急性主动脉夹层术前急性肾损伤危险因素分析

Preoperative acute kidney injury in acute aortic dissection-risk factors analysis

目的 探讨急性主动脉夹层（ADD）术前急性肾损伤（AKI）的危险因素.方法 回顾性分析北京安贞医院于2009年5月至2013年12月期间AAD患者的临床资料.采用单因素比较和多因素Logistic回归分析统计术前发生AKI的危险因素.结果 共有254例患者入选,其中Stanford A型夹层178例、B型76例.Stanford A型夹层患者AKI的发病率为23％（41例）,Stanford B型夹层患者AKI的发病率为36.8％（26例）.单因素分析显示,Stanford A型夹层AKI的发生与性别（P=0.0042）、舒张压（P=0.0328）、心包积液（P=0.0002）、肾动脉累及（P=0.0344）存在相关性;Stanford B型夹层AKI的发生与收缩压（P=0.0357）、肾动脉累及（P=0.0124）存在相关性.多因素Logistic回归分析发现,Stanford A型夹层AKI的独立危险因素包括男性（OR =5.398,95％CI 1.497～19.468,P=0.01）、舒张压（OR =0.961,95％CI 0.943～0.980,P＜0.01）、双侧肾动脉受累（OR =5.392,95％CI 1.390～20.914,P=0.015）;Stanford B型夹层AKI的独立危险因素包括收缩压（OR=1.023,995％CI 1.003～1.044,P=0.0238）、双侧肾动脉受累（OR=19.076,95％CI 1.914-190.164,P=0.0120）.结论 男性、舒张压和双侧肾动脉受累是A型主动脉夹层患者急性肾损伤的独立危险因素;收缩压和双侧肾动脉受累是B型主动脉夹层患者急性肾损伤的独立危险因素.

Objective To determine preoperative risk factors for acute kidney injury in patients with the acute aortic dissection, to search for the intervention of preoperative AKI. Methods From May 2009 to May 2013, the baseline data was retrospectively analyzed in patients with acute aortic dissection at Beijing An zhen Hospital, Capital Medical University. The relationship between the baseline data and laboratory variables and the maximum imaging examination and the serum creatinine were compared by using single factor and multi-factor Lo- gistic regression analysis. Results A total of 254 patients were enrolled. The incidence of AKI was 23%（n=41 ） in patients with type A AAD, and the incidence of AKI was 36.8% （n=28） in patients with type B AAD. Single factor analysis was showed that preoperative risk factors for acute kidney injury of type A AAD included include gender （P=O.0（M2）, diastolic blood pressure （P=0.0328）, pericardial effusion （P=0.0002）, renal artery involve- ment （P=O.03d-4）. Single factor analysis was showed that preoperative risk factors for acute kidney injury of type A AAD included systolic blood pressure（P=0.0357）, renal artery involvement（P=0.0124）. Multivariable Logistic re- gression analysis was showed that male （0R=5.398, 95%CI 1.497-19.468, P=0.01）, systolic blood pressure （OR=0.961, 95%CI 0.943-0.980, P〈0.01）, bilateral renal artery involvement （0R=5.392, 95%CI 1.390- 20.914, P=0.015 ） independent predictors for acute kidney injury in patients with type A AAD. Multivariable Lo- gistic regression analysis was showed that systolic blood pressure （OR = 1.023, 95%CI 1.003-1.044, P=0.0238 ）,Bilateral renal artery involvement（OR=19.076, 95%CI 1.914-190.164, P=O.0120） was independent predictors for AKI in patients with type B AAD. Conclusion Male, diastolic blood pressure on admission, and bilateral renal artery involvement was independent risk factors for preoperative AKI in patients with type A AAD, Systolic blood pressure on admission and bilateral renal artery involvement was were independent risk factors for preoperative AKI in patients with type B AAD.