冠状动脉旁路移植术后急性肾损伤的危险因素分析

Risk Factors Analysis of Acute Kidney Injury After Transplantation of Coronary Artery Bypass

目的对比冠状动脉旁路移植术(coronary artery bypass grafting,CABG)后急性肾损伤(acute kidney injury,AKI)诊断标志物的表达水平,分析CABG后AKI的危险因素。方法选取73例CABG患者作为研究对象,以CABG是否发生AKI分组为AKI组与对照组;对比两组患者术后24h血清肌酐(serum creatinine,Scr)、血清尿素氮(serum urea nitrogen,BUN)、尿液胱抑素C(urine cystatin C,Cys C)及肾损伤分子-1(kidney injury molecule-1,KIM-1)的表达水平;以AKI为作因变量,而患者的临床资料作为自变量,分析CABG后AKI的危险因素,并进行多因素及单因素Logistic回归分析,为CABG后AKI的预防策略提供依据。结果 AKI组与对照组术前Scr、BUN、Cys C及KIM-1的表达水平对比,差异均无统计学意义(P>0.05);AKI组术后Scr、BUN、Cys C及KIM-1的表达水平均显著高于对照组,两组数据差异具有统计学意义(t分别为3.586、3.728、4.325、3.089,P均小于0.05);单因素Logistic回归分析显示,年龄、高血压、移植血管桥数量、机械通气时间及术后低心排作为CABG后AKI的危险因素;多因素Logistic回归分析显示,年龄、移植血管桥数量及术后低心排作为CABG后AKI的独立危险因素,具有统计学意义(P<0.05)。结论 CABG后应密切监测患者的Scr、BUN、Cys C及KIM-1的表达水平,作为AKI的诊断标志物;年龄、移植血管桥数量及术后低心排作为CABG后AKI的独立危险因素,应严格进行术前评估、降低手术风险、围术期保护及改善肾功能,降低CABG后AKI发生的风险。

Objective To investigate the diagnostic marker expression levels of acute kidney injury （AKI）after coronary artery bypass grafting （CABG）and to analysis the risk factors of AKI after CABG. Methods 73 cases of CABG patients were involved and divided into AKI group and control group based on whether patients occurred acute kidney injury or not after operation. The serum creatinine（Scr）, blood urea nitrogen（BUN）, urine cystatin C （Cys C） and kidney injury molecule-1 （KIM-1 ）levels in all patients were detected before and 24h after CABG operation. The data were analyzed to identify the risk factors for AKI after CABG. Results There was no significantly difference on the levels of Scr, BUN, Cys C and KIM-1 before the operation between AKI group and the control group （P 〉 0.05）. The levels of Scr, BUN, Cys C and KIM- 1 in AKI group after operation were significantly higher than that of control group（P 〈0.05）. The single factor Logistic regression analysis showed that the age, high blood pressure, the number of grafts, duration of mechanical ventilation and postoperative low cardiac ranked were as risk factors for AKI after CABG. Multivariate Logistic regression analysis showed that the patient age, number of grafts and postoperative low cardiac output were as an independent risk factor for AKI after CABG, with a statistically significant（P 〈 0.05）. Conclusion The Scr, BUN, Cys C and KIM-1 levels could be used as diagnostic marker for AKI after CABG. The patient age, number of grafts and postoperative low cardiac output after CABG could be used as an independent risk factor for AKI, and should be strictly assessed preoperative to reduce the risk of surgery, protect and improve kidney function, and reduce the risk of AKI post-CABG.