Wiesbauer Franz, Heinze Georg, Mitterbauer Christa, Harnoncourt Franz, Hörl Walter H, Oberbauer Rainer
Department of Cardiology, Medical University of Vienna, Währinger Gürtel 18-20, 1090 Vienna, Austria.
J Am Soc Nephrol. 2008 Nov;19(11):2211-8. doi: 10.1681/ASN.2008010101. Epub 2008 Jul 23.
The efficacy of statins for the prevention of cardiovascular events is well established in the general population but remains unknown in renal transplant recipients. In this study, the association of statin use with patient and graft survival was investigated in a cohort of 2041 first-time recipients of renal allografts between 1990 and 2003. Multivariable Cox regression demonstrated that statin use was independently associated with lower mortality rates. Twelve-year survival rates were 73% for statin users and 64% for nonusers (P = 0.055). The adjusted hazard ratio for all-cause mortality associated with statin use was 0.64 (95% confidence interval 0.48 to 0.86). Graft survival rates during the same time period were 76% for statin users and 70% for nonusers (P = 0.055). The adjusted hazard ratio for graft survival associated with statin use was 0.76 (95% confidence interval 0.55 to 1.04). Results from marginal structural models were virtually identical. In summary, statin use was associated with prolonged patient survival, but no difference in graft survival was detected. Although these results are encouraging, a definitive causal relationship can be determined only from randomized clinical trials.
他汀类药物预防心血管事件的疗效在普通人群中已得到充分证实，但在肾移植受者中仍不清楚。在本研究中，对1990年至2003年间2041例首次接受肾移植的患者队列进行调查，以研究他汀类药物使用与患者及移植物存活之间的关联。多变量Cox回归显示，他汀类药物的使用与较低的死亡率独立相关。他汀类药物使用者的12年生存率为73%，未使用者为64%（P = 0.055）。与他汀类药物使用相关的全因死亡率调整后风险比为0.64（95%置信区间0.48至0.86）。同期移植物存活率他汀类药物使用者为76%，未使用者为70%（P = 0.055）。与他汀类药物使用相关的移植物存活调整后风险比为0.76（95%置信区间0.55至1.04）。边际结构模型的结果基本相同。总之，他汀类药物的使用与患者生存期延长相关，但未检测到移植物存活的差异。尽管这些结果令人鼓舞，但只有通过随机临床试验才能确定明确的因果关系。
