Wang Siyang, Yao Huan, Yu Hong, Chen Chan, Zhou Ronghua, Wang Rurong, Yu Hai, Liu Bin
The Department of Anesthesiology, West China Hospital of Sichuan University, Chengdu, PR China.
Medicine (Baltimore). 2017 May;96(19):e6883. doi: 10.1097/MD.0000000000006883.
Acute renal injury (AKI) is a common renal complication after cardiac surgery. The aim of this study was to determine the effect of perioperative statin therapy (PST) on postoperative renal outcome in patients undergoing cardiac procedures.
We searched for the reports that evaluating the effect of PST on renal outcomes after cardiac surgery between March 1983 and June 2016 in the electronic database Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE/PubMed, and EMBASE/OVID.
Nine randomized controlled trials (RCTs) enrolling 2832 patients, with 1419 in the PST group and 1413 in the control group, were included in this meta-analysis. Our results suggested that PST increased the incidence of postoperative renal complication (relative risk [RR] 1.18, 95% confidence interval [CI] 1.01-1.36, P = .03) with low heterogeneity (I = 30%, P = .18). Six studies with 3116 patients detected no significant difference in severe renal complication between PST and control groups (RR 1.23, 95%CI 0.84-1.79, P = .28). Postoperative serum creatinine (sCr) at 48 hours was shown to be higher in the PST group (mean difference [MD] 0.03, 95% CI 0.03-0.03; P < .01). The length of hospital stay was decreased slightly by 0.59 day in the PST group (95% CI -0.85 to -0.33; P < .01).
Perioperative statin therapy seems to jeopardize short-term renal outcome in patients undergoing cardiac surgery, but the occurrence of severe renal complication was not affected.
急性肾损伤（AKI）是心脏手术后常见的肾脏并发症。本研究的目的是确定围手术期他汀类药物治疗（PST）对接受心脏手术患者术后肾脏结局的影响。
我们在电子数据库考克兰系统评价数据库（CENTRAL）、医学期刊数据库（MEDLINE/PubMed）和荷兰医学文摘数据库（EMBASE/OVID）中检索了1983年3月至2016年6月间评估PST对心脏手术后肾脏结局影响的报告。
本荟萃分析纳入了9项随机对照试验（RCT），共2832例患者，其中PST组1419例，对照组1413例。我们的结果表明，PST增加了术后肾脏并发症的发生率（相对危险度[RR]1.18，95%置信区间[CI]1.01 - 1.36，P = 0.03），异质性较低（I = 30%，P = 0.18）。6项涉及3116例患者的研究发现，PST组和对照组在严重肾脏并发症方面无显著差异（RR 1.23，95%CI 0.84 - 1.79，P = 0.28）。PST组术后48小时的血清肌酐（sCr）较高（平均差[MD]0.03，95%CI 0.03 - 0.03；P < 0.01）。PST组的住院时间略有缩短，缩短了0.59天（95%CI - 0.85至 - 0.33；P < 0.01）。
围手术期他汀类药物治疗似乎会危及心脏手术患者的短期肾脏结局，但严重肾脏并发症的发生率未受影响。
