术前高尿酸血症是体外循环心脏手术后急性肾损伤的独立危险因素

Independent association of preoperative hyperuricemia with acute kidney injury after cardiac surgery with cardiopulmonary bypass

目的探究术前高尿酸血症(hyperuricemia)对心肺转流术(cardiopulmonary bypass,CPB)体外循环心脏手术后急性肾损伤(acute kidney injury,AKI)发生的影响。方法回顾性分析567例接受CPB心脏手术的成年患者,根据患者术前末次血清尿酸水平分为高尿酸血症组与非高尿酸血症组,比较两组患者心脏手术后AKI的发生率,通过二分类Logistic回归分析评价术前高尿酸血症与术后AKI发生的关系。结果在纳入的567例患者中,高尿酸血症组有303例,占53.4%;共有217例(38.3%)心脏手术后发生AKI,其中高尿酸血症组135例(44.6%),非高尿酸血症组82例(31.1%),差异有统计学意义(χ^2=10.874,P=0.001)。与非高尿酸血症组相比,高尿酸血症组患者的重症监护病房(ICU)滞留天数及住院天数均延长(均P<0.05)。在校正了年龄、性别、伴发疾病(高血压、糖尿病、脑血管病)、贫血、术前肾功能、术前心功能、体外循环时间、主动脉阻断时间、心脏手术类型、术后低血压等影响因素后,二分类Logistic回归分析显示术前高尿酸血症是CPB心脏手术后发生AKI的独立危险因素(OR=1.912,95%CI1.270~2.879,P=0.002)。结论AKI是CPB心脏手术后常见并发症,而术前高尿酸血症是CPB心脏手术后AKI发生的独立危险因素。高尿酸血症可能参与了AKI的发病机制,在心脏术前对其进行干预可能有利于预防术后AKI的发生。

Objective To investigate the impact of preoperative hyperuricemia on acute kidney injury (AKI) after cardiac surgery with cardiopulmonary bypass (CPB). Methods A total of 567 adult patients undergoing cardiac surgery with CPB were enrolled to conduct a retrospective cohort database analysis. The patients were divided into hyperuricemia group and non-hyperuricemia group according to preoperative serum uric acid, and the incidence of AKI in two groups were compared. Binary logistic regression analysis was used to evaluate the relationship between preoperative hyperuricemia and AKI. Results Among 567 patients after cardiac surgery with CPB, hyperuricemia occurred in 303 cases (53.4%), and AKI occurred in 217 cases (38.3%). There was significant difference in the incidence of AKI between hyperuricemia group and non-hyperuricemia group (44.6% vs 31.1%, χ^2=10.874, P=0.001). The duration of intensive care unit (ICU) stay and the length of stay were longer in hyperuricemia group than those in non-hyperuricemia group (both P<0.05). After adjusting for age, gender, comorbidities (hypertension, diabetes mellitus, cerebrovascular disease), preoperative renal function, preoperative heart function, CPB time, intraoperative aortic block time, type of cardiac surgery and postoperative hypotension, binary logistic regression analysis showed that preoperative hyperuricemia was an independent risk factor of AKI after cardiac surgery with CPB (OR=1.912, 95% CI 1.270-2.879, P=0.002). Conclusion AKI is a common complication following cardiac surgery with CPB, and hyperuricemia is independently associated with CPB-associated AKI. Hyperuricemia may be involved in the pathogenesis of AKI, and intervention before cardiac surgery may be beneficial to prevent postoperative AKI.