| Surgery is one of fundamental therapeutics for the treatment of cardiovascular diseasethough AKI (acute kidney injury) after operation still keep a high incidence and increasemortality and in-hospital duration. Numerous clinical investigations indicate that multiplerisk factors contributed to postoperational AKI in cardiac surgery, of which diabetesmellitus is described an important independent risk factor due to the increased sensitivityof diabetic patient on renal ischemia reperfusion injury. However, recent clinicalinvestigations demonstrated that intensive blood glucose strategy could not moderate AKIoccurrence. Glycemic oscillation is frequently phenomenon during cardiac perioperation,but its effects on AKI are still not investigated. At the same time, as traditional non-steroidanti-inflammatory drugs, the use of aspirin in cardiovascular diseases is becoming moreand more popular. Though some researches founded that aspirin can decrease theincidence of AKI, the nephritic protection of aspirin on cardiac surgery patients withdifferent glycemic oscillation have not been investigated. This study is designed toinvestigate the relationship between perioperative glycemic oscillation and postoperativeAKI and the protective role of aspirin on cardiac surgery patients by a retrospectiveanslysis. In addition, we try to find the protective mechanism of aspirin on renal ischemia reperfusion at diabetic rats by detecting the biomarker of AKI.Perioperative Glycemic Oscillation Increased Probability ofPostoperative AKIObjective：To investigate the correlation between perioperative glycemic variability andincidence of AKI and evaluate effects of preoperative aspirin on AKI.Methods:An observational retrospective study was performed on clinical patients (n=2298)receiving CABG, valve or CABG plus valve surgery from2001~2010. The patient wasexcluded if <18yrs old or incomplete records of serum creatinine and glucose levelsperioperatively. The largest rise or fall between the glucose levels before (1day) and after(during the first7days postoperatively) surgery was taken for assessing inter-day glucosefluctuation or variability. And based on the difference of pre-and post-operative glucoselevels, the patients were divided into Group1,2,3and4with the difference≤25mg/dl,26~50mg/dl,51~75mg/dl,>75mg/dl, respectively. Postoperatively, AKI was definedbased on the Acute Kidney Injury Network (AKIN) criteria.Results:There were442,664,616and576patients in Group1,2,3and4respectively. Whencomparing these four groups, there were no significant differences in baseline parametersincluding age, gender, body mass index, history of diabetes, chronic lung disease,cerebrovascular disease, hypertension, heart failure, previous myocardial infarction,preoperative medications, and intraoperative parameters such as perfusion time and crossclamp time, except that more smokers in Group4vs2. The incidences of postoperativeAKI were6.6%and8.3%in Group1and Group2, respectively. Compared to Group3andGroup4, incidence of AKI occurrence reachede statistical significance, P<0.05. The sametrend of these changes was observed in patients with or without diabetes. Withmultivariate analysis, risk factors for postoperative AKI described as heart failure （OR 1.493，P=0.013, glycemic oscillation (OR1.005, P=0.001), aspirin（OR0.392，P<0.001）,perfusion time （OR1.006，P<0.001）, peripheral artery disease（OR1.476，P=0.050）and agina （OR1.504，P=0.062）. Patients in each group prescripted aspirin preoperativelyexperienced much less AKI, P<0.05. MACE and30d mortality did not perform anystatistical significance.Conclusion:The present study showed that oscillation of perioperative blood glucose values over50mg/dl increased AKI, prescription of aspirin before cardiac surgery had potential ininhibiting AKI.Effects of Protection for Aspirin against Renal Ischemic ReperfusionInjury in Diabetic RatsObjective：To prove effect of aspirin on modrating ischemia-reperfusion injury in diabetic ratsby way of gavage pretreatment.Methods：Thirty two adult male Sprague-Dawley rats with diabetes induced by streptozotocin(STZ) were randomized to receive vehicle (saline) or aspirin10,20,30mg/kg/day X15days, respectively. Fifteen days after the treatments, the left renal artery of anesthetizedrats was occluded for30min, and then the kidney was reperfused for2hours. Bloodsamples were obtained for ELISA analysis of serum NGAL and cystatin-C, and kidneywere harvested for immunohistochemical NGAL testing.Results：In the rats with renal ischemia/reperfusion injury, NGAL protein was found to bemuch upregulated in rat kidneys, and the induced NGAL appeared in a punctuatecytoplasmic distribution, mainly within proximal tubule cells. In addition, serum NGALand cystatin-C proteins were markedly increased (P<0.05). In contrast, aspirinpretreatments significantly reduced NGAL protein expression in the kidney, and serum release of NGAL and cystatin-C (P<0.05).These results indicated that aspirin pretreatmentsignificantly reduced NGAL and cystatin-C levels, early markers for acute kidney injury,in the plasma and kidneys.Conclusions:Prior aspirin administration decreased NGAL expression and serum releases ofNGAL and Cystatin-C after renal ischemia-reperfusion injury in diabetic rats, indicatingthat aspirin had renal protective effects when suffering ischemia/reperfusion injury. |
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