血尿酸预测急性重症胆管炎术后并发急性肾功能不全的价值及局限性

Value of sermn uric acid in prediction of acute renal dysfunction in postoperative patients with aute cholangitis of severe type

目的评估血尿酸（UA）预测急性重症腑管炎（ACST）术后并发急性肾功能不全的价值。方法回顾性分析102例ACST患者（ACST组）的临床资料，以30例同期手术的单纯胆囊结石患者作为对照组。结果（1）术前对照组血UA平均（246．42±67．12）μmol／L，ACST组平均（322．87±101．13）μmol／L，两组比较差异有统计学意义，P〈0．001。（2）ACST术后并发急性肾功能不全者入院时血UA平均（389．37±102．29）μmol／L，ACST术后未并发急性肾功能不全者入院时血UA平均（303．47±87．45）μmol／L，两者比较差异有统计学意义，P〈0．001。（3）血IA与急性肾功能不全病情轻重不完全平行，对病情的判断不如血肌酐（Cr）。（4）血UA〉320μmol／L预测ACST患者术后并发急性肾功能不全的敏感度和特异度分别为81．81％和73．75％，似然比为3．12。结论血UA对预测ACST术后并发急性肾功能不全有较高的价值，但对病情的判断不如血Cr有意义。

Objective To determine the value and limitations of serum uric acid （UA） in prediction of acute renal dysfunction in postoperative patients with acute cholangitis of severe type （ACST）. Method A retrospective analysis was performed in 102 patients with ACST. Results （ 1 ）The mean of UA of healthy subjects was （246.42 ± 67.12） μmol/L, the UA levels of patients with ACST was （322.87 ± 101.13） μmol/L, there was significantly higher than that of healthy subjects （P 〈 0.001 ）. （ 2）The levels of UA of patients with acute renal dysfunction after operation for ACST were （389.37 ± 102.29）μmol/L, there were significantly higher than those without acute renal dysfunction（303.47 ± 87.45） μmol/L. （3）There was a relationship between the level of UA and condition of the patients, but the value of UA for evaluating the severity was not as good as serum Cr. （4）Serum UA （ 〉 320 μmol/L） had a sensitivity of 81.81% and a specificity of 73.75% for predicting acute renal dysfunction. Likelihood ratios of UA for predicting acute renal dysfunction was 3.12. Conclusion Serum UA is useful for predicting acute renal dysfunction after operation for patients with ACST, but it is not as good as serum Cr for evaluating the severity of patients condition.