CAJ | 학술논문

目的探讨术前血清尿酸水平对老年患者心脏手术后急性肾损伤(AKI)的影响.方法回顾性分析广东省人民医院2005年1月至2011年5月行体外循环心脏手术的936例老年(≥60岁)患者的临床资料.以术前末次血清肌酐为基线值,采用RIFLE标准诊断AKI.按尿酸水平的三分位数进行分组,A组为男性≤384.65 μmol/L,女性≤354.00 μmol/L,共312例;B组为男性384.66～476.99 μmol/L,女性354.01 ～437.96卜μrnol/L,共311例;C组为男性≥477.00 μmol/L,女性≥437.97μmol/L,共313例.通过多因素logistic回归分析心脏手术后发生AKI的危险因素.结果发生AKI的患者共576例(61.5％),AKI患者和非AKI患者的血清尿酸水平分别为(436.6 119.1)μmol/L和(398.0±107.2)μmol/L,差异有统计学意义(P＜0.001).发生AKI的患者A组共175例(56.1％),B组共175例(56.3％),C组共226例(72.2％),3组间的AKI发生率差异有统计学意义(P ＜0.001).多因素logistic回归分析显示,校正年龄、性别、合并症(高血压、糖尿病、脑血管疾病、慢性阻塞性肺疾病)、既往心脏手术史、估算肾小球滤过率＜60 ml·min-1·1.73 m-2、心功能≥3级(NYHA分级)、尿蛋白阳性、联合冠状动脉旁路移植术和瓣膜手术、体外循环时间、主动脉阻断时间、术前用药(血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、调脂药)、术后早期用药(血管紧张素转换酶抑制剂或血管紧张素Ⅱ受体拮抗剂、利尿剂、地高辛)、术后早期中心静脉压后,与A组比较C组术后发生AKI的风险增加(OR:1.897,95％CI:1.270 ～2.833,P=0.002).结论术前较高的血清尿酸水平可增加老年患者心脏手术后发生AKI的风险.
목적 탐토술전혈청뇨산수평대노년환자심장수술후급성신손상(AKI)적영향.방법 회고성분석광동성인민의원2005년1월지2011년5월행체외순배심장수술적936례노년(≥60세)환자적림상자료.이술전말차혈청기항위기선치,채용RIFLE표준진단AKI.안뇨산수평적삼분위수진행분조,A조위남성≤384.65 μmol/L,녀성≤354.00 μmol/L,공312례;B조위남성384.66～476.99 μmol/L,녀성354.01 ～437.96복μrnol/L,공311례;C조위남성≥477.00 μmol/L,녀성≥437.97μmol/L,공313례.통과다인소logistic회귀분석심장수술후발생AKI적위험인소.결과 발생AKI적환자공576례(61.5％),AKI환자화비AKI환자적혈청뇨산수평분별위(436.6 119.1)μmol/L화(398.0±107.2)μmol/L,차이유통계학의의(P＜0.001).발생AKI적환자A조공175례(56.1％),B조공175례(56.3％),C조공226례(72.2％),3조간적AKI발생솔차이유통계학의의(P ＜0.001).다인소logistic회귀분석현시,교정년령、성별、합병증(고혈압、당뇨병、뇌혈관질병、만성조새성폐질병)、기왕심장수술사、고산신소구려과솔＜60 ml·min-1·1.73 m-2、심공능≥3급(NYHA분급)、뇨단백양성、연합관상동맥방로이식술화판막수술、체외순배시간、주동맥조단시간、술전용약(혈관긴장소전환매억제제혹혈관긴장소Ⅱ수체길항제、조지약)、술후조기용약(혈관긴장소전환매억제제혹혈관긴장소Ⅱ수체길항제、이뇨제、지고신)、술후조기중심정맥압후,여A조비교C조술후발생AKI적풍험증가(OR:1.897,95％CI:1.270 ～2.833,P=0.002).결론 술전교고적혈청뇨산수평가증가노년환자심장수술후발생AKI적풍험.
Objective To investigate the impact of pre-operative uric acid on acute kidney injury (AKI) after cardiac surgery in elderly patients.Methods Clinical data were collected from 936 elderly patients (age ≥ 60 years)undergoing cardiac surgery with cardiopulmonary bypass in Guangdong General Hospital between January 2005 and May 2011.The baseline serum creatinine was defined as the latest serum creatinine before surgery,and AKI was diagnosed according to RIFLE criteria.Patients were divided into three groups according to the sex-specific cutoff values of serum uric acid tertiles (group A:≤ 384.65 μmol/L in men,and ≤354.00 μmol/L in women; group B:384.66-476.99 μmol/L in men and 354.01-437.96μmol/L in women; group C:≥ 477.00 μmol/L in men and ≥ 437.97 μmol/L inwomen).Multivariate logistic regression analysis was used to analyze the independent risk factors for AKI.Results Among 936 elderly patients,576 cases (61.5％) developed AKI.Mean uric acid concentration was higher in AKI patients than in Non-AKI patients ((436.6 ± 119.1) μmol/L vs.(398.0 ± 107.2) μmol/L,P ＜0.001).The incidence of AKI was 56.1％ (175/312) in group A,56.3％ (175/311) in group B,72.2％ (226/313) in group C (P ＜ 0.001).Multiple logistic regression analysis showed that,after adjusted for age,gender,co-morbidities (hypertension,diabetes mellitus,cerebrovascular disease,chronic obstructive pulmonary disease),previous cardiac surgery,eGFR ＜ 60 ml · min-1 · 1.73 m-2,heart function ≥ 3(NYHA),positive urine protein,combination of coronary artery bypass grafting and valvular surgery,cardiopulmonary bypass operation time,aortic cross-clamping time,pre-operative angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blockers and lipid-lowering drugs use,early postoperative angiotensin converting enzyme inhibitor or angiotensin Ⅱ receptor blockers,diuretics and digoxin use,postoperation central venous pressure,risk of post operative AKI was significantly higher in group C than in group A(OR:1.897,95％ CI:1.270-2.833,P =0.002).Conclusion Pre-operative elevated uric acid is an independent risk factor of AKI after cardiac surgery in elderly patients.