术前血清尿酸水平与三尖瓣手术后急性肾损伤的相关性研究

The association between the serum uric acid level and acute kidney injury following tricuspid valve surgery

目的:探究术前血清尿酸与三尖瓣外科术后急性肾损伤(acute kidney injury,AKI)发生的相关性。方法:回顾性分析广东省人民医院2018年1月至2019年6月,在体外循环下三尖瓣外科手术患者的临床资料。以术前血清尿酸水平的四分位数进行分组,通过单因素和多因素Logistic回归模型结合限制性立方样条模型分析术前尿酸水平与术后AKI的相关性及剂量反应曲线关系。结果:研究共纳入230例患者,有43例(18.7%)患者发生术后AKI。在校正多种因素的影响后,RCS分析提示术前血清尿酸水平与术后AKI发生呈现线性关系(非线性检验P=0.0778)。多因素Logistic回归分析提示,尿酸每增加10μmol/L,术后发生AKI的风险增加5%(OR=1.05,P=0.186)。发生术后AKI的风险,以Q1组患者为参照,Q2组患者是4.6倍(OR=4.62,P=0.0952);Q3组是8.0倍(OR=8.01,P=0.0147);Q4组是7.9倍(OR=7.92,P=0.0165)。尿酸浓度分组越大,术后发生AKI的风险越高(趋势性检验P=0.0114)。结论:AKI是三尖瓣外科术后常见并发症,术前尿酸是术后AKI发生的危险因素。

Objective:The aim of this study was to reveal the relationship of preoperative serum uric acid(SUA)levels with the risk of acute kidney injury(AKI)after tricuspid valve surgery.Methods:Preoperative and perioperative data were assessed in the study population.Patients were stratified into statistical quartiles of postoperative SUA.Multivariate Logistic regression and restricted cubic splines(RCS)were used to explore the association and the dose–response relationship with SUA and postoperative AKI.Results:Of 230 patients enrolled,AKI occurred in 43 patients(18.7%).After adjusting for potential confounders,A significant linear association was observed between SUA level and postoperative AKI according to RCS analysis.SUA was associated with an increased risk of developing AKI,with OR of 1.05(per 10μmol/L increase,95%CI:1.01-1.10,P=0.0186).The OR(95%CI)between SUA groups and AKI was 4.6(0.8-27.8)for quartile 2 group,8.0(1.5-42.6)for quartile 3,and 7.9(1.5-43.1)for quartile 4,respectively,when compared with the quartile 1 SUA level.Conclusions:Elevated preoperative serum SUA was associated with an increased risk of AKI after alve surgery.