尿基质金属蛋白酶-10与老年结直肠癌患者根治术后急性肾损伤发生的相关性

Association of Urinary matrix Metalloproteinase-10 and Acute Kidney Injury after Radical Resection of Colorectal Cancer in Elderly Patients

目的探讨尿基质金属蛋白酶10(MMP-10)与老年结直肠癌患者根治术后急性肾损伤发生的关系,为临床预防和治疗急性肾损伤发生提供新的参考。方法选取2018年10月—2021年10月在重庆大学附属肿瘤医院接受结直肠癌根治术的老年患者作为研究对象,选取术后发生急性肾损伤者90例为损伤组,术后未发生急性肾损伤者90例为对照组。收集患者围术期一般资料,ELISA法检测患者术后尿MMP-10水平,并进行多因素logistic回归分析。结果损伤组年龄大于对照组,收缩压、总胆固醇、术后并发症总发生率及术后24 h内的尿MMP-10水平均高于对照组,手术时间长于对照组,术中补液量、术中出血量均多于对照组,差异均有统计学意义(P<0.05);将年龄、收缩压、总胆固醇、手术时间、术中补液量、术中出血量、术后并发症发生情况及尿MMP-10水平作为自变量,是否发生急性肾损伤作为因变量进行logistic回归分析,经校正混杂因素后,年龄、术中出血量、术后有并发症及尿MMP-10水平均为老年结直肠癌患者根治术后急性肾损伤发生的独立危险因素(P<0.05)。将尿MMP-10进行三等分后,作为分类变量进一步使用logistic回归分析尿MMP-10水平与老年结直肠癌患者根治术后急性肾损伤发生之间的关系,经多因素校正后,与尿MMP-10低水平组(<1.29μmol/L)患者相比,中水平组(1.29~2.31μmol/L)和高水平组(>2.31μmol/L)的患者术后发生急性肾损伤的风险提高。结论尿MMP-10水平升高与老年结直肠癌患者根治术后急性肾损伤发生密切相关,尿MMP-10是其独立危险因素。

Objective To investigate the relationship between urinary matrix metalloproteinase-10(MMP-10)and acute kidney injury(AKI)in elderly patients with colorectal cancer after radical resection,and to provide a new reference for clinical prevention and treatment of AKI.Methods Elderly patients who received radical resection of colorectal cancer in Chongqing University Cancer Hospital from October 2018 to October 2021 were selected as the study subjects.A total of 90 patients with postoperative acute kidney injury were selected as the injury group,and another 90 patients without postoperative acute kidney injury were selected as the control group.Perioperative general data was collected,urinary MMP-10 levels were measured by ELISA,and multivariate logistic regression analysis was performed.Results The injury group was older than the control group,systolic blood pressure,total cholesterol,incidence of total postoperative complications and urinary MMP-10 level within 24 h after operation were higher than the control group,the operation time was longer than the control group,intraoperative fluid replacement volume and intraoperative blood loss were more than the control group,and the differences were statistically significant(P<0.05).Age,systolic blood pressure,total cholesterol,operation time,intraoperative fluid replacement,intraoperative blood loss,postoperative complications and urinary MMP-10 level were used as independent variables,and the occurrence of acute kidney injury was used as dependent variable for lo-gistic regression analysis.After adjusting for confounding factors,age,intraoperative blood loss,postoperative complications and urinary MMP-10 levels were all independent risk factors for acute kidney injury after radical resection in elderly patients with colorectal cancer(P<0.05).After tripartitioning urinary MMP-10 as a categorical variable,logistic regression was further used to analyze the relationship between urinary MMP-10 levels and the occurrence of acute renal injury in elderly patients with colorectal cancer after radical surgery,and after multivariate adjustment,patients in the medium-level(1.29 to 2.31μmol/L)and high-level(>2.31μmol/L)groups had an increased risk of postoperative acute kidney injury compared with patients in the low-level urinary MMP-10 group(<1.29μmol/L).Conclusion Elevated levels of urinary MMP-10 are closely related to the occurrence of acute renal injury in elderly patients with colorectal cancer after radical surgery,urinary MMP-10 is an independent risk factor.