Klinik fuer Herz- und Gefaeßchirurgie, Deutsches Herzzentrum Muenchen, Technische Universitaet Muenchen, Munich Heart Alliance, Lazarettstrasse 36, 80636 Munich, Germany.
Dis Markers. 2013;35(2):129-34. doi: 10.1155/2013/279046. Epub 2013 Aug 7.
Cardiac surgery-associated acute kidney injury (CSA-AKI) depicts a major complication after cardiac surgery using cardiopulmonary bypass (CPB).
CSA-AKI has clearly been linked to increased perioperative morbidity and mortality. Dysregulations of vasomotor tone are assumed to be causal for CSA-AKI. While catechol-O-methyltransferase (COMT) is involved in metabolizing catecholamines, a single-nucleotide polymorphism (SNP) in the COMT gene leads to different enzyme activities according to genotype. Pilot studies found associations between those COMT genotypes and CSA-AKI.
We prospectively included 1741 patients undergoing elective cardiac surgery using cardiopulmonary bypass (CPB). Patients were genotyped for COMT-Val158Met-(G/A) polymorphism (rs4680).
Demographic characteristics and procedural data revealed no significant differences between genotypes. No association between COMT genotypes and the RIFLE criteria could be detected. A multiple linear regression analysis for postoperative creatinine increase revealed highly significant associations for aortic cross-clamp time (P < 0.001), CPB time (P < 0.001), norepinephrine (P < 0.001), and age (P < 0.001). No associations were found for COMT genotypes or baseline creatinine. With an R (2) = 0.39 and a sample size of 1741, the observed power of the regression analysis was >99%.
Based on our results, we can rule out an association between the COMT-Val158Met-(G/A) polymorphism and the appearance of CSA-AKI.
体外循环心脏手术后的急性肾损伤（CSA-AKI）是心脏手术后的一种主要并发症。
CSA-AKI 明显与围手术期发病率和死亡率的增加有关。血管舒缩功能紊乱被认为是 CSA-AKI 的原因。儿茶酚-O-甲基转移酶（COMT）参与儿茶酚胺的代谢，而 COMT 基因中的单核苷酸多态性（SNP）根据基因型导致不同的酶活性。初步研究发现这些 COMT 基因型与 CSA-AKI 之间存在关联。
我们前瞻性地纳入了 1741 例接受体外循环（CPB）心脏手术的择期患者。对患者进行 COMT-Val158Met-（G/A）多态性（rs4680）的基因分型。
基因型之间的人口统计学特征和程序数据无显著差异。未发现 COMT 基因型与 RIFLE 标准之间存在关联。术后肌酐升高的多元线性回归分析显示，主动脉阻断时间（P < 0.001）、CPB 时间（P < 0.001）、去甲肾上腺素（P < 0.001）和年龄（P < 0.001）与术后肌酐升高有高度显著关联。未发现 COMT 基因型或基线肌酐与术后肌酐升高有任何关联。回归分析的 R（2）= 0.39，样本量为 1741，观察到的回归分析的效能>99%。
根据我们的结果，我们可以排除 COMT-Val158Met-（G/A）多态性与 CSA-AKI 发生之间的关联。
