尿蛋白在预测老年心脏术后患者急性肾损伤中的价值

The value of proteinuria in predicting acute kidney injury after cardiac surgery in elderly patients

目的评价尿蛋白在预测老年心脏手术患者术后急性肾损伤（AKI）中的价值。方法回顾性分析2005年1月至2010年12月在广东省人民医院行体外循环心脏手术的老年（年龄≥60岁）患者围术期的临床资料。根据改善全球肾脏病预后组织（KDIGO）标准诊断AKI，将患者分为两组，对两组资料进行单因素后，采用Logistic回归分析进一步确定心脏术后AKI的独立危险因素。结果共入组848例患者，术后524例（61.8%）发生AKI，其中AKI 1、2、3期发生例数分别为332例（39.2%）、141例（16.6%）、51例（6.0%）。848例患者中蛋白尿阳性135例（15.9%），其中轻度蛋白尿组105例（12.4%），重度蛋白尿组30例（3.5%）。Logistic回归分析显示蛋白尿与术后AKI的发生相关，且伴随蛋白尿的加重，AKI的发生风险上升，轻、重度蛋白尿发生AKI的OR值分别为1.758（1.020～3.029）、4.758（1.326～17.077）。结论术前尿蛋白可能对老年心脏手术后AKI发生具有预测作用，且随着蛋白尿的加重，术后AKI的发生风险增加。

ObjectiveTo evaluate the value of proteinuria in predicting acute kidney injury（AKI）after cardiac surgery in elderly patients.MethodsTo retrospectively analyze the perioperative clinical data of elderly patients（age 60 or older）undergone cardiac surgery with cardiopulmonary bypass at Guangdong General Hospital from January 2005 to December 2010.Target patients were divided into two groups according to AKI defined by the KDIGO criteria.Data for those two groups were examined by single-factor analysis, and then logistic regression analysis was used to further determine independent factors of AKI after cardiac surgery.ResultsAmong 848 elderly patients, AKI occurred in 524（61.8%）participants, including 39.2%（n=332）at AKI stage 1, 16.6%（n=141）at AKI stage 2, and 6.0%（n=51）at AKI stage 3.A total of 15.9% of patients（n=135）had preoperative proteinuria, including 12.4%（n=105）with mild proteinuria, and 3.5%（n=30）with heavy proteinuria.Logistic regression analysis showed that proteinuria was correlated with postoperative AKI.With the increase of proteinuria, the risk of AKI also increased, and the OR values of mild and severe proteinuria were 1.758（1.020-3.029）and 4.758（1.326-17.077）, respectively.ConclusionsPreoperative proteinuria may predict the occurrence of AKI after cardiac surgery in elderly patients.There is a gradual increase in the risk of AKI as proteinuria becomes more severe.Early institution of therapeutic interventions may be used in elderly patients with preoperative proteinuria undergoing cardiac surgery to attenuate the risk of AKI.