血清尿酸水平与心脏手术后急性肾损伤的关系研究  

Relationship between pre-operative serum uric acid and acute kidney injury after cardiac surgery

作　　者：车妙琳[1] 刘上[2] 郦忆[1] 钱家麒[1] 倪兆慧[1] 薛松[1] 严玉澄[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,上海200127 [2]上海交通大学医学院附属仁济医院心胸外科,上海200127

出　　处：《上海交通大学学报（医学版）》2012年第3期312-316,共5页Journal of Shanghai Jiao tong University:Medical Science

基　　金：上海市医学发展基金重点研究课题(2003ZD001)~~

摘　　要：目的探讨血清尿酸水平升高与心脏手术后急性肾损伤(AKI)的关系。方法收集接受心脏手术患者的临床和随访资料,并根据患者术前的血清尿酸水平分为高尿酸组和非高尿酸组,回顾性分析两组患者术后AKI的发生率、严重程度及预后情况,采用多因素Logistic回归分析评价AKI的发生与血清尿酸水平升高的关系。结果入选的1 056例患者中,328例(31.1%)术后发生了AKI;高尿酸组和非高尿酸组AKI的发生率分别为49.3%和26.0%,组间比较差异有统计学意义(P<0.001);与非尿酸升高组比较,尿酸升高组患者术后ICU滞留时间延长(P<0.001),存活率降低(P=0.001)。校正了年龄、术前肾功能、左心功能不全、CABG联合瓣膜手术、手术时间和术后循环血容量不足等影响因素后,多因素Logistic回归分析结果显示术前血清尿酸升高是心脏手术后发生AKI的独立危险因素(OR=1.97,95%CI 1.22～3.18,P=0.006)。结论心脏手术患者术前血清尿酸水平升高与术后AKI的发生有关,可能是心脏手术后AKI的独立危险因素。Objective To investigate the relationship between serum uric acid increase and acute kidney injury（AKI） after cardiac surgery.Methods The clinical data and follow-up data of patients undergoing cardiac surgery were collected,and patients were divided into elevated uric acid group and non-elevated uric acid group according to pre-operative serum uric acid.The prevalences of AKI,severity of AKI and outcomes in two groups were retrospectively analysed,and the relationship between the incidence of AKI and serum uric acid increase was evaluated by multivariate Logistic regression analysis.Results After cardiac surgery,328 of 1 056 patients（31.1%） developed AKI.There were significant differences in the prevalences of AKI between elevated uric acid group and non-elevated uric acid group（49.3% vs 26.0%,P0.001）.The duration of ICU stay was longer,and the survival was lower in elevated uric acid group than in non-elevated uric acid group（P0.001 and P=0.001）.After adjustment for age,pre-operative renal function,left ventricular insufficiency,combined surgery,operation time and post-operative circulation volume insufficiency,multivariate Logistic regression analysis revealed that pre-operative serum uric acid increase was an independent risk factor of AKI after cardiac surgery（OR=1.97,95%CI 1.22-3.18,P=0.006）.Conclusion Pre-operative serum uric acid increase may be associated with incidence of AKI after cardiac surgery,and the former may be an independent risk factor of the later.

关 键 词：急性肾损伤 心脏手术 血清尿酸 危险因素 

分 类 号：R654.2[医药卫生—外科学] R692.5[医药卫生—临床医学]