老年患者体质量指数与冠状动脉移植术后急性肾损伤的相关性  

Correlation between body mass index and acute kidney injury after coronary artery transplantation in elderly patients

作　　者：高洪锋[1] 程端[1] 杨露铭 雷静 王敏[1] GAO Hong-feng;CHENG Rui;YANG Lu-ming;LEI Jing;WANG Min(Department of Surgery Intensive Care Unit,The Affiliated Xinjiang Hospital of Wuhan Asia Heart Hospital,Urumuqi 830000,China)

机构地区：[1]武汉亚洲心脏病医院新疆医院外科重症监护病房

出　　处：《岭南心血管病杂志》2019年第3期311-316,共6页South China Journal of Cardiovascular Diseases

摘　　要：目的探讨老年患者体质量指数(body mass index,BMI)与冠状动脉移植术后急性肾损伤(acute kidneyinjury,AKI)的关系。方法收集2015年4月至2016年11月在武汉亚洲心脏病医院新疆医院心内科接受冠状动脉移植手术的老年患者的临床资料,根据中国人群BMI 分级标准将受试者分为偏瘦组、正常组、超重组以及肥胖组。记录患者的人口统计学资料以及患者术前、术中、术后相关指标变化情况,采用倾向性得分匹配法(propensity score method,PSM)、多因素Logistic 逐步回归法分析不同BMI对老年患者冠状动脉移植术后AKI发生率及预后的影响以及术后AKI 发生的危险因素。结果共有472 例冠状动脉移植术老年患者符合纳入标准,PSM后每组匹配成功101例患者,一共404例患者成功纳入,匹配后除了患者年龄在组间差异具有统计学意义(P<0.01)外,其他协变量在4 组间均匀分布,未见明显统计学差异(P>0.05);偏瘦组、正常组、超重组、肥胖组4 组患者AKI 的总发病率分别为28.7%、33.7%、39.6%、47.5%,各组间比较差异具有统计学意义(χ2=8.053,P=0.012)。偏瘦组、正常组、超重组、肥胖组发生AKI 1 期患者占总AKI 发病率的比例分别为55.2%、64.7%、75.0%、77.1%,组间比较差异具有显著性统计学意义(χ2=7.062,P<0.01)。肥胖组住院时间最长,超重组病死率最低,4 组间住院时间、病死率比较,差异具有统计学意义(P<0.05)。4 组患者间重症监护病房入住时间及肾脏替代治疗患者比例比较,差异无统计学意义(P>0.05)。多因素Logistic逐步回归分析结果显示,男性、高BMI、低的估算肾小球滤过率(estimated glomerular filtration rate,eGFR)、原发性高血压、体外循环时间延长、低白蛋白血症、高血清肌酐(serum creatinine,Scr)浓度是AKI发生的危险因素,其中BMI每增加2.5 kg/m2,AKI 发病风险增加14.3%(OR=1.327,95%CI:1.112~1.491,P=0.000)。结论老年患者较高的BMI 可以增加冠�Objectives To investigate the relationship between body mass index(BMI)and acute kidney injury(AKI) after coronary artery transplantation in elderly patients. Methods The clinical data of elderly patients undergoing coronary artery transplantation from April 2015 to November 2016 were collected in the Affiliated Hospital of Wuhan Asia Heart Hospital. The subjects were divided into lean group,normal group,overweight group and obese group according to the BMI classification standard of Chinese population. The demographic data of the patients and the changes of related indexes before,during and after coronary artery transplantation were recorded. Propensity score method(PSM)and multivariate Logistic stepwise regression were used to analyze the effects of different BMI on the incidence,prognosis and risk factors of AKI in elderly patients after coronary artery transplantation. Results A total of 472 elderly patients with coronary artery transplantation met the inclusion criteria,and 101 patients were successfully matched in each group after PSM. A total of 404 patients were successfully enrolled. After matching,there was no significant difference in the distribution of other covariates among the four groups except age (P<0.01). The total incidence of AKI were 28.7%,33.7%,39.6% and 47.5% in lean group,normal group,overweight group and obese group,respectively. The difference among the 4 groups was statistically significant (χ2=8.053,P=0.012). The incidence of AKI in stage 1 were 55.2%,64.7%,75.0% and 77.1% in lean group,normal group,overweight group and obese group,respectively. There was significant statistical difference among the 4 groups(χ2=7.062,P<0.01). Obesity group had the longest hospitalization duration,overweight group had the lowest mortality rate,the differences of hospitalization duration and mortality rate among the 4 groups were statistically significant(P<0.05). There were no significant differences of intensive care unit(ICU)stay duration and percentage of patients with renal replacement among the

关 键 词：冠状动脉疾病 体质量指数 冠状动脉移植术 急性肾损伤 危险因素 

分 类 号：R541.4[医药卫生—心血管疾病]