意大利IRCCS圣拉斐尔科学研究所Giovanni Landoni团队研究了静脉注射氨基酸保护心脏手术患者肾脏的效果。这一研究成果发表在2024年6月12日出版的《新英格兰医学杂志》上。

急性肾损伤（AKI）是心脏手术中一种严重而常见的并发症，其中肾灌注减少是一个关键因素。静脉注射氨基酸可增加肾脏灌注，补充肾功能储备。然而，氨基酸在减少心脏手术后AKI发生方面的疗效尚不确定。

在一项多国双盲试验中，研究组随机将计划接受体外循环心脏手术的成年患者分为静脉输注氨基酸平衡混合物，剂量为每天每公斤理想体重2克，或输注安慰剂（林格溶液），最长3天。主要结局是AKI的发生，根据肾脏疾病的改良全球结果肌酐标准定义。次要结局包括AKI的严重程度、肾脏替代治疗的使用和持续时间以及30天全因死亡率。

研究组在三个国家的22个中心招募了3511名患者，将1759名患者分配到氨基酸组，1752名患者分配到安慰剂组。氨基酸组474名患者（26.9%）和安慰剂组555名患者（31.7%）发生AKI（相对风险，0.85；95%置信区间[CI]，0.77至0.94；P=0.002）。两组的3期AKI分别发生在29名患者（1.6%）和52名患者（3.0%）中（相对风险，0.56；95%CI，0.35至0.87）。氨基酸组24名患者（1.4%）和安慰剂组33名患者（1.9%）使用了肾脏替代疗法。两组在其他次要结局或不良事件方面没有显著差异。

研究结果表明，在接受心脏手术的成年患者中，输注氨基酸减少了AKI的发生。

附：英文原文

Title: A Randomized Trial of Intravenous Amino Acids for Kidney Protection

Author: Giovanni Landoni, Fabrizio Monaco, Lian Kah Ti, Martina Baiardo Redaelli, Nikola Bradic, Marco Comis, Yuki Kotani, Claudio Brambillasca, Eugenio Garofalo, Anna Mara Scandroglio, Cristina Viscido, Gianluca Paternoster, Annalisa Franco, Sabrina Porta, Federica Ferrod, Maria Grazia Calabrò, Antonio Pisano, Igor Vendramin, Gaia Barucco, Francesco Federici, Luca Severi, Alessandro Belletti, Andrea Cortegiani, Andrea Bruni, Carola Galbiati, Angelo Covino, Ekaterina Baryshnikova, Giuseppe Giardina, Maria Venditto, Daniel Kroeller, Cristina Nakhnoukh, Lorenzo Mantovani, Simona Silvetti, Margherita Licheri, Fabio Guarracino, Rosetta Lobreglio, Ambra Licia Di Prima, Stefano Fresilli, Rosa Labanca, Marta Mucchetti, Rosalba Lembo, Rosario Losiggio, Tiziana Bove, Marco Ranucci, Evgeny Fominskiy, Federico Longhini, Alberto Zangrillo, Rinaldo Bellomo

Issue&Volume: 2024-06-12

Abstract:

BACKGROUND

Acute kidney injury (AKI) is a serious and common complication of cardiac surgery, for which reduced kidney perfusion is a key contributing factor. Intravenous amino acids increase kidney perfusion and recruit renal functional reserve. However, the efficacy of amino acids in reducing the occurrence of AKI after cardiac surgery is uncertain.

METHODS

In a multinational, double-blind trial, we randomly assigned adult patients who were scheduled to undergo cardiac surgery with cardiopulmonary bypass to receive an intravenous infusion of either a balanced mixture of amino acids, at a dose of 2 g per kilogram of ideal body weight per day, or placebo (Ringer’s solution) for up to 3 days. The primary outcome was the occurrence of AKI, defined according to the Kidney Disease: Improving Global Outcomes creatinine criteria. Secondary outcomes included the severity of AKI, the use and duration of kidney-replacement therapy, and all-cause 30-day mortality.

RESULTS

We recruited 3511 patients at 22 centers in three countries and assigned 1759 patients to the amino acid group and 1752 to the placebo group. AKI occurred in 474 patients (26.9%) in the amino acid group and in 555 (31.7%) in the placebo group (relative risk, 0.85; 95% confidence interval [CI], 0.77 to 0.94; P=0.002). Stage 3 AKI occurred in 29 patients (1.6%) and 52 patients (3.0%), respectively (relative risk, 0.56; 95% CI, 0.35 to 0.87). Kidney-replacement therapy was used in 24 patients (1.4%) in the amino acid group and in 33 patients (1.9%) in the placebo group. There were no substantial differences between the two groups in other secondary outcomes or in adverse events.

CONCLUSIONS

Among adult patients undergoing cardiac surgery, infusion of amino acids reduced the occurrence of AKI.

DOI: NJ202406120000001

Source: https://www.nejm.org/doi/full/10.1056/NEJMoa2403769