非体外循环下冠脉搭桥术后急性肾损伤的危险因素及术前尿酸、白蛋白的预测价值分析

Risk Factors of Acute Kidney Injury after Off-pump Coronary Artery Bypass Grafting and the Predictive Value of Preoperative Uric Acid and Albumin

目的:探讨非体外循环下冠脉搭桥术(OPCAB)后急性肾损伤(AKI)的危险因素,并分析术前尿酸(UA)、白蛋白(ALB)对OPCAB术后AKI的预测价值。方法:纳入我院2018年5月~2020年5月收治的134例行OPCAB术的冠心病患者,收集其临床资料。术后观察48h,根据患者是否发生AKI分成AKI组和非AKI组,分析患者OPCAB术后AKI发生的影响因素,绘制受试者工作特征(ROC)曲线分析术前血清UA、ALB对OPCAB术后AKI的预测价值。结果:在134例患者中,有37例患者行OPCAB术后发生AKI,发生率为27.61%(37/134)。单因素分析结果显示,AKI组年龄≥65岁、高血压史、糖尿病史、术前心功能Ⅳ级人数占比和术前血清UA较非AKI组升高,而术前血清ALB较非AKI组降低(P<0.05)。多因素Logistic回归分析结果显示,年龄≥65岁、高血压史、糖尿病史、术前心功能Ⅳ级、术前血清UA≥350.71μmol/L是术后发生AKI的危险因素,而术前血清ALB≥39.22 g/L是AKI的保护因素(P<0.05)。术前血清UA、ALB及二者联合预测OPCAB术后AKI发生的曲线下面积(AUC)分别为0.771、0.722、0.881。结论:OPCAB术后AKI发生率较高,AKI主要与患者年龄、高血压史、糖尿病史、术前心功能分级以及术前血清UA、ALB水平有关,其中术前血清UA、ALB对AKI发生有一定预测价值,临床可通过测定术前UA、ALB水平,辅助评估OPCAB术后AKI的发生风险。

Objective: To investigate the risk factors of acute kidney injury(AKI) after off-pump coronary artery bypass grafting(OPCAB), and analyze the predictive value of preoperative uric acid(UA) and albumin(ALB) in OPCAB postoperative AKI. Methods:134 patients with coronary heart disease who underwent OPCAB in our hospital from May 2018 to May 2020 were included, and their clinical data were collected. Postoperative observation was performed for 48 h, according to whether the patients had AKI, they were divided into AKI group and non-AKI group, the influencing factors in patients with OPCAB postoperative AK were analyzed. Receiver operating characteristic(ROC) curve was drawn to analyze the predictive value of preoperative serum UA and ALB for OPCAB postoperative AKI. Results: Among 134 patients, AKI occurred in 37 patients after OPCAB, with an incidence of 27.61%(37/134). Univariate analysis showed that age ≥65 years old, hypertension history, diabetes history, preoperative heart function grade IV accounted and preoperative serum UA in AKI group were significantly higher than those in the non-AKI group, while the preoperative serum ALB was lower than that in the non-AKI group(P<0.05). Multiariable Logistic regression analysis showed that age ≥65 years old, hypertension history, diabetes history, preoperative heart function grade IV and preoperative serum UA ≥350.71 μmol/L were risk factors for postoperative AKI occurred, and preoperative serum ALB ≥39.22 g/L was a protective factor for AKI(P <0.05). The area under the curve(AUC) of preoperative serum UA, ALB and their combination in predicting OPCAB postoperative AKI were 0.771, 0.722 and 0.881,respectively. Conclusion: The incidence rate of OPCAB postoperative AKI is higher, and AKI is mainly related to the patient’s age,hypertension history, diabetes history, preoperative heart function grade and preoperative serum UA and ALB. The preoperative serum UA and ALB have certain predictive value for the AKI occurred, the preoperative level of both can be measured clinically, so they can auxiliary evaluate the risk of OPCAB postoperative AKI.