目的探讨肝移植术后早期急性肾损伤（AKI）的预测指标。方法本前瞻性研究对象为2007年4月至2012年12月在中山大学附属第三医院接受原位肝移植术的64例终末期肝病患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男59例，女5...目的探讨肝移植术后早期急性肾损伤（AKI）的预测指标。方法本前瞻性研究对象为2007年4月至2012年12月在中山大学附属第三医院接受原位肝移植术的64例终末期肝病患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男59例，女5例；平均年龄（44±11）岁。根据术后3 d 有否发生 AKI，将患者分为 AKI 组（30例）和非 AKI 组（34例）。术前抽取外周静脉血检测胱抑素 C，同时留取尿液检测β2微球蛋白和 N-乙酰-β-D-葡萄糖苷酶（NAG）；围手术期检测Scr。两组正态分布数据比较采用 t 检验，偏态分布数据比较采用非参数秩和检验。结果 AKI 组术前Scr 为（80±26）μmol/L，非 AKI 组为（76±19）μmol/L，两组比较差异无统计学意义（t=0.596，P＆gt;0.05）。AKI 组术前血胱抑素 C、尿β2微球蛋白、尿 NAG 分别为（1.06±0.24）mg/L、1.49（0.19～22.63）mg/L、43（11～188）U/L，明显高于非 AKI 组的（0.95±0.20）mg/L、0.21（0.19～14.10）mg/L、21（2～101）U/L （t=2.129，Z=1.963，Z=3.840；P〈0.05）。结论肝移植术前血胱抑素 C、尿β2微球蛋白、尿 NAG 可作为预测术后早期 AKI 的敏感指标。展开更多
Background Malnutrition has been shown to be related to adverse clinical outcomes in patients with cardiovascular diseases.However,the association of nutritional state and long-term all-cause mortality in critical pat...Background Malnutrition has been shown to be related to adverse clinical outcomes in patients with cardiovascular diseases.However,the association of nutritional state and long-term all-cause mortality in critical patients with atrial fibrillation(AF)remains unknown.Methods Critical patients who complicated with AF in the third edition of the Medical Information Mart in Critical Care(MIMIC-Ⅲ)registry were enrolled into this study.The primary endpoint was long-term all-cause mortality.Patients'nutrition status was tested by 4 screening tools,which included controlling nutritional status(CONUT),prognostic nutritional index(PNI),geriatric nutritional risk index(GNRI)scores and body mass index(BMI).Kaplan-Meier and Cox proportional analyses were used to investigate the association between nutritional state and 4-year all-cause mortality.Results A total of 630 critical patients with AF(72.0±11.2 years,male 36.5%)were included in this study,and the 4-year all-cause mortality rate was42.5%(n=268).It was up to 68.5%patients with malnutrition according to CONUT score.Kaplan-Meier and multivariate Cox proportional regression showed that the moderate to severe malnutrition was independent indicator for long-term mortality based on CONUT score(moderate vs.normal,adjusted hazard ratio[HR]:1.78,95%CI:1.22-2.62;Severe vs.normal adjusted HR:2.18,95%CI:1.52-3.15,respectively].Furthermore,the CONUT score showed the best effect of predicting worsen long-term prognosis among 4 malnutrition screening tools(The Area under cure[AUC]of CONUT vs.PNI vs.GNRI vs.BMI=0.656 vs.0.643 vs.0.617 vs.0.552).Conclusions Malnutrition is a common complication and significantly affects the prognosis of critical patients with AF,and CONUT score is an optimal screening tool to assess the nutritional status and long-term prognosis in these patient.展开更多
文摘目的探讨肝移植术后早期急性肾损伤（AKI）的预测指标。方法本前瞻性研究对象为2007年4月至2012年12月在中山大学附属第三医院接受原位肝移植术的64例终末期肝病患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男59例，女5例；平均年龄（44±11）岁。根据术后3 d 有否发生 AKI，将患者分为 AKI 组（30例）和非 AKI 组（34例）。术前抽取外周静脉血检测胱抑素 C，同时留取尿液检测β2微球蛋白和 N-乙酰-β-D-葡萄糖苷酶（NAG）；围手术期检测Scr。两组正态分布数据比较采用 t 检验，偏态分布数据比较采用非参数秩和检验。结果 AKI 组术前Scr 为（80±26）μmol/L，非 AKI 组为（76±19）μmol/L，两组比较差异无统计学意义（t=0.596，P＆gt;0.05）。AKI 组术前血胱抑素 C、尿β2微球蛋白、尿 NAG 分别为（1.06±0.24）mg/L、1.49（0.19～22.63）mg/L、43（11～188）U/L，明显高于非 AKI 组的（0.95±0.20）mg/L、0.21（0.19～14.10）mg/L、21（2～101）U/L （t=2.129，Z=1.963，Z=3.840；P〈0.05）。结论肝移植术前血胱抑素 C、尿β2微球蛋白、尿 NAG 可作为预测术后早期 AKI 的敏感指标。
基金supported by National Natural Science Foundation of China (No.82072216 and No.81871597)Natural Science Foundation of Guangdong Province,China (No.2019A1515010093)。
文摘Background Malnutrition has been shown to be related to adverse clinical outcomes in patients with cardiovascular diseases.However,the association of nutritional state and long-term all-cause mortality in critical patients with atrial fibrillation(AF)remains unknown.Methods Critical patients who complicated with AF in the third edition of the Medical Information Mart in Critical Care(MIMIC-Ⅲ)registry were enrolled into this study.The primary endpoint was long-term all-cause mortality.Patients'nutrition status was tested by 4 screening tools,which included controlling nutritional status(CONUT),prognostic nutritional index(PNI),geriatric nutritional risk index(GNRI)scores and body mass index(BMI).Kaplan-Meier and Cox proportional analyses were used to investigate the association between nutritional state and 4-year all-cause mortality.Results A total of 630 critical patients with AF(72.0±11.2 years,male 36.5%)were included in this study,and the 4-year all-cause mortality rate was42.5%(n=268).It was up to 68.5%patients with malnutrition according to CONUT score.Kaplan-Meier and multivariate Cox proportional regression showed that the moderate to severe malnutrition was independent indicator for long-term mortality based on CONUT score(moderate vs.normal,adjusted hazard ratio[HR]:1.78,95%CI:1.22-2.62;Severe vs.normal adjusted HR:2.18,95%CI:1.52-3.15,respectively].Furthermore,the CONUT score showed the best effect of predicting worsen long-term prognosis among 4 malnutrition screening tools(The Area under cure[AUC]of CONUT vs.PNI vs.GNRI vs.BMI=0.656 vs.0.643 vs.0.617 vs.0.552).Conclusions Malnutrition is a common complication and significantly affects the prognosis of critical patients with AF,and CONUT score is an optimal screening tool to assess the nutritional status and long-term prognosis in these patient.
