Magyar Attila, Wagner Martin, Thomas Phillip, Malsch Carolin, Schneider Reinhard, Störk Stefan, Heuschmann Peter U, Leyh Rainer G, Oezkur Mehmet
Department of Cardiovascular Surgery, University Hospital Würzburg, Würzburg, Germany,
Institute of Clinical Epidemiology and Biometry, University of Würzburg, Würzburg, Germany,
Int J Nephrol Renovasc Dis. 2019 Jan 23;12:9-18. doi: 10.2147/IJNRD.S165308. eCollection 2019.
Acute kidney injury (AKI) is a serious complication after cardiac surgery that is associated with increased mortality and morbidity. Heme oxygenase-1 (HO-1) is an enzyme synthesized in renal tubular cells as one of the most intense responses to oxidant stress linked with protective, anti-inflammatory properties. Yet, it is unknown if serum HO-1 induction following cardiac surgical procedure involving cardiopulmonary bypass (CPB) is associated with incidence and severity of AKI.
In the present study, we used data from a prospective cohort study of 150 adult cardiac surgical patients. HO-1 measurements were performed before, immediately after and 24 hours post-CPB. In univariate and multivariate analyses, the association between HO-1 and AKI was investigated.
AKI with an incidence of 23.3% (35 patients) was not associated with an early elevation of HO-1 after CPB in all patients (=0.88), whereas patients suffering from AKI developed a second burst of HO-1 24 hours after CBP. In patients without AKI, the HO-1 concentrations dropped to baseline values (=0.031). Furthermore, early HO-1 induction was associated with CPB time (=0.046), while the ones 24 hours later lost this association (=0.219).
The association of the second HO-1 burst 24 hours after CBP might help to distinguish between the causality of AKI in patients undergoing CBP, thus helping to adapt patient stratification and management.
急性肾损伤（AKI）是心脏手术后的一种严重并发症，与死亡率和发病率的增加相关。血红素加氧酶-1（HO-1）是一种在肾小管细胞中合成的酶，是对与保护、抗炎特性相关的氧化应激最强烈的反应之一。然而，在涉及体外循环（CPB）的心脏手术过程中，血清HO-1诱导是否与AKI的发生率和严重程度相关尚不清楚。
在本研究中，我们使用了一项对150名成年心脏手术患者的前瞻性队列研究的数据。在CPB前、CPB后即刻和CPB后24小时进行HO-1测量。在单变量和多变量分析中，研究了HO-1与AKI之间的关联。
在所有患者中，AKI的发生率为23.3%（35例患者），与CPB后HO-1的早期升高无关（P = 0.88），而患有AKI的患者在CPB后24小时出现了第二次HO-1激增。在没有AKI的患者中，HO-1浓度降至基线值（P = 0.031）。此外，早期HO-1诱导与CPB时间相关（P = 0.046），而24小时后的诱导则失去了这种关联（P = 0.219）。
CPB后24小时第二次HO-1激增的关联可能有助于区分接受CPB患者中AKI的因果关系，从而有助于调整患者分层和管理。
