心脏术后急性肾损伤预测模型的研究现状

Current status of research on models for predicting acute kidney injury following cardiac surgery

急性肾损伤(acute kidney injury,AKI)是心脏术后常见的高死亡率的并发症之一,国内外先后建立了多个心脏术后AKI预测模型。本文介绍国内外常用的14种心脏术后AKI预测模型的构成特点、临床应用以及预测能力的比较。年龄、充血性心力衰竭(congestive heart failure,CHF)、高血压、左室射血分数(left ventricular ejection fraction,LVEF)、糖尿病、瓣膜手术、冠状动脉旁路移植术(coronary artery bypass grafting,CABG)联合瓣膜手术、急诊手术、术前肌酐、术前肾小球滤过率估值(estimated glomerular filtration rate,e GFR)、纽约心脏协会(New York Heart Association,NYHA)心功能分级>Ⅱ级、既往心脏手术史、体外循环(cardiopulmonary bypass,CPB)时间和术后低心排血量综合征(low cardiac output syndrome,LCOS)等危险因素被多次(>3次)纳入不同的预测模型。欧美人群中比较Cleveland、Mehta和SRI模型对AKI和需肾脏替代治疗(renal replacement therapy,RRT)的AKI(RRT-AKI)的预测能力时,Cleveland有较高的分辨度,但对于中国人群,以上3种模型对AKI和RRT-AKI的预测能力均欠佳。

Acute kidney injury （AKI） is a complication with high morbidity and mortality after cardiac surgery. In order to predict the incidence of AKI after cardiac surgery, many risk prediction models have been established worldwide. We made a detailed introduction to the composing features, clinical application and predictive capability of 14 commonly used models. Among the 14 risk prediction models, age, congestive heart failure, hypertension, left ventricular ejection fraction, diabetes, cardiac valve surgery, coronary artery bypass grafting （CABG） combined with cardiac valve surgery, emergency surgery, preoperative creatinine, preoperative estimated glomerular filtration rate （eGFR）, preoperative New York Heart Association （NYHA） score〉 II, previous cardiac surgery, cadiopulmonary bypass （CPB） time and low cardiac output syndrome （LCOS） are included in many risks prediction models （〉3 times）. In comparison to Mehta and SRI models, Cleveland risk prediction model shows the best discrimination for the prediction of renal replacement therapy （RRT）-AKI and AKI in the European. However, in Chinese population, the predictive ability of the above three risk prediction models for RRT-AKI and AKI is poor.