Am J Cardiol:他汀类治疗可降低CABG术后急性肾损伤风险

　　美国学者的一项研究表明，冠脉旁路移植术（CABG）之前启动他汀类治疗可在一定程度上降低术后急性肾损伤（AKI）风险，并且在年轻患者中较为显著。论文于2013年1月2日在线发表于《美国心脏病学杂志》（Am J Cardiol）。

　　此项研究利用医疗保险数据库共纳入17,077例接受非急诊CABG的患者。将受试者分为术前20天内新启动他汀类治疗者以及术前≥200天未应用他汀类药物治疗者，以便将偏倚降至最低。AKI定义为CABG术后15天之内发生。利用泊松回归计算多变量校正危险比（RR）和95%置信区间（95%CI）。利用倾向评分方法进行重复分析，以便对临床和医疗保健应用变量加以校正。

　　结果显示，他汀类新应用者和未应用者的CABG术后AKI发生率分别为3.4%和6.2%。实施校正分析后可观察到他汀类应用对急性肾损伤的保护作用（RR 0.78）。这种保护效应存在年龄差异，≥65岁和＜65岁患者的RR分别为0.91和0.62，但急性肾损伤在老年人群中更为常见。

Effect of Statin Use on Acute Kidney Injury Risk Following Coronary Artery Bypass Grafting

Acute kidney injury (AKI) is a serious complication of cardiovascular surgery. Although some nonexperimental studies suggest that statin use may reduce postsurgical AKI, methodologic differences in study designs leave uncertainty regarding the reality or magnitude of the effect. The aim of this study was to estimate the effect of preoperative statin initiation on AKI after coronary artery bypass grafting (CABG) using an epidemiologic approach more closely simulating a randomized controlled trial in a large CABG patient population. Health care claims from large, employer-based and Medicare insurance databases for 2000 to 2010 were used. To minimize healthy user bias, patients were identified who underwent nonemergent CABG who either newly initiated a statin <20 days before surgery or were unexposed for ≥200 days before CABG. AKI was identified <15 days after CABG. Multivariate-adjusted risk ratios (RRs) and 95% confidence intervals (CIs) were calculated using Poisson regression. Analyses were repeated using propensity score methods adjusted for clinical and health care utilization variables. A total of 17,077 CABG patients were identified. Post-CABG AKI developed in 3.4% of statin initiators and 6.2% of noninitiators. After adjustment, a protective effect of statin initiation on AKI was observed (RR 0.78, 95% CI 0.63 to 0.96). This effect differed by age, with an RR of 0.91 (95% CI 0.68 to 1.20) for patients aged ≥65 years and an RR of 0.62 (95% CI 0.45 to 0.86) for those aged <65 years, although AKI was more common in the older group (7.7% vs 4.0%). In conclusion, statin initiation immediately before CABG may modestly reduce the risk for postoperative AKI, particularly in younger CABG patients.