急性肾损伤（AKI）可预测心脏和血管手术后的死亡。术前较高的高密度脂蛋白 (HDL) 浓度与术后 AKI 较少相关。在动物中，HDL 抑制内皮细胞粘附分子表达的抗炎能力可减少缺血和失血性休克引起的肾脏损伤。本研究的目的是评估重大心脏和血管手术后 HDL 抗炎能力与 AKI 之间的统计关系。前瞻性观察研究。四级医疗中心。100 名接受长期他汀类药物治疗的成人慢性肾病患者接受重大择期治疗心脏和血管手术。无。麻醉诱导时收集的载脂蛋白 B 耗尽的血清与肿瘤坏死因子 α 刺激的人内皮细胞一起孵育。采用逆转录酶-聚合酶链式反应测定细胞间粘附分子-1 (ICAM-1) 信使 RNA。使用酶联免疫吸附测定法测量患者血浆中的载脂蛋白 A-I 和术后可溶性 ICAM-1 浓度。 HDL 浓度与 HDL ICAM-1 抑制能力不相关（Spearman R = 0.05；p = 0.64）。 12 名患者 (12%) 被发现具有功能失调的促炎性 HDL。促炎 HDL 患者的术后 AKI 发生率高于抗炎 HDL 患者 (p = 0.046)。调整 AKI 危险因素后，较高的术前 HDL 抑制内皮 ICAM-1 的能力与较低的 AKI 几率独立相关（优势比，0.88；95% CI，0.80-0.98；p = 0.016）。 HDL 抗炎能力与术后 AKI 之间的关联与 HDL 浓度无关 (p = 0.018)。此外，较高的长期他汀类药物剂量与较高的 HDL 抑制内皮 ICAM-1 的能力相关（p = 0.045）。接受心脏和血管手术的慢性肾病患者，如果其促炎性 HDL 功能失调，则发生以下疾病的风险较高：术后 AKI 与抗炎 HDL 患者的比较。相反，较高的 HDL 抗炎能力与较低的术后 AKI 风险相关，与 HDL 浓度无关。较高的长期他汀类药物剂量与较高的 HDL 抗炎能力相关。版权所有 © 2024，重症监护医学协会和 Wolters Kluwer Health, Inc. 保留所有权利。

Acute kidney injury (AKI) predicts death after cardiac and vascular surgery. Higher preoperative high-density lipoprotein (HDL) concentrations are associated with less postoperative AKI. In animals, HDL's anti-inflammatory capacity to suppress endothelial cell adhesion molecule expression reduces kidney damage due to ischemia and hemorrhagic shock. The objective of this study is to evaluate the statistical relationship between HDL anti-inflammatory capacity and AKI after major cardiac and vascular surgery.Prospective observational study.Quaternary medical center.One hundred adults with chronic kidney disease on long-term statin therapy undergoing major elective cardiac and vascular surgery.None.Apolipoprotein B-depleted serum collected at anesthetic induction was incubated with tumor necrosis factor alpha stimulated human endothelial cells. Reverse transcriptase-polymerase chain reaction was used to measure intercellular adhesion molecule-1 (ICAM-1) messenger RNA. Enzyme-linked immunosorbent assay assays were used to measure apolipoprotein A-I and postoperative soluble ICAM-1 concentrations in patient plasma. HDL concentration did not correlate with HDL ICAM-1 suppression capacity (Spearman R = 0.05; p = 0.64). Twelve patients (12%) were found to have dysfunctional, pro-inflammatory HDL. Patients with pro-inflammatory HDL had a higher rate of postoperative AKI than patients with anti-inflammatory HDL (p = 0.046). After adjustment for AKI risk factors, a higher preoperative HDL capacity to suppress endothelial ICAM-1 was independently associated with lower odds of AKI (odds ratio, 0.88; 95% CI, 0.80-0.98; p = 0.016). The association between HDL anti-inflammatory capacity and postoperative AKI was independent of HDL concentration (p = 0.018). Further, a higher long-term statin dose was associated with higher HDL capacity to suppress endothelial ICAM-1 (p = 0.045).Patients with chronic kidney disease undergoing cardiac and vascular surgery who have dysfunctional, pro-inflammatory HDL have a higher risk of postoperative AKI compared with patients with anti-inflammatory HDL. Conversely, a higher HDL anti-inflammatory capacity is associated with a lower risk of postoperative AKI, independent of HDL concentration. Higher long-term statin dose is associated with higher HDL anti-inflammatory capacity.Copyright © 2024 by the Society of Critical Care Medicine and Wolters Kluwer Health, Inc. All Rights Reserved.