围手术期他汀治疗对心脏手术后发生急性肾损伤影响的meta分析

李奇; 杨英; 杨简; 范致星; 杨超君; 杨俊

doi:10.13201/j.issn.1001-1439.2018.09.019

围手术期他汀治疗对心脏手术后发生急性肾损伤影响的meta分析

- 1 三峡大学心血管病研究所三峡大学第一临床医学院心内科(湖北宜昌, 443003);
- 2 三峡大学循证与转化医学研究所
基金项目:
国家自然科学基金 (No:81170133, 81670333)

湖北省科技支撑计划 (No:2015BKA340)

详细信息

通讯作者: 杨俊,E-mail:yangjun@ctgu.edu.cn

中图分类号: R654.3

收稿日期: 2018-06-05

Effect of perioperative statin therapy on acute kidney injury after cardiac surgery:a meta-analysis

- 1 Department of Cardiology, the First Affiliated Hospital of Three Gorges University, Yichang, Hubei, 443003, China;
- 2 Institute of Evidence-Based and Translational Medicine, China Three Gorges University

More Information

Corresponding author: YANG Jun, E-mail: yangjun@ctgu.edu.cn

Received Date: 05 June 2018

摘要

摘要: 目的:系统评价围手术期他汀治疗 (PST) 对心脏手术后急性肾损伤 (AKI) 发生的影响。方法:通过计算机检索PubMed、EMbase、Cochrane library、万方、中国知网等数据库, 选取2003-01-01-2018-04-01有关围手术期服用他汀类药物影响心脏手术患者术后AKI发生的随机对照试验 (RCTs), 获得相关数据后应用RevMan5.3软件进行meta分析。结果:最终纳入8项RCTs共包括3 278例患者。Meta分析结果显示, 与对照组相比, 他汀组患者术后AKI的发生率显著增加 (RR=1.17, 95%CI:1.02~1.34;P=0.03);同样, 他汀组患者术后48h内血肌酐值增加亦明显高于对照组 (MD=2.53, 95%CI:0.09~4.98;P=0.04);而2组患者在术后肾脏替代治疗的需要率方面差异无统计学意义 (RR=1.13, 95%CI:0.43~2.85;P=0.80);2组在术后病死率方面亦无显著差异 (RR=3.66, 95%CI:1.03~13.08;P=0.05)。结论:PST可能与心脏手术后AKI发生率的增加以及短期内SCr的升高有关, 且不能改善心脏手术患者的生存率。本meta分析受纳入RCTs数量的限制, 尚需收集更多高质量的RCTs加以证实。
- 他汀类药物 /
- 心脏手术 /
- 急性肾损伤 /
- Meta分析
Abstract: Objective: The aim of this study was to determine the effect of perioperative statin therapy (PST) on acute kidney injury (AKI) in patients undergoing cardiac procedures.Method: PubMed, EMbase, the Cochrane library, Wanfang databases and CNKI databases were searched up from January 2003 to April 2018 for randomized controlled trials (RCTs) that assessed the effects of perioperative statin therapy (PST) on AKI after cardiac surgery and then the result of meta-analysis was performed by applying the soft of RevMan 5.3.Result: We included Eight RCTs with a total of 3278 participants in this meta-analysis.The results suggested that PST increased the incidence of AKI compared with placebo (RR=1.17, 95%CI:1.02-1.34;P=0.03).Postoperative serum creatinine (SCr) at 48 hours was higher in the PST group (MD=2.53, 95%CI:0.09-4.98;P=0.04).In addition, there was no significant difference in postoperative need for renal replacement therapy (RRT) (RR=1.13, 95%CI:0.43-2.85;P=0.80) and mortality (RR=3.66, 95%CI:1.03-13.08;P=0.05) between PST group and control group.Conclusion: Meta-analysis suggests that PST seems to be associated with an increase in AKI and SCr at short-term, while it has no effect on postoperative mortality.However, due to limited by the quantity of RCTs included, more high-quality RCTs should be conducted.
- statins /
- cardiac surgery /
- acute kidney injury /
- meta-analysis

HTML全文

参考文献(27)

[1]	Thiele RH, Isbell JM, Rosner MH.AKI associated with cardiac surgery[J].Clin J Am Soc Nephrol, 2015, 10 (3):500-514.
[2]	Parida S, Badhe AS.Cardiac surgery-associated acute kidney injury[J].J Anesth, 2013, 27 (3):433-446.
[3]	Birnie K, Verheyden V, Pagano D, et al.Predictive models for kidney disease:improving global outcomes (KDIGO) defined acute kidney injury in UK cardiac surgery[J].Crit Care, 2014, 18 (6):606.
[4]	Bastin AJ, Ostermann M, Slack AJ, et al.Acute kidney injury after cardiac surgery according to Risk/Injury/Failure/Loss/End-stage, Acute Kidney Injury Network, and Kidney Disease:Improving Global Outcomes classifications[J].J Crit Care, 2013, 28 (4):389-396.
[5]	廖玉华, 杨勇.炎症与动脉粥样硬化的新探索[J].临床心血管病杂志, 2014, 30 (6):461-463.
[6]	Smith LE, Smith DK, Blume JD, et al.High-Density Lipoprotein Cholesterol Concentration and Acute Kidney Injury After Cardiac Surgery[J].J Am Heart Assoc, 2017, 6 (12):e006975.
[7]	Thiele RH, Isbell JM, Rosner MH.AKI associated with cardiac surgery[J].Clin J Am Soc Nephrol, 2015, 10 (3):500-514.
[8]	Hillis LD, Smith PK, Anderson JL, et al.2011ACCF/AHA Guideline for Coronary Artery Bypass Graft Surgery:a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines[J].Circulation, 2011, 124 (23):e652-e735.
[9]	Windecker S, Kolh P, Alfonso F, et al.2014 ESC/EACTS Guidelines on myocardial revascularization[J].Kardiol Pol, 2014, 72 (12):1253-1379.
[10]	Wang J, Gu C, Gao M, et al.Preoperative Statin Therapy and Renal Outcomes After Cardiac Surgery:A Meta-analysis and Meta-regression of 59, 771 Patients[J].Can J Cardiol, 2015, 31 (8):1051-1060.
[11]	Layton JB, Hansen MK, Jakobsen CJ, et al.Statin initiation and acute kidney injury following elective cardiovascular surgery:apopulation cohort study in Denmarkdagger[J].Eur J Cardiothorac Surg, 2016, 49 (3):995-1000.
[12]	Prowle JR, Calzavacca P, Licari E et al.Pilot doubleblind, randomized controlled trial of short-term atorvastatin for prevention of acute kidney injury after cardiac surgery[J].Nephrology (Carlton), 2012, 17 (3):215-224.
[13]	Billings FT, Hendricks PA, Schildcrout JS, et al.HighDose Perioperative Atorvastatin and Acute Kidney Injury Following Cardiac Surgery:A Randomized Clinical Trial[J].JAMA, 2016, 315 (9):877-888.
[14]	Zheng Z, Jayaram R, Jiang L, et al.Perioperative Rosuvastatin in Cardiac Surgery[J].N Engl J Med, 2016, 374 (18):1744-1753.
[15]	Putzu A, Capelli B, Belletti A, et al.Perioperative statin therapy in cardiac surgery:a meta-analysis of randomized controlled trials[J].Crit Care, 2016, 20 (1):395.
[16]	Mehta RL, Kellum JA, Shah SV, et al.Acute Kidney Injury Network:report of an initiative to improve outcomes in acute kidney injury[J].Crit Care, 2007, 11 (2):R31.
[17]	Bellomo R, Ronco C, Kellum JA, et al.Acute renal failure-definition, outcome measures, animal models, fluid therapy and information technology needs:the Second International Consensus Conference of the Acute Dialysis Quality Initiative (ADQI) Group[J].Crit Care, 2004, 8 (4):R204-R212.
[18]	Chello M, Patti G, Candura D, et al.Effects of atorvastatin on systemic inflammatory response after coronary bypass surgery[J].Crit Care Med, 2006, 34 (3):660-667.
[19]	Mannacio VA, Iorio D, De Amicis V, et al.Effect of rosuvastatin pretreatment on myocardial damage after coronary surgery:a randomized trial[J].J Thorac Cardiovasc Surg, 2008, 136 (6):1541-1548.
[20]	Park JH, Shim J, Song J, et al.Effect of atorvastatin on the incidence of acute kidney injury following valvular heart surgery:a randomized, placebo-controlled trial[J].Intensive Care Medicine, 2016, 42 (9):1398-1407.
[21]	Tamayo E, Alvarez FJ, Alonso O, et al.Effects of simvastatin on systemic inflammatory responses after cardiopulmonary bypass[J].J Cardiovasc Surg (Torino), 2009, 50 (5):687-694.
[22]	Spadaccio C, Pollari F, Casacalenda A, et al.Atorvastatin increases the number of endothelial progenitor cells after cardiac surgery:a randomized control study[J].J Cardiovasc Pharmacol, 2010, 55 (1):30-38.
[23]	Bellomo R.Perioperative Statins in Cardiac Surgery and Acute Kidney Injury[J].JAMA, 2016, 315 (9):873-874.
[24]	Golomb BA, Evans MA.Statin adverse effects:a review of the literature and evidence for a mitochondrial mechanism[J].Am J Cardiovasc Drugs, 2008, 8 (6):373-418.
[25]	Lee E, Ryan S, Birmingham B, et al.Rosuvastatin pharmacokinetics and pharmacogenetics in white and Asian subjects residing in the same environment[J].Clin Pharmacol Ther, 2005, 78 (4):330-341.
[26]	Tsai NW, Lee LH, Huang CR, et al.Statin therapy reduces oxidized low density lipoprotein level, a risk factor for stroke outcome[J].Crit Care, 2014, 18 (1):R16.
[27]	An J, Shi F, Liu S, et al.Preoperative statins as modifiers of cardiac and inflammatory outcomes following coronary artery bypass graft surgery:a meta-analysis[J].Interact Cardiovasc Thorac Surg, 2017, 25 (6):958-965.