血清白蛋白联合β2-微球蛋白对Stanford A型主动脉夹层术后并发急性肾损伤的预测价值

Value of serum albumin combined with β2-microglobulin in predicting postoperative acute kidney injury of patients with Stanford A type aortic dissection

目的探讨血清白蛋白(Alb)联合β2-微球蛋白(β2-MG)对Stanford A型主动脉夹层术后急性肾损伤(AKI)的预测价值。方法收集2018年1月至2020年12月海南医学院第一附属医院收治的117例AKI患者临床资料,根据患者术后是否并发急性肾损伤将其分为AKI组(n=51)与NAKI组(n=66),分别比较AKI组与NAKI组、AKI组生存患者与死亡患者术后早期的血清Alb、β2-MG水平。分析AKI发生的独立危险因素,并分析血清Alb、β2-MG水平单独及联合检测对AKI发生的预测价值。结果AKI组患者术后早期的血清Alb水平低于NAKI组患者,血清β2-MG水平高于NAKI组患者(P<0.01)。经治疗后,51例AKI患者中,22例患者因治疗无效死亡,29例患者生存。死亡患者术后早期的血清Alb水平低于生存患者,而β2-MG水平高于生存患者(P<0.01)。单因素分析结果显示,AKI组患者的术前高密度脂蛋白胆固醇(HDL-C)水平、术后早期Alb水平均低于NAKI组患者,而低密度脂蛋白胆固醇(LDL-C)水平、单核细胞绝对值、中性粒细胞绝对值、尿氮素(BUN)、血清肌酐(SCr)、术中体位循环(CPB)时间、术后早期β2-MG水平及术后感染率均高于NAKI组患者(P<0.05)。多因素分析结果显示,术前HDL-C水平及术后早期Alb水平高是主动脉夹层患者术后发生AKI的保护因素(P<0.05),而术中CPB时间长、术后早期β2-MG水平高是Stanford A型主动脉夹层手术后发生AKI的危险因素(P<0.05)。受试者工作特征(ROC)曲线分析结果显示,术前早期Alb水平、β2-MG水平单独及联合预测Stanford A型主动脉夹层术后AKI发生的曲线下面积(AUC)分别为0.698、0.780、0.850。结论Stanford A型主动脉夹层患者行孙氏手术后发生AKI的概率、致死率高,术前血脂紊乱、术中CPB时间过长、术后早期Alb浓度过低、β2-MG浓度高将增加术后AKI的发生风险,而血清Alb及β2-MG水平在诊断术后早期AKI中均具有较高的效能,两者联合应用可进一步提高诊断效能。

Objective To investigate the value of serum albumin(Alb)combined withβ2-microglobulin(β2-MG)in predicting postoperative acute kidney injury(AKI)of patients with Stanford A type aortic dissection.Method A total of 117 Stanford A type aortic dissection patients in the First Affiliated Hospital of Hainan Medical University from January 2018 to December 2020 were enrolled.Patients were divided into two groups according to the presence or absence of AKI,AKI group(n=51)and NAKI group(n=66).The early postoperative serum Alb andβ2-MG levels were compared between the two groups,and between AKI survival patients and death patients.The independent risk factors of AKI,and the predictive value of serum Alb andβ2-MG of single and combined detection were analyzed.Result The early postoperative serum Alb level in AKI group was significantly lower than that in NAKI group,and theβ2-MG level in AKI group was significantly higher than that in NAKI group(P<0.01).After symptomatic treatment,22 patients of the 51 patients with AKI died due to ineffective treatment,and the remaining 29 patients survived.Alb level in early postoperative period of death patients was significantly lower than that in survival patients,andβ2-MG level was significantly higher than that in survival patients(P<0.01).Univariate analysis showed that high-density lipoprotein cholesterol(HDL-C)level and early postoperative Alb level in AKI group were lower than those in NAKI group,while low-density lipoprotein cholesterol(LDL-C)level,absolute value of monocytes,absolute value of neutrophils,urine nitrogen(BUN),creatinine(SCr),cardiopulmonary bypass(CPB)time,early postoperativeβ2-MG level and postoperative infection rate in AKI group were higher than those in NAKI group(P<0.05).Multivariate analysis showed that preoperative HDL-C and early postoperative Alb level were protective factors for AKI after Stanford A type aortic dissection(P<0.05),while CPB time and early postoperativeβ2-MG level were risk factors for AKI after Stanford A type aortic dissection(P<0.05).Receiver operating characteristic(ROC)curve showed that both Alb andβ2-MG had good efficacy in predicting AKI after Stanford A type aortic dissection,with area under the curve(AUC)of 0.698 and 0.780,respectively,while the combined detection of the two could effectively improve the predictive efficacy,with an AUC of 0.850.Conclusion Stanford A type aortic dissection patients have a high probability and fatality rate of AKI after Sun’s surgery preoperative dyslipidemia,prolonged intraoperative CPB time,low Alb concentration at the early postoperative stage,and highβ2-MG concentration will increase the risk of postoperative AKI.Serum Alb andβ2-MG levels have high efficacy in the diagnosis of early postoperative AKI.Combined application of the two methods can further improve the diagnostic efficiency.