高密度脂蛋白对成人心脏术后急性肾损伤中的预测作用

Predictive effect of high density lipoprotein on acute kidney injury after adult heart surgery

目的探讨术前血清高密度脂蛋白水平在心脏手术后急性肾损伤(AKI)预测中的潜在作用。方法回顾性分析2017年3月至2017年5月在本院行体外循环心脏手术的成人患者295例。根据术后是否发生AK1分为两组,AKI组40例,非AKI组255例。收集患者临床资料,采用单因素和多因素logistic回归分析AKI发生的危险因素。结果AKI组中5例(12.5%)进行了床边肾脏替代治疗(CRRT),AKI组有5例患者死亡,非AKI组有5例患者死亡。多因素logistic回归分析显示,患者年龄、性另(男性)、合并症(高血压和糖尿病)、术中转机时间、术前尿酸值>420pmol/L及高密度脂蛋白含量低于正常值1 mmol/L是体外循环心脏术后发生AKI的独立危险因素。结论AKI是成人体外循环心脏手术后的常见并发症。术前患者血清高密度脂蛋白低于1 mmol/L可增加术后发生AKI的概率。

Objective To investigate the effect of preoperative serum high - density lipoprotein on acute kidney injury ( AKI) after cardiac surgery. Methods A retrospective analysis of 295 cases of adult patients undergoing cardiopulmonary bypass during our hospital from March 2017 to May 2017 was retrospectively analyzed. According to whether AKI was divided into two groups, AKI group ( n = 4 0 ) and non - AKI group( n = 2 5 5 ).The clinical data were collected and the risk factors of AKI were analyzed by single factor and m ultivariate logistic regression. Results Five p atients( 12. 5%) in the AKI group underwent bedside continuous renal replacement therapy (CRRT ), 5 died in the AKI group, and 5 patients died in the non-AKI group. Multivariate logistic regression analysis showed that the high-density lipoprotein content was lower than the normal value of 1 mmol/L in patients with age, sex (male ), comorbidities (hypertension and diabetes m ellitus), cardiopulmonary bypass and preoperative uric acid value > 420μmol/L was also an independent risk factor for AKI after cardiopulmonary bypass. Conclusions AKI is a common complication after cardiopulmonary bypass in adults. Preoperative serum high-density lipoprotein less than 1 mmol / L can increase the probability of occurrence of AKI after surgery.