CAJ | 학술논문

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>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。
목적탐토간이식술후조기급성신손상（AKI）적예측지표。방법본전첨성연구대상위2007년4월지2012년12월재중산대학부속제삼의원접수원위간이식술적64례종말기간병환자。소유환자균첨서지정동의서，부합의학윤리학규정。기중남59례，녀5례；평균년령（44±11）세。근거술후3 d 유부발생 AKI，장환자분위 AKI 조（30례）화비 AKI 조（34례）。술전추취외주정맥혈검측광억소 C，동시류취뇨액검측β2미구단백화 N-을선-β-D-포도당감매（NAG）；위수술기검측Scr。량조정태분포수거비교채용 t 검험，편태분포수거비교채용비삼수질화검험。결과 AKI 조술전Scr 위（80±26）μmol/L，비 AKI 조위（76±19）μmol/L，량조비교차이무통계학의의（t=0.596，P>0.05）。AKI 조술전혈광억소 C、뇨β2미구단백、뇨 NAG 분별위（1.06±0.24）mg/L、1.49（0.19～22.63）mg/L、43(11～188）U/L，명현고우비 AKI 조적（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）。결론간이식술전혈광억소 C、뇨β2미구단백、뇨 NAG 가작위예측술후조기 AKI 적민감지표。
Objective To investigate the predictive indicators of early acute kiney injury (AKI) following liver transplantation. Methods A total of 64 patients with end-stage liver diseases undergoing orthotopic liver transplantation (OLT) in the Third Affiliated Hospital of Sun Yat-sen University from April 2007 to December 2012 were enrolled in this prospective study. The informed consents of all patients were obtained and the ethical committee approval was received. There were 59 males and 5 females with a mean age of (44±11) years old. According to whether the patients suffered AKI 3 d after OLT, they were divided into AKI group (n=30) and non-AKI group (n=34). Cystatin C in the peripheral venous blood and urineβ2-microglobulin (β2-MG), urine N-acetyl-β-D-glucosidase (NAG) were detected before operation. And serum creatinine (Scr) was detected during the perioperative period. Normally distributed data were compared between two groups using t test. Skew distributed data were compared using rank sum test. Results The Scr was (80±26) μmol/L in AKI group before operation and was (76±19) μmol/L in <br> non-AKI group, where no significant difference was observed between two groups (t=0.596, P>0.05). The blood Cystatin C, urine β2-MG, urine NAG were (1.06±0.24) mg/L, 1.49 (0.19~22.63) mg/L, 43(11~188) U/L respectively in AKI group before operation, which were significantly higher compared with those in non-AKI group [(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). Conclusion Preoperative blood Cystatin C, urine β2-MG and urine NAG can be the sensitive indicators for predicting early AKI following OLT.