辛伐他汀对黄疸患者肾功能的保护作用

The protective effects of simvastatin on renal function in patients with jaundice

目的：探讨使用辛伐他汀对梗阻性黄疸患者术后的肾功能保护作用。方法：在2011年1月到2012年12月间，选择106例因梗阻性黄疸需要手术的患者进行前瞻性试验。根据患者是否使用过辛伐他汀（〉3个月）将患者分为试验组与对照组。分别在术前，术后，术后3个月与6个月检测血清肌酐（SCr）、肌酐清除率（C疋1）。结果：接受手术的梗阻性黄疸患者无论有无使用辛伐他汀均未出现肾功能下降。没有使用辛伐他汀的患者在术后早期出现肾功能恶化现象（SCr术前VS术后：（91．06±17．68）gmol·L^-1vs（99．90±24．75）μmol·L^-1，P〈0。001；CrCl术前VS术后：（73．6±21．4）ml·min^-1 vs（67．7±21．8）ml·min^-1，P〈0．001），但使用辛伐他汀的患者肾功能基本不变（SCr术前VS术后：（91．95±20．33）μmol·L^-1VS（91．06±18．57）μmol·L^-1，P〉0．05；CrCl术前VS术后：（77．3±20．2）ml·min^-1 vs （76．7±20．8）ml·min，P〉0．05）。在随访期间，无论是否使用辛伐他汀，患者术后3～6个月时均会出现肾功能恶化现象。结论：提示使用辛伐他汀能避免患者术后肾功能下降，但不能避免随访期内肾功能的进一步恶化。仍需要更大范围的试验验证辛伐他汀的使用与肾保护功能之间有必然的关系。

OBJECTIVE To identify the effects of simvastatin on renal function in patients suffering from obstructive jaundice. METHODS 106 cases of patients with obstructive jaundice were enrolled in 2011 Jan. to 2012 Dec.. The patients were divided into two groups （test group and control group） according to whether had used simvastatin （〉3 months）. The serum creatinine （SCr） and creatinine clearance （CrCI） were tested preoperatively, postoperatively at 3 and 6 months. RESULTS A deterioration of renal function in control group was observed in the early postoperative period（SCr preoperative vs postopera tive： （91.06± 17. 68）μmol· L1 vs （99. 90 ± 24. 75）μmol· L-1 , P〈0. 001 and CrCI preoperative vs postoperative： （73.6 ± 21.4）mL.min^-1 vs （67. 7 ±21.8）ml · min-1, P〈0. 001 ）, no significant change was observed in test group on renal function （SCr preoperative vs postoperative： （91.95 ± 20. 33）μmol.L^-1 vs （91.06 ± 18. 57）μmol.L^-1 , P〉0. 05 and CrCI preoperative vs postoperative： （77. 3 ± 20. 2）mL.min^-1 vs （76. 7 ± 20. 8）mL,min- 1, P〉0. 05, During the follow-up period, renal function in all patients were decreased after 3 and 6 months. CONCLUSION This research indicated that the simvastatin can prevent postoperative renal function decline, but can＇t avoid further renal function deterioration during the follow-up period. Large sample research was necessary for detection of the relationship between simvastatin and protection of renal function.