他汀类药物对老年急性肾损伤患者短期预后的影响  

Efficacy of statin on short-term prognosis in elderly patients with acute kidney injury

作　　者：赵佳慧[1] 温静[1] 刘洋[1] 刘胜[1] 程庆砾[1] 

机构地区：[1]解放军总医院南楼临床部肾脏病科,北京100853

出　　处：《中华医学杂志》2014年第44期3519-3521,共3页National Medical Journal of China

摘　　要：目的：回顾性分析长期服用他汀类药物对老年急性肾损伤（ AKI）患者预后的影响。方法收集2010年6月至2011年12月在解放军总医院住院的老年患者中确诊为AKI的病例资料，分为他汀组（ AKI前服药超过3个月）及非他汀组，分析两组AKI后3个月内病死率、血清肌酐（ Scr ）倍增终点事件的差异。将终点事件与应用他汀类药物、合并症、并发症等因素行logistic回归分析。结果共377例老年AKI患者，Scr达峰时间约为7．8 d，达峰时Scr升高至发生AKI前Scr的2．06倍，约24．7％的患者并发多器官功能障碍综合征（ MODS）。 AKI后3个月内54．6％的患者肾功能完全恢复，他汀组患者（n＝145）肾功能恢复率显著高于非他汀组患者（n＝232）（P＜0．01）。 AKI后3个月内的病死率约为32．1％，两组差异无统计学意义。 AKI发生3个月后，非死亡患者中他汀组患者肌酐倍增的例数显著低于非他汀组（ P＜0．01）。 Logistic回归分析显示老年患者AKI后3个月内的死亡与合并感染、并发MODS显著相关。老年AKI后发生肌酐倍增与诊断AKI时Scr较基线增高的倍数、并发MODS、合并慢性肾脏病显著相关，服用他汀可以显著降低AKI后肌酐倍增的风险（ P＝0．02；OR：0．46；95％CI：0．24～0．9）。结论老年患者发生AKI时合并感染及并发MODS严重增加AKI患者死亡的风险。长期服用他汀不能降低AKI的病死率，但可显著降低肌酐倍增的风险。Objective To evaluate the effects of statins on the short-term prognosis in elderly patients with acute kidney injury （AKI）.Methods The data of hospitalized elderly patients with AKI at our hospital from June 2010 to December 2011 were analyzed retrospectively .The etiology , characteristics , prognosis and relative risk factors were examined .They were divided into statin and non-statin groups according to whether or not statins were taken over 3 months before a diagnosis of AKI .Results For 377 cases of elderly patients with AKI , serum creatinine （ Scr ） tmax was around 7.8 days and 2.06 times of peak increased in the level of Scr to baseline .About 24.7%of those were complicated with multiple organ dysfunction syndrome （ MODS ） .Renal function fully recovered within 3 months after AKI in 206 cases （54.6%） of elderly patients with AKI.The renal function recovery rate of patients in statin group （ n=145） was significantly higher than that of those in non-statin group （n=232） （P〈0.01）.And 121 case （32.1%） died within 3 months after AKI.At the end of 3 months after AKI, the doubling of Scr level in statin group was significantly lower than that in non-statin group （ P〈0.01 ） .Logistic regression analysis showed that risk factors of mortality within 3 months in elders with AKI were significantly associated with infection and concurrent MODS .The doubling of Scr level after AKI in elders was significantly associated with the level of Scr at a diagnosis of AKI , MODS and the history of chronic kidney disease .The risk of doubling in Scr level was significantly reduced in patients of statin group after AKI （ P=0.02, OR：0.46;95%CI：0.24-0.9）.Conclusions The risks of death in elderly patients with AKI are associated with infection and concurrent MODS .Long-term use of statin in elderly patients can significantly reduce the risk of doubling Scr level in surviving patients .

关 键 词：老年 急性肾损伤 他汀 预后 

分 类 号：R692[医药卫生—泌尿科学]