促红细胞生成素对胸腹主动脉替换术患者急性肾损伤保护作用的研究

Protective effect of erythropoietin on acute renal injury in thoracoabdominal aortic surgery

目的:急性肾损伤(acute kidney injury,AKI)是胸腹主动脉瘤手术的常见并发症。多项研究发现促红细胞生成素(erythropoietin,EPO)对AKI具有保护作用。本研究评估EPO对于胸腹主动脉替换手术患者AKI的保护作用。方法:选取2018年1月到2021年12月,于上海德达医院进行胸腹主动脉替换手术的96例CrawfordⅡ型动脉瘤患者为研究对象。随机分为EPO治疗组(n=48)和对照组(n=48)。EPO的治疗剂量是200 U/kg,皮下注射,术前4~6d,1次/d,术后继续应用5d。采用血肌酐、肾小球滤过率(estimated glomerular filtration rate,eGFR)和尿中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)来分析AKI的程度。结果:EPO治疗组AKI的发生率为50%,显著低于对照组(70.8%,P<0.05)。EPO治疗组患者术后第2天血肌酐的上升水平和eGFR下降水平显著低于对照组(P<0.05)。术后1、2、3、4和7d,EPO治疗组患者尿NGAL水平显著低于对照组(P<0.05)。结论:围手术期给予EPO治疗可以降低胸腹主动脉瘤手术患者的AKI的发生率,降低尿液NGAL的含量。EPO对于胸腹主动脉瘤手术患者并发的AKI具有保护作用。

Objective:Acute kidney injury(AKI)is a common complication following open surgical thoracoabdominal aortic aneurysm(TAAA)repair.Erythropoietin(EPO)has been shown in many studies to have a reno-protective effect.The present study was conducted to examine the role of EPO in preventing TAAA-AKI.Methodse:A total of 96 patients treated with Crawford extentⅡTAAA repair,who were admitted to Shanghai Deltahealth Hospital from January 2018 to December 2021,were selected as the research subjects.They were randomly divided into an EPO treatment group(n=48)and a control group(n=48).EPO was given subcutaneously at a dosage of 200 U/kg/d four to six days before the operation and continued five days after the operation.The SCr,estimated glomerular filtration rate(eGFR)and urine neutrophil gelatinase-associated lipocalin(NGAL)were measured to evaluate the renal injury.Results:The incidence of TAAA-AKI was significantly lower in the EPO group(50%)when compared with the control group(70.8%;P<0.05).Results of increases in SCr and decreases in eGFR at postoperative day 2 were significantly lower in the EPO group than in the control group(P<0.05).The urine NGAL in the EPO group was significantly lower than the control group at 1d,2d,3d,4d,and 7d after the operation(P<0.05),respectively.Conclusions:Treatment with EPO during the perioperative period in TAAA repair decreases the incidence of AKI and urine NGAL.EPO has a protective effect on AKI during TAAA repair.