冠状动脉旁路移植术后早期血尿酸水平与急性肾损伤的相关性  

Correlation between serum uric acid level and acute renal injury after coronary artery bypass grafting

作　　者：徐丹青[1] 杜娟[1] 郑哲[1] 唐跃[1] 邹亮[1] 张永辉[1] 张海涛[1] 

机构地区：[1]中国医学科学院北京协和医学院阜外医院成人心外科ICU,北京100037

出　　处：《中华医学杂志》2017年第26期2033-2037,共5页National Medical Journal of China

摘　　要：目的评价术后早期血尿酸水平作为预测冠状动脉旁路移植术（CABG）术后急性。肾损伤（AKI）发生的风险因子的应用价值。方法本研究采用回顾性队列研究的方法，共纳入阜外医院心外科2012年9月至2013年12月行CABG的1306例患者，将患者按术后第1天早晨血尿酸水平的五分位数分为5组，Q1组为尿酸〈195μmol／L（262例），Q2组为尿酸195～236μmoL／L（263例），Q3组为尿酸237～280μmol／L（260例），Q4组为尿酸281～336斗moL／L（261例），Q5组为尿酸〉336μmoL／L（260例）。比较5组间临床资料及术后临床结果，主要终点事件为AKI（RIFLE诊断标准）、AKI≥I期及术后需要连续肾脏替代治疗（CRRT）的发生率；用受试者工作特征（ROC）曲线下面积来评估术后早期血尿酸水平作为风险因子预测术后AKI发生的能力，并与术后第1天早晨血肌酐水平进行比较。结果入选的1306例患者中，335例（25．65％）术后发生了AKI。校正5组间差异有统计学意义的变量后，Q5组的AKI、AKI≥I期及术后CRRT的发生率较其他组均明显升高（P〈0．01）。术后早期血肌酐预测AKI发生的ROC曲线下面积为0．648（95％CI：0．612～0．683），术后早期血尿酸预测AKI发生的ROC曲线下面积为0．722（95％CI：0．688—0．755），均P〈0．001，且术后早期血尿酸较肌酐对于预测AKI的发生更为敏感（P〈0．001）。结论术后12h内的血尿酸水平是CABG患者术后AKI发生的独立预测因素，有助于早期识别发生AKI的高风险患者。Objective To evaluate whether early postoperative serum uric acid level can predict postoperative acute renal injury （AKI） among patients undergoing coronary artery bypass grafting （CABG）. Methods The study retrospectively enrolled 1 306 patients undergoing CABG in Fuwai Hospital between September 2012 and December 2013. The patients were divided into 5 groups by the concentrations of serum uric acid measured on the morning of the first postoperative day, and uric acid categories were as follow： less than 195μmol/L （Q1 group, 262 cases）, 195 -236μmol/L （Q2 group, 263 cases）, 237 -280μmol/L （Q3 group, 260 cases）, 281 -336μmol/L （Q4 group, 261 cases）, more than 336μmol/L （Q5 group, 260 cases）. The primary end points were AKI （RIFLE criteria）, severe AKI （AKI ≥stage I ）, postoperative continuous renal replacement therapy （CRRT） requirement, in-hospital death, length of stay in hospital and intensive care unit（ICU）. The area under the receiver-operating characteristic （ROC） curve （AUC） was used to determine the ability of the early postoperative serum uric acid level as a risk factor for postoperative AKI prediction. Results Among the 1 306 patients enrolled in the study, AKI was found in 335 patients （25.65%）. After adjusting for variables that were different between the 5 groups, the Q5 group had significantly higher risk of AKI, AKIn〉 stage I and the requirement of CRRT （P 〈0. 01 ）. The ROC for the outcome of postoperative AKI had an AUC of 0. 648 （ 95% CI： 0. 612 - 0. 683 ） when serum creatininc levels alone were used and 0. 722 （95% CI： O. 688 -0. 755） when serum uric acid levels alone were used （ both P 〈 0. 001 ） . Early postoperative serum uric acid was a better predictor than serum creatinine（ P 〈 0.001 ）. Conclusion The serum uric acid concentration within 12 hours after operation is an independent predictor of postoperative AKI in patients undergoing CABG, which could be used to identify patients at high risk f

关 键 词：尿酸 冠状动脉分流术 急性肾损伤 

分 类 号：R654.2[医药卫生—外科学]