术前血清尿酸水平对体外循环心脏术后急性肾损伤的预测价值

Predictive value of pre-operative serum uric acid on acute kidney injury after cardiac surgery

目的探讨术前血清尿酸水平对体外循环心脏术后急性肾损伤(AKI)的预测价值。方法回顾性分析宁波市医疗中心李惠利医院2017年3～8月接受体外循环心脏手术的198例患者资料,根据术后是否发生AKI分为AKI组和对照组。对患者的临床资料先进行单因素分析筛选,再将有意义的变量进行多因素回归分析,并使用受试者工作特征(ROC)曲线分析术前血清尿酸水平对术后AKI的预测价值。结果术后发生AKI的患者共50例(25.3%),其中5例(2.5%)需要行连续肾替代疗法治疗。AKI组和对照组患者的术前血清尿酸水平分别为(488.91±105.52)μmol/L和(306.36±69.81)μmol/L,差异有统计学意义(t=-8.294,P=0.036)。多因素logistic回归分析显示,校正年龄、合并症(高血压、糖尿病)、NYHA心功能分级≥Ⅲ级、体外循环时间>100 min和阻断时间>60 min后,术前血清尿酸水平>357μmol/L的患者发生AKI的风险增加(OR:9.074,95%CI:1.563～23.783,P=0.021)。ROC曲线下面积为0.935(95%CI:0.877～0.993,P=0.000),尿酸取截断值为355.5μmol/L,敏感度为95.5%,特异度为81.2%。结论术前血清尿酸水平对体外循环心脏术后AKI有较好的预测价值。

Objective To investigate the predictive value of pre-operative serum uric acid level for acute kidney injury(AKI)after cardiopulmonary bypass surgery.Methods A retrospective analysis was made on 198 patients who undergone cardiopulmonary bypass surgery from March to August 2017 in LiHuiLi Hospital of Ningbo Medical Center.The patients were divided into AKI group and control group according to whether AKI occurred after operation.The clinical data were firstly screened by single factor analysis,and the significant variables were analyzed by multiple factor regression analysis.The receiver operating characteristic(ROC)curve was used to analyze the predictive value of preoperative serum uric acid level on postoperative AKI.Results A total of 50 patients(25.3%)had postoperative AKI,5 of them(2.5%)required continuous renal replacement therapy(CRRT).The preoperative serum uric acid levels of AKI patients and non AKI patients were(488.91±105.52)μmol/L and(306.36±69.81)μmol/L respectively,and the difference was statistically significant(t=-8.294,P=0.036).Multiple logistic regression analysis showed that,after adjusted for age,comorbidities(hypertension,diabetes),NYHA classification≥3,cardiopulmonary bypass time>100 min and blocking time>60 min,the risk of AKI was significantly higher in patient with preoperative serum uric acid level>357μmol/L(OR:9.074,95%CI:1.563-23.783,P=0.021).The area under the curve of ROC was 0.935(95%CI:0.877-0.993,P=0.000).The cutoff value of uric acid was 355.5μmol/L,with a sensitivity of 95.5%and a specificity of 81.2%.Conclusions Preoperative serum uric acid level has a good predictive value for AKI after cardiopulmonary bypass surgery.