Kassimatis Theodoros I, Goldsmith David J A
Nephrology Department, Asklepieion General Hospital, Athens, Greece.
King's Health Partners AHSC, Guy's Hospital Campus, London SE1 9RT, UK.
Pharmacol Res. 2014 Oct;88:62-73. doi: 10.1016/j.phrs.2014.06.011. Epub 2014 Jul 1.
HMG-CoA reductase inhibitors (statins) have been shown to improve cardiovascular (CV) outcomes in the general population as well as in patients with cardiovascular disease (CVD). Statins' beneficial effects have been attributed to both cholesterol-lowering and cholesterol-independent "pleiotropic" properties. By their pleiotropic effects statins have been shown to reduce inflammation, alleviate oxidative stress, modify the immunologic responses, improve endothelial function and suppress platelet aggregation. Patients with chronic kidney disease (CKD) exhibit an enormous increase in CVD rates even from early CKD stages. As considerable differences exist in dyslipidemia characteristics and the pathogenesis of CVD in CKD, statins' CV benefits in CKD patients (including those with a kidney graft) should not be considered unequivocal. Indeed, accumulating clinical evidence suggests that statins exert diverse effects on dialysis and non-dialysis CKD patients. Therefore, it seems that statins improve CV outcomes in non-dialysis patients whereas exert little (if any) benefit in the dialysis population. It has also been proposed that dyslipidemia might play a causative role or even accelerate renal injury. Moreover, ample experimental evidence suggests that statins ameliorate renal damage. However, a high quality randomized controlled trial (RCT) and metaanalyses do not support a beneficial role of statins in renal outcomes in terms of proteinuria reduction or retardation of glomerular filtration rate (GFR) decline.
羟甲基戊二酸单酰辅酶A还原酶抑制剂（他汀类药物）已被证明可改善普通人群以及心血管疾病（CVD）患者的心血管（CV）结局。他汀类药物的有益作用归因于降低胆固醇和非胆固醇依赖性的“多效性”特性。通过其多效性作用，他汀类药物已被证明可减轻炎症、缓解氧化应激、改变免疫反应、改善内皮功能并抑制血小板聚集。慢性肾脏病（CKD）患者即使在CKD早期阶段，CVD发生率也会大幅增加。由于CKD患者的血脂异常特征和CVD发病机制存在相当大的差异，他汀类药物对CKD患者（包括肾移植患者）的心血管益处不应被视为明确无疑。事实上，越来越多的临床证据表明，他汀类药物对透析和非透析CKD患者有不同的影响。因此，他汀类药物似乎可改善非透析患者的心血管结局，而对透析人群几乎没有（如果有的话）益处。也有人提出，血脂异常可能起致病作用，甚至加速肾损伤。此外，大量实验证据表明他汀类药物可改善肾损伤。然而，一项高质量的随机对照试验（RCT）和荟萃分析并不支持他汀类药物在降低蛋白尿或延缓肾小球滤过率（GFR）下降方面对肾脏结局有有益作用。
