C反应蛋白与急性A型主动脉夹层术后急性肾损伤的相关性

The association of high sensitive C reactive protein with acute kidney injury in a type aortic dissection patients after cardiopulmonary surgery

目的 探讨急性A型主动脉夹层患者术前高敏C反应蛋白（hs-CRP）水平与手术后急性肾损伤（AKI）发生的相关性,为制定预防和治疗措施提供依据.方法 2009年2月至2010年10月,心外重症监护中心（ICU）收治187例行主动脉替换术的急性A型主动脉夹层患者.本观察排除标准：术前未检测hs-CRP、术前感染和术后在诊断AKI前合并感染.共169例患者符合入选条件.根据患者术后ICU期间是否发生AKI,将患者分为AKI组和非AKI组.根据是否行肾脏替代治疗（RRT）将患者分为RRT治疗组和非RRT治疗组.对术后发生AKI及因AKI进行RRT治疗的相关危险因素进行单因素分析及多因素logistic回归分析.结果 169例患者中95例（56.2％）在ICU发生AKI,8例需行RRT治疗（4.7％）.单因素和多因素分析显示,术前hs-CRP升高是AKI发生的独立危险因素（OR=0.975,95％置信区间0.952～0.999,P=0.041）.术前hs-CRP异常增高和主动脉阻断时间长是AKI患者病情进展需RRT治疗的独立危险因素.RRT组和非RRT组住院死亡比例差异有统计学意义（25.0％对3.7％,P＜0.05）.hs-CRP预警急性A型主动脉夹层手术后AKI需RRT治疗的的ROC曲线下面积为0.733,95％置信区间0.570～0.896,P=0.026.hs-CRP＞ 30.42 mg/L作为预警AKI患者需RRT的界定值,敏感性为87.5％,特异性为53.4％.结论 急性A型主动脉夹层术前hs-CRP与手术后发生AKI显著相关,是术后发生AKI及需RRT治疗的独立危险因素.

Objective This study aims to analyze if high sensitivity C Reactive Protein （hs-CRP） was a independent risk factor of acute kidney injury（AKI） after A type aortic dissection surgery.Methods Clinical data of the 169 patients who underwent A type acute aortic dissection surgery from February 2009 to October 2010 were collected.Patients without preoperative detection of hs-CRP,patients with preoperative infection and patients diagnosed infection before AKI were excluded.Enrolled patients were divided into AKI group and non-AKI group,and according to using RRT or not,the patients were divided into RRT group and non-RRT group.All the factors were evaluated by means of univariate and multivariate logistic regression analysis to identify relative risk factors of AKI.Results AKI occurred in 95 cases（56.2％）,Using RRT in 8 cases （4.7％）.hsCRP is an independent risk factor of AKI（OR =0.975,95％ CI 0.952-0.999,P =0.041）.hs-CRP and aortic cross clamping time were the independent risk factors of using RRT,The in-hospital mortality was significant difference between RRT group and non-RRT group （P ＜ 0.05）.The area under the ROC curve of hs-CRP on RRT diagnosis was 0.733,95％ CI 0.570-0.896,P =0.026.The sensitivity of CRP ＞ 30.42 mg/L warning AKI need RRT was 87.5％,the specificity was 53.4％.Conclusion AKI after A type aortic dissection surgery was a severe complication and RRT associated with in-hospital mortality,hs-CRP was higher in acute aortic dissection patients.The level of hs-CRP and aortic cross clamping time were independent risk factors of AKI and RRT.