围手术期他汀治疗对心脏手术后发生急性肾损伤影响的meta分析  

Effect of perioperative statin therapy on acute kidney injury after cardiac surgery:a meta-analysis

作　　者：李奇 杨英 杨简 范致星[1] 杨超君 杨俊[1,2] LI Qi;YANG ging;YANG Jian;FAN Zhixing;YANG Chaojun;YANG Jun(Department of Cardiology,the First Affiliated Hospital of Three Gorges University,Yichang,Hubei,443003,China;Institute of Evidence-Based and Translational Medicine,China Three Gorges University)

机构地区：[1]三峡大学心血管病研究所三峡大学第一临床医学院心内科,湖北宜昌443003 [2]三峡大学循证与转化医学研究所

出　　处：《临床心血管病杂志》2018年第9期922-927,共6页Journal of Clinical Cardiology

基　　金：国家自然科学基金(No:81170133;81670333);湖北省科技支撑计划(No:2015BKA340)

摘　　要：目的:系统评价围手术期他汀治疗(PST)对心脏手术后急性肾损伤(AKI)发生的影响。方法:通过计算机检索PubMed、EMbase、Cochrane library、万方、中国知网等数据库,选取2003-01-01-2018-04-01有关围手术期服用他汀类药物影响心脏手术患者术后AKI发生的随机对照试验(RCTs),获得相关数据后应用RevMan5.3软件进行meta分析。结果:最终纳入8项RCTs共包括3 278例患者。Meta分析结果显示,与对照组相比,他汀组患者术后AKI的发生率显著增加(RR=1.17,95%CI:1.02~1.34;P=0.03);同样,他汀组患者术后48h内血肌酐值增加亦明显高于对照组(MD=2.53,95%CI:0.09~4.98;P=0.04);而2组患者在术后肾脏替代治疗的需要率方面差异无统计学意义(RR=1.13,95%CI:0.43~2.85;P=0.80);2组在术后病死率方面亦无显著差异(RR=3.66,95%CI:1.03~13.08;P=0.05)。结论:PST可能与心脏手术后AKI发生率的增加以及短期内SCr的升高有关,且不能改善心脏手术患者的生存率。本meta分析受纳入RCTs数量的限制,尚需收集更多高质量的RCTs加以证实。Objective：The aim of this study was to determine the effect of perioperative statin therapy（PST）on acute kidney injury（AKI）in patients undergoing cardiac procedures.Method：PubMed,EMbase,the Cochrane library,Wanfang databases and CNKI databases were searched up from January 2003 to April 2018 for randomized controlled trials（RCTs）that assessed the effects of perioperative statin therapy（PST）on AKI after cardiac surgery and then the result of meta-analysis was performed by applying the soft of RevMan 5.3.Result：We included Eight RCTs with a total of 3278 participants in this meta-analysis.The results suggested that PST increased the incidence of AKI compared with placebo（RR=1.17,95%CI：1.02-1.34;P=0.03）.Postoperative serum creatinine（SCr）at 48 hours was higher in the PST group（MD=2.53,95%CI：0.09-4.98;P=0.04）.In addition,there was no significant difference in postoperative need for renal replacement therapy（RRT）（RR=1.13,95%CI：0.43-2.85;P=0.80）and mortality（RR=3.66,95%CI：1.03-13.08;P=0.05）between PST group and control group.Conclusion：Meta-analysis suggests that PST seems to be associated with an increase in AKI and SCr at short-term,while it has no effect on postoperative mortality.However,due to limited by the quantity of RCTs included,more high-quality RCTs should be conducted.

关 键 词：他汀类药物 心脏手术 急性肾损伤 META分析 

分 类 号：R654.3[医药卫生—外科学]