肾恶性肿瘤患者行肾部分切除术后急性肾损伤分级的影响因素分析

Analysis of factors influencing the grading of acute kidney injury in patients with malignant renal tumors after partial nephrectomy

目的 探讨肾恶性肿瘤患者行肾部分切除术后急性肾损伤(AKI)分级的影响因素。方法 收集2013年1月至2023年1月在青岛市市立医院因恶性肾肿瘤行肾部分切除术的患者一般信息、手术及治疗相关数据、临床分期和病理分级、实验室检查结果、手术记录等临床资料,根据患者术后是否出现AKI及AKI程度分为非AKI组、AKI1期组和AKI 2期组,应用Logistic回归分析AKI的影响因素,受试者操作特征(ROC)曲线分析血清肌酐对肾恶性肿瘤患者行肾部分切除术后发生AKI的预测效能。结果 共纳入503例肾恶性肿瘤行肾部分切除术患者,其中非AKI378例(75.1%),AKI 1期83例(16.5%),AKI 2期42例(8.3%)。AKI 1期组中高血压患者比例、糖尿病患者比例、术前48 h内血清肌酐变化值、肿瘤体积、热缺血时间、体质量指数与非AKI组比较差异均有统计学意义(P均<0.05);AKI 2期组中性别构成、高血压患者比例、糖尿病患者比例、R.E.N.A.L.评分、术前48 h内血清肌酐变化值、肿瘤体积、热缺血时间、BMI与AKI 1期组比较差异均有统计学意义(P均<0.05)。Logistic回归分析显示,肾部分切除术后发生AKI的影响因素包括BMI、高血压、糖尿病、术前48 h内血清肌酐变化值、肿瘤体积、热缺血时间,发生AKI2期的影响因素还包括性别和R.E.N.A.L.评分(P均<0.05)。血清肌酐对AKI和AKI 2期的诊断截断值分别为23.29、39.88 mmol/L,灵敏度分别为98.1%、99.8%,特异度分别为81.3%、89.6%,ROC曲线下面积分别为0.969、0.974。结论 恶性肾肿瘤患者行肾部分切除术后发生AKI的影响因素有高血压、糖尿病、术前48 h内血清肌酐变化值、肿瘤体积、热缺血时间、BMI,AKI 2期的影响因素还有性别和R.E.N.A.L.评分,临床医师应早期识别这些影响因素并采取积极干预,以降低术后AKI发生率及减轻损伤程度。

Objective To investigate the influencing factors of the grading of acute kidney injury(AKI)caused by partial nephrectomy in patients with malignant renal tumors.Methods General information,surgery and treatment data,clinical and pathological grading,laboratory test results,surgical records and pathological reports and other clinical data of patients with malignant renal tumors who underwent partial nephrectomy in Qingdao Municipal Hospital from January 2013 to January 2023 were collected.All patients were divided into the non-AKI,stage1 and stage 2 AKI groups according to the incidence of AKI.The influencing factors of AKI were identified by Logistic regression analysis.The efficiency of serum creatinine in predicting AKI after partial nephrectomy was analyzed by the receiver operating characteristic(ROC)curve.Results A total of 503 patients with malignant renal tumors underwent partial nephrectomy,including 378 cases(75.1%)of non-AKI,83 cases(16.5%)of stage 1 AKI and 42 cases(8.3%)of stage 2 AKI,respectively.Patients with stage 1 AKI showed statistically significant differences in the proportion of hypertension and diabetes mellitus,changes of creatinine levels at preoperative 48 h,tumor volume,warm ischemia time,and body mass index(BMI)compared with non-AKI counterparts(all P<0.05).Patients with stage 2 AKI showed statistically significant differences in the gender composition,proportion of hypertension and diabetes mellitus,R.E.N.A.L.score,changes of creatinine levels at preoperative 48 h,tumor volume,warm ischemia time and BMI compared with AKI counterparts(all P<0.05).Logistic regression analysis revealed that the influencing factors of stage 1 AKI after partial nephrectomy included BMI,hypertension,diabetes mellitus,the changes of serum creatinine levels at preoperative 48 h,tumor volume and warm ischemia time,and the influencing factors of stage 2 AKI also consisted of gender and R.E.N.A.L score(all P<0.05).The cutoff values of serum creatinine levels for the diagnosis of AKI and stage 2 AKI were 23.29 and 39.88 mmol/L,with a sensitivity of 98.1%and 99.8%,a specificity of 81.3%and 89.6%,and an area under the ROC curve(AUC)of 0.969 and 0.974,respectively.Conclusions The influencing factors for AKI after partial nephrectomy in patients with malignant renal tumors are hypertension,diabetes mellitus,changes in creatinine levels at preoperative 48 h,tumor volume,warm ischemia time and BMI.In addition,the influencing factors for patients with stage 2 AKI consist of gender and R.E.N.A.L.score.Early identification of these influencing factors and active interventions can reduce the incidence of postoperative AKI and alleviate the severity of AKI.