsy, under the microscope, we can observe Renal units liver cells, cardiac cells and tissues structure.group B:5, determination of blood creatinine,. Intraperitoneal injection of iopromide (Ultravist 370), volume 5ml/kg, while low-dose continuous intravenous dopamine, volume 2.3ug/kg.min (according to the human and rabbit dose conversion formula obtained), again after 48 hours venous serum creatinine, make the rabbits death suddenly, Separate the kidney, liver and heart. making biopsy, under the microscope, we can observe Renal units liver cells, cardiac cells and tissues structure.Group C:5, determination of blood creatinine, method used daily to the rabbits fed antioxidant probucol (the music), volume 0.02g/kg (in accordance with the human and rabbit dose conversion formula obtained), consecutive administration for 20 days; intraperitoneal injection of iopromide (Ultravist 370), volume 5ml/kg; 48 hours after the re-venous serum creatinine,make the rabbits death suddenly, Separate the kidney, liver and heart, making biopsy, making biopsy, under the microscope, we can observe Renal units liver cells, cardiac cells and tissues structure. Group D:5, determination of blood creatinine; method used daily to the rabbits fed antioxidant probucol (the music), volume 0.02g/kg (according to the human and rabbit dose conversion formula obtained), consecutive administration for 20 days; intraperitoneal injection of iopromide (Ultravist 370), volume 5ml/kg, while low-dose continuous intravenous dopamine, volume 2.3ug/kg.min (according to the human and the rabbit dose conversion formula obtained); 48 hours after the re-venous serum creatinine; make the rabbits death suddenly, Separate the kidney, liver and heart, making biopsy, under the microscope, we can observe Renal units liver cells, cardiac cells and tissues structure.Group E:5, blank control group, the determination of blood creatinine, make the rabbits death suddenly, Separate the kidney, liver and heart, making biopsy, under the microscope, we can observe Renal units liver cells, cardiac cells and tissues structure。3.Statistical analysis:The statistical software SPSS 13.0 measurement data using (x±s) that mean comparison between groups by analysis of variance, before and after contrast medium was used to compare indices t test, P<0.05 indicates the difference statistically significant.The results:Through this study, we draw the following conclusions:In the pathogenesis of CIN, renal medullary ischemia is an important factor, low-dose dopamine can improve renal medullary ischemia through the expansion of renal artery,thereby it can improve the contrast agent nephropathy; oxidative stress in the CIN also play a role,so,the anti-oxidant probucol improves contrast induced nephropathy; low-dose dopamine can improve renal ischemia, Probucol is the antagonists of Reaetive oxygen speeies, the combination will be better for CIN. Contrast agent can not cause acute injury on the liver cells and myocardial cells. |
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