Golestaneh Ladan, Lindsey Kathryn, Malhotra Pooja, Kargoli Faraj, Farkas Emily, Barner Hendrick, Qazi Rizwan, Schmidt Anna, Rauchman Michael, Al-Aly Ziyad, Johnson Robert, Martin Kevin, Dagher Pierre, Friedman Allon, El-Achkar Tarek M
Montefiore Medical Center, Albert Einstein Medical Center, 3411 Wayne Ave, Suite 5H, Bronx, NY, 10467, USA,
J Nephrol. 2015 Apr;28(2):193-9. doi: 10.1007/s40620-014-0152-2. Epub 2014 Oct 28.
Acute kidney injury (AKI) after cardiac bypass surgery (CABG) is common and carries a significant association with morbidity and mortality. Since minocycline therapy attenuates kidney injury in animal models of AKI, we tested its effects in patients undergoing CABG.
DESIGN, SETTING, PARTICIPANTS AND MEASUREMENTS: This is a randomized, double-blinded, placebo-controlled, multi-center study. We screened high risk patients who were scheduled to undergo CABG in two medical centers between Jan 2008 and June 2011. 40 patients were randomized and 19 patients in each group completed the study. Minocycline prophylaxis was given twice daily, at least for four doses prior to CABG. Primary outcome was defined as AKI [0.3 mg/dl increase in creatinine (Cr)] within 5 days after surgery. Daily serum Cr for 5 days, various clinical and hemodynamic measures and length of stay were recorded.
The two groups had similar baseline and intra-operative characteristics. The primary outcome occurred in 52.6% of patients in the minocycline group as compared to 36.8% of patients in the placebo group (p = 0.51). Peak Cr was 1.6 ± 0.7 vs. 1.5 ± 0.7 mg/dl (p = 0.45) in minocycline and placebo groups, respectively. Death at 30 days occurred in 0 vs. 10.5% in the minocycline and placebo groups, respectively (p = 0.48). There were no differences in post-operative length of stay, and cardiovascular events between the two groups. There was a trend towards lower diastolic pulmonary artery pressure [16.8 ± 4.7 vs. 20.7 ± 6.6 mmHg (p = 0.059)] and central venous pressure [11.8 ± 4.3 vs. 14.6 ± 5.6 mmHg (p = 0.13)] in the minocycline group compared to placebo on the first day after surgery.
Minocycline did not protect against AKI post-CABG.
心脏搭桥手术（CABG）后急性肾损伤（AKI）很常见，且与发病率和死亡率显著相关。由于米诺环素治疗可减轻急性肾损伤动物模型中的肾损伤，我们测试了其在接受心脏搭桥手术患者中的效果。
设计、地点、参与者与测量：这是一项随机、双盲、安慰剂对照、多中心研究。我们筛查了2008年1月至2011年6月期间计划在两个医疗中心接受心脏搭桥手术的高危患者。40例患者被随机分组，每组19例患者完成研究。米诺环素预防性用药每天两次，至少在心脏搭桥手术前给药四剂。主要结局定义为术后5天内发生急性肾损伤（肌酐（Cr）升高0.3mg/dl）。记录术后5天的每日血清肌酐、各种临床和血流动力学指标以及住院时间。
两组患者的基线和术中特征相似。米诺环素组52.6%的患者出现主要结局，而安慰剂组为36.8%（p = 0.51）。米诺环素组和安慰剂组的肌酐峰值分别为1.6±0.7 vs. 1.5±0.7mg/dl（p = 0.45）。米诺环素组和安慰剂组30天死亡率分别为0%和10.5%（p = 0.48）。两组患者术后住院时间和心血管事件无差异。与安慰剂组相比，米诺环素组术后第一天的舒张压肺动脉压[16.8±4.7 vs. 20.7±6.6mmHg（p = 0.059）]和中心静脉压[11.8±4.3 vs. 14.6±5.6mmHg（p = 0.13）]有降低趋势。
米诺环素不能预防心脏搭桥手术后的急性肾损伤。
