CAJ | 학술논문

目的：回顾性分析长期服用他汀类药物对老年急性肾损伤（ AKI）患者预后的影响。方法收集2010年6月至2011年12月在解放军总医院住院的老年患者中确诊为AKI的病例资料，分为他汀组（ AKI前服药超过3个月）及非他汀组，分析两组AKI后3个月内病死率、血清肌酐（ Scr ）倍增终点事件的差异。将终点事件与应用他汀类药物、合并症、并发症等因素行logistic回归分析。结果共377例老年AKI患者，Scr达峰时间约为7．8 d，达峰时Scr升高至发生AKI前Scr的2．06倍，约24．7％的患者并发多器官功能障碍综合征（ MODS）。 AKI后3个月内54．6％的患者肾功能完全恢复，他汀组患者（n＝145）肾功能恢复率显著高于非他汀组患者（n＝232）（P＜0．01）。 AKI后3个月内的病死率约为32．1％，两组差异无统计学意义。 AKI发生3个月后，非死亡患者中他汀组患者肌酐倍增的例数显著低于非他汀组（ P＜0．01）。 Logistic回归分析显示老年患者AKI后3个月内的死亡与合并感染、并发MODS显著相关。老年AKI后发生肌酐倍增与诊断AKI时Scr较基线增高的倍数、并发MODS、合并慢性肾脏病显著相关，服用他汀可以显著降低AKI后肌酐倍增的风险（ P＝0．02；OR：0．46；95％CI：0．24～0．9）。结论老年患者发生AKI时合并感染及并发MODS严重增加AKI患者死亡的风险。长期服用他汀不能降低AKI的病死率，但可显著降低肌酐倍增的风险。
목적：회고성분석장기복용타정류약물대노년급성신손상（ AKI）환자예후적영향。방법수집2010년6월지2011년12월재해방군총의원주원적노년환자중학진위AKI적병례자료，분위타정조（ AKI전복약초과3개월）급비타정조，분석량조AKI후3개월내병사솔、혈청기항（ Scr ）배증종점사건적차이。장종점사건여응용타정류약물、합병증、병발증등인소행logistic회귀분석。결과공377례노년AKI환자，Scr체봉시간약위7．8 d，체봉시Scr승고지발생AKI전Scr적2．06배，약24．7％적환자병발다기관공능장애종합정（ MODS）。 AKI후3개월내54．6％적환자신공능완전회복，타정조환자（n＝145）신공능회복솔현저고우비타정조환자（n＝232）（P＜0．01）。 AKI후3개월내적병사솔약위32．1％，량조차이무통계학의의。 AKI발생3개월후，비사망환자중타정조환자기항배증적례수현저저우비타정조（ P＜0．01）。 Logistic회귀분석현시노년환자AKI후3개월내적사망여합병감염、병발MODS현저상관。노년AKI후발생기항배증여진단AKI시Scr교기선증고적배수、병발MODS、합병만성신장병현저상관，복용타정가이현저강저AKI후기항배증적풍험（ P＝0．02；OR：0．46；95％CI：0．24～0．9）。결론노년환자발생AKI시합병감염급병발MODS엄중증가AKI환자사망적풍험。장기복용타정불능강저AKI적병사솔，단가현저강저기항배증적풍험。
Objective To evaluate the effects of statins on the short-term prognosis in elderly patients with acute kidney injury (AKI).Methods The data of hospitalized elderly patients with AKI at our hospital from June 2010 to December 2011 were analyzed retrospectively .The etiology , characteristics , prognosis and relative risk factors were examined .They were divided into statin and non-statin groups according to whether or not statins were taken over 3 months before a diagnosis of AKI .Results For 377 cases of elderly patients with AKI , serum creatinine ( Scr ) tmax was around 7.8 days and 2.06 times of peak increased in the level of Scr to baseline .About 24.7%of those were complicated with multiple organ dysfunction syndrome ( MODS ) .Renal function fully recovered within 3 months after AKI in 206 cases (54.6%) of elderly patients with AKI.The renal function recovery rate of patients in statin group ( n=145) was significantly higher than that of those in non-statin group (n=232) (P<0.01).And 121 case (32.1%) died within 3 months after AKI.At the end of 3 months after AKI, the doubling of Scr level in statin group was significantly lower than that in non-statin group ( P<0.01 ) .Logistic regression analysis showed that risk factors of mortality within 3 months in elders with AKI were significantly associated with infection and concurrent MODS .The doubling of Scr level after AKI in elders was significantly associated with the level of Scr at a diagnosis of AKI , MODS and the history of chronic kidney disease .The risk of doubling in Scr level was significantly reduced in patients of statin group after AKI ( P=0.02, OR:0.46;95%CI:0.24-0.9).Conclusions The risks of death in elderly patients with AKI are associated with infection and concurrent MODS .Long-term use of statin in elderly patients can significantly reduce the risk of doubling Scr level in surviving patients .