术前血清胱抑素C联合尿蛋白半定量测定早期预测心脏手术后急性肾损伤  

Preoperative serum cystatin C combined with dipstick proteinuria predicts acute kidney injury after cardiac surgery

作　　者：王旭冬[1] 车妙琳[2] 谢波[1] 薛松[1] 

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

出　　处：《中华胸心血管外科杂志》2016年第10期612-615,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的评价血清胱抑素c（cystatinC）水平联合尿蛋白半定量测定早期预测患者心脏术后急性肾损伤（AKI）的临床价值。方法2011年6月至2013年3月616例成人心脏手术患者，排除年龄小于18岁，伴有终末期肾脏病，术前接受透析治疗，术中或术后24h内死亡的患者。应用logistic回归分析住院期间的危险因素，受试者工作曲线（ROC）评价血清cystatinC联合尿蛋白半定量测定预测术后AKI的价值。结果随着血清cystatinC水平的升高，患者的年龄增加（P〈0．001），重度尿蛋白（P=0．021）、高尿酸血症（P〈0．001）、心功能不全（P〈0．05）及近期心肌梗死（P=0．002）的发生比例升高。重度蛋白尿患者，合并糖尿病（P=0．010）、高尿酸血症（P=0．043）、心功能不全（P〈0．001）的比例较高，并伴血肌酐升高（P〈0．001）、肾小球滤过率降低（P〈0．001）。多因素分析结果显示，矫正年龄（OR=1．04）、高血压（OR=1．88）和联合手术（OR=3．47）等因素后，术前重度蛋白尿（OR=3．14）、术前血清cystatinC水平仍是术后发生AKI的独立危险因素。术前高水平血清cysatinC合并大量尿蛋白的患者，术后发生AKI、持续AKI、严重AKI及透析的比例及病死率最高（均P〈0．05）。术前血清cystatinC联合尿蛋白半定量测定预测心脏手术后AKI、持续性AKI、严重AKI的ROC曲线下面积分别为0．695、0．753、0．718，均P〈0．001。结论术前血清cystatinC联合尿蛋白半定量测定可更好地早期预测心脏手术后急性肾损伤的发生。Objective To evaluate serum cystatin C combined with dipstick proteinuria as early markers to predict AKI available before surgery. Methods We prospectively followed 616 patients undergoing cardiac surgery. Univariate as well as multivariate regression was performed. Cystatin C combined with dipstick proteinuria before surgery was assessed for its＇ pre- dictive value of AKI using receiver operator characteristic（ROC） curves. Results Patients in higher cystatin C quartiles were older （ P 〈 0. 001 ）, more often to have heavy proteinuria （ P = 0. 021 ）, hyperuricemia（ P 〈 0. 001 ）, heart failure （ P 〈 0. 001 ） and recent MI（ P = 0. 002 ）. Those with heavy proteinuria were more often to have diabetes mellitus（DM） （ P = 0. 010 ） , hype- ruricemia （ P = 0. 043 ）, worse cardiac function （ P 〈 0.001 ）, higher creatinine levels （ P 〈 0.001 ） and lower eGFR levels （ P 〈 0. 001 ）. In a multiple logistic regression model, preoperative heavy proteinuria（ OR = 3.14） and preoperative cystatin C quar- tiles each associated with an increased odds of AKI, independent of advanced age （ OR = 1.04 ）, hypertension （ OR = 1.88 ） and combined surgery（ OR = 3.47）. The risk for adverse outcomes such as postoperative AKI, persistent AKI, severe AKI, di- alysis and mortality were highest in patients with highest quartile of cystatin C （P 〈 0.05, respectively） and heavy proteinuria （P 〈 0.05, respectively）. The area under the ROC curve （AUCs） for preoperative cystatin C combined with proteinuria to de- tect AKI, persistent AKI and severe AKI were 0. 695, 0. 753 and 0. 718, P 〈 0. 001 respectively. Conclusion These data suggest that preoperative serum cystatin C combined with dipstick proteinuria may improve prediction of AKI among patients un- dergoing cardiac surgery.

关 键 词：心脏外科手术 肾/损伤 生物标志物 预测 

分 类 号：R692[医药卫生—泌尿科学]