Singh Inderjeet, Rajagopalan Sujit, Srinivasan Anand, Achuthan Shyambalaji, Dhamija Puneet, Hota Debasish, Chakrabarti Amitava
Department of Pharmacology, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
Interact Cardiovasc Thorac Surg. 2013 Aug;17(2):345-52. doi: 10.1093/icvts/ivt178. Epub 2013 Apr 28.
Acute kidney injury (AKI) following cardiac surgery is a common complication associated with serious morbidity and mortality. Activation of inflammatory cascade and vascular endothelial dysfunction plays a vital role during the perioperative period leading to AKI. Statins are known to suppress inflammation and improve endothelial dysfunction over and above the cholesterol lowering efficacy.
Observational studies with a defined population in terms of preoperative statin therapy and no preoperative statin therapy undergoing cardiac surgery (CABG, isolated valve surgery or both) and with reported data on the incidence of acute renal failure/injury and/or mortality were identified and analysed for inclusion in the analysis. Outcomes evaluated were occurrence of postoperative acute kidney injury/failure, requirement of any postoperative renal replacement therapy and short-term all-cause mortality rate. A meta-analysis was conducted and a pooled estimate of odds ratio (OR) was calculated using the inverse variance method.
A total of 17 studies with a total population of 24 998 statin users and 22 082 non-statin users were included in the final analysis. PST resulted in a significantly lower incidence of renal replacement therapy in patients undergoing CABG (OR: 0.56 [0.41-0.76]) but not in isolated valve surgery (OR: 1.80 [0.73-4.44]). Also preoperative statin therapy resulted in a significantly lower postoperative mortality (0.72 [0.61-0.84]) irrespective of the type of surgery. There was no effect of preoperative statin therapy on the incidence of AKI in any of the sub-group of the patients.
Patients undergoing CABG might derive benefit from preoperative statin therapy in terms of reducing the need for postoperative renal replacement therapy and mortality. However, the uncertainty concerning the reno-protective efficacy of preoperative statin therapy in patients undergoing isolated valve surgery needs further investigation.
心脏手术后急性肾损伤（AKI）是一种常见并发症，与严重的发病率和死亡率相关。炎症级联反应的激活和血管内皮功能障碍在导致AKI的围手术期起着至关重要的作用。已知他汀类药物除了具有降低胆固醇的功效外，还能抑制炎症并改善内皮功能障碍。
确定并分析了在术前接受他汀类药物治疗和未接受术前他汀类药物治疗的情况下进行心脏手术（冠状动脉旁路移植术、单纯瓣膜手术或两者皆有）的特定人群的观察性研究，并报告了急性肾衰竭/损伤发生率和/或死亡率的数据，以纳入分析。评估的结果包括术后急性肾损伤/衰竭的发生情况、任何术后肾脏替代治疗的需求以及短期全因死亡率。进行了荟萃分析，并使用逆方差法计算了优势比（OR）的合并估计值。
最终分析纳入了总共17项研究，其中他汀类药物使用者总数为24998人，非他汀类药物使用者总数为22082人。术前他汀类药物治疗使接受冠状动脉旁路移植术的患者肾脏替代治疗的发生率显著降低（OR：0.56 [0.41 - 0.76]），但在单纯瓣膜手术中未降低（OR：1.80 [0.73 - 4.44]）。此外，无论手术类型如何，术前他汀类药物治疗均使术后死亡率显著降低（0.72 [0.61 - 0.84]）。术前他汀类药物治疗对任何亚组患者的AKI发生率均无影响。
接受冠状动脉旁路移植术的患者可能从术前他汀类药物治疗中获益，可减少术后肾脏替代治疗的需求和死亡率。然而，术前他汀类药物治疗对接受单纯瓣膜手术患者的肾脏保护疗效的不确定性需要进一步研究。
