慢性腎臓病を合併した心臓手術に対する新たな治療戦略

心脏手术并发慢性肾脏病的治疗新策略

• 批准号: 25462149
• 负责人: 吉武 勇
• 金额: $ 1.16万
• 依托单位: Nihon University
• 依托单位国家: 日本
• 项目类别: Grant-in-Aid for Scientific Research (C)
• 财政年份: 2013
• 资助国家: 日本
• 起止时间: 2013-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://kaken.nii.ac.jp/grant/KAKENHI-PROJECT-25462149/
• 关键词: 慢性腎臓病; 心臓手術; アンギオテンシンII受容体拮抗薬; レニン・アンギオテンシン・アルドステロン系; 心房性ナトリウム利尿ペプタイド

慢性腎臓病 （CKD）合併の心臓手術に対し、周術期心房性ナトリウム利尿ペプタイド（h-ANP）投与に術後アンギオテンシンII受容体拮抗薬（ARB）内服を行うactive RAAS control therapy（ART）につき検証。2002～2009年、CKD合併CABG患者のうち周術期hANP投与群（HIT群：60例）、周術期hANP投与＋術後ARB投与群（ART群：56例）および周術期hANP非投与＋術後ARB非投与群（C群：50例）を対象に後ろ向き研究を施行。術前・術後１年のCr（mg/dl），e-GFR（ml/min/1.73m2）はHIT群1.30±0.49→1.20±0.63、45.2±12.1→53.8±20.3、ART群1.25±0.53→1.30±1.02、48.1±11.5→52.7±18.9、C群1.26±0.51→1.75±2.00、47.7±12.5→47.4±19.1とC群に比しHIT、ART群で腎機能温存されたが有意差は認めず。BNP（pg/ml）はHIT群157.6±176.8→88.2±69.0、ART群144.2±196.5→79.4±67.3、C群145.6±237.3→177.1±177.7とC群に比しHIT、ART群で有意（p=0.001）に改善。術後1年以内の透析導入はHIT群1例（1.7%）、ART群1例(1.8%)、C群5例(10%)。術前、術後1カ月の血漿レニン活性（ng/ml/hr）、血中アルドステロン濃度（pg/ml）はHIT群7.12±12.32→2.44±2.37、72.7±55.0→93.0±75.0、ART群5.47±9.92→4.58±7.33、60.1±42.9→71.2±40.8、C群4.43±6.93→2.98±3.35、67.5±34.7→119.1±99.2とHIT、ART群でRAAS系の抑制を確認。

Chronic rheumatic disease (CKD) combined with cardiac surgery and periphery atrial convulsion, diuresis, diuresis, and II receptor antagonism (ARB) were administered intravenously with active RAAS control therapy (ART) after treatment. From 2002 to 2009, the patients with CKD and CABG received hANP group (HIT group: 60 cases), ARB group (ART group: 56 cases), ARB non-group (group C: 50 cases) and ARB non-group (group C: 50 cases). Cr (mg/dl) 1 year before and after the operation E-GFR (ml/min/1.73m2) HIT group 1.30 ±0.49 ±1.20 ±0.63,45.2 ±12.1 ±53.8 ±20.3, ART group 1.25 ±0.53,48.1 ±11.5 ±52.7 ±18.9, C group 1.26 ±0.51 ±1.75 ±2.00,47.7 ±12.5 ±47.4 ±19.1C group compared with HIT and ART group with warm storage capacity. BNP (pg/ml), HIT group (157.6 ±176.8), ART group (144.2 ±196.5), C group (145.6 ±237.3), C group (145.6 ±237.3) and ART group (145.6 ±237.3) were significantly improved than those of HIT and ART group. Within 1 year after dialysis, there were 1 case (1.7%) in HIT group, 1 case (1.8%) in ART group and 5 cases (10%) in group C. Ng/ml/hr, pg/ml, HIT group 7.12 ±12.32 ±2.44, 72.7 ±55.0 ±93.0 ±75.0, ART group 5.47 ±9.92 ±4.58 ±7.33,60.1 ±42.9 ±71.2 ±40.8, C group 4.43 ±6.93,67.5 ±34.7 ±119.1 ±99.2 HIT, respectively. ART group Ras is "suppressed" confirmation.