БИОМАРКЕРЫ ОСТРОГО ПОСТКОНТРАСТНОГО ПОВРЕЖДЕНИЯ ПОЧЕК У ПАЦИЕНТОВ, ПЕРЕНЕСШИХ ЧРЕСКОЖНЫЕ КОРОНАРНЫЕ ВМЕШАТЕЛЬСТВА

Высокая распространенность ишемической болезни сердца требует увеличения интервенционных вмешательств с использованием рентгеноконтрастных веществ (РКВ). Одним из возможных последствий является развитие острого повреждения почек (ОПП). Ранее формирование ОПП после процедуры с введением контраста всегда расценивалось как контраст-индуцированное. Учитывая сложность патогенеза ОПП, в настоящее время рекомендуется использовать более всеобъемлющий термин «постконтрастное ОПП» (ПК-ОПП). Основным критерием диагностики считается увеличение концентрации сывороточного креатинина не менее чем на 0,3 мг/дл (26,5 мкмоль/л) или не менее чем в 1,5–1,9 раза от исходного уровня в течение 48–72 ч после процедуры. ПК-ОПП является частым осложнением после внутрисосудистого введения йодсодержащих контрастных веществ и ассоциировано с увеличением длительности пребывания в стационаре и неблагоприятным отдаленным прогнозом, включая нежелательные сердечно-сосудистые события, а также трансформацию в хроническую болезнь почек. ПК-ОПП развивается у 5–20 % госпитализированных пациентов, подвергшихся чрескожным коронарным вмешательствам. Аналоги йодсодержащих РКВ пока не разработаны, поэтому полностью избежать ПК-ОПП не представляется возможным. Основной диагностический критерий не является биомаркером по сути, а отражает тяжесть уже состоявшегося повреждения. В связи с этим актуальным остается вопрос о поиске таких биомаркеров, которые способствовали бы не только ранней диагностике, но и профилактике данного осложнения. В настоящее время идентифицированы новые и более ранние сывороточные и мочевые биомаркеры для диагностики повреждения почек, которые могут быть выявлены до момента повышения уровня креатинина в сыворотке крови. В обзоре представлена информация о наиболее актуальных биомаркерах ПК-ОПП.

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