红细胞生成素对心脏手术后急性肾损伤的作用研究

Effects of erythropoietin on acute kidney injury in patients undergoing cardiac surgery

目的旨在探讨心脏手术前使用红细胞生成素(erythropoietin,EPO)能否改善术后急性肾损伤及预后。方法采用单中心随机对照研究,纳入92例南京市第一医院心胸外科行心脏手术患者,随机分为EPO组(n=46)和对照组(n=46),比较急性肾损伤(acute kidney injury,AKI)发生率及术后透析、死亡、住院时间等术后预后指标,行重复测量设计方差分析比较术后多时段肾脏功能及炎症指标。结果EPO组较对照组中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinaseassociated lipocalin,NGAL)、白细胞介素-18(interleukin-18,IL-18)在术后多时段呈现显著降低(F值分别为15.330,8.243;P值分别为<0.001,0.006),AKI发生率呈降低趋势,但无统计学意义(χ^2=2.029,P=0.235),而在其他预后方面2组间均无统计学差异。结论术前使用EPO对心脏手术患者安全并存在一定的肾脏保护作用,但对其他预后改善情况尚不明确。

Objective To investigate whether prEoperative administration of erythropoietin(EPO)can improve acute kidney injury(AKI)and its prognosis in patients undergoing cardiac surgery.Methods A singlEcenter randomized controlled study including 92 patients undergoing cardiac surgery in Department of Thoracic and Cardiovascular Surgery of Nanjing First Hospital was conducted.Patients were randomly divided into EPO group and control group.Post-operative prognosis indicators such as incidence of AKI,requirement of renal replacement therapy,death and length of stay in hospital were compared between the two groups.Renal function and inflammation indicators at different stages after surgery were analyzed by repeated measurement analysis of variance.Results Compared with the control group,the early renal injury biomarkers of neutrophil gelatinase associated lipocalin(NGAL)and interleukin-18(IL-18)in the EPO group were significant decrease at different stages after operation(F=15.330 and 8.243 respectively,P<0.001 and 0.006 respectively).The incidence of AKI was lower in the EPO group but without statistically significance(19.6%vs.32.6%,χ^2=2.029,P=0.235).There were no statistical differences in other parameters of post-operative prognosis between the two groups.Conclusions PrEoperative administration of EPO is safe and may have renal protection effects in patients undergoing cardiac surgery.However,the effects of EPO on other parameters of post-operative prognosis are unknown.