肺移植术后早期急性肾损伤的危险因素及预后分析  

Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation

作　　者：陈奥 练巧燕 张建恒[1] 徐鑫[1] 韦兵[1] 蔡宇航 黄丹霞[1] 何建行[1] 巨春蓉[1] Chen Ao;Lian Qiaoyan;Zhang Jianheng;Xu Xin;Wei Bing;Cai Yuhang;Huang Danxia;He Jianxing;Ju Chunrong(Guangzhou Institute of Respiratory Health,State Key Laboratory of Respiratory Disease,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou 510012,China)

机构地区：[1]广州医科大学附属第一医院广州呼吸健康研究院呼吸疾病国家重点实验室,510012

出　　处：《器官移植》2021年第2期220-225,231,共7页Organ Transplantation

基　　金：广东省自然科学基金(2018A030313107)。

摘　　要：目的分析肺移植术后早期急性肾损伤(AKI)的危险因素及预后。方法回顾性分析155例肺移植或心肺联合移植受者的临床资料,根据2012年改善全球肾脏病预后组织指南分为AKI组(104例)及非AKI组(51例)。总结肺移植术后早期AKI发生情况;收集受者的主要指标,对肺移植术后早期发生AKI的危险因素进行单因素和多因素分析;分析肺移植受者的预后情况并绘制生存曲线。结果肺移植术后早期AKI的发生率为67.1%(104/155),其中AKI 1期47例,AKI 2期34例,AKI 3期23例,术后早期需要连续性肾脏替代治疗(CRRT)的受者16例。术前合并糖尿病、术前合并肺动脉高压、术中平均动脉压(MAP)<60 mmHg、术中大量输血、术后1周内他克莫司(Tac)超治疗浓度为肺移植术后早期发生AKI的独立危险因素。截止至随访终点,共66例(42.6%)受者死亡,其中AKI组50例,非AKI组16例。AKI组累积生存率低于非AKI组(40%比66%,P<0.05),随着AKI严重程度增加,肺移植受者累积生存率降低。结论肺移植术后早期AKI发生率高、预后差,术前合并糖尿病、肺动脉高压,术中MAP<60 mmHg、大量输血和术后1周内Tac超治疗浓度为肺移植术后早期发生AKI的独立危险因素。Objective To analyze the risk factors and clinical prognosis of acute kidney injury(AKI)early after lung transplantation.Methods Clinical data of 155 recipients undergoing lung transplantation or combined heart-lung transplantation were retrospectively analyzed,and they were divided into the AKI group(n=104)and non-AKI group(n=51)according to the 2012 Kidney Disease:Improving Global Outcomes Clinical Practice Guideline.The incidence of AKI early after lung transplantation was summarized.The main indexes of recipients were collected.The risk factors of the occurrence of AKI early after lung transplantation were subjected to univariate and multivariate analysis.The clinical prognosis of lung transplant recipients was evaluated and the survival curve was delineated.Results The incidence of AKI early after lung transplantation was 67.1%(104/155),including 47 recipients with stage 1 AKI,34 recipients with stage 2 AKI and 23 recipients with stage 3 AKI,respectively.Sixteen recipients required continuous renal replacement therapy(CRRT)early after lung transplantation.Preoperative complication with diabetes mellitus,preoperative complication with pulmonary hypertension,intraoperative mean arterial pressure(MAP)<60 mmHg,intraoperative massive blood transfusion,and treatment with excessive therapeutic concentration of tacrolimus(Tac)within postoperative 1 week were the independent risk factors for the occurrence of AKI early after lung transplantation.Up to the end of followup,66 recipients(42.6%)died,including 50 recipients in the AKI group and 16 recipients in the non-AKI group.The cumulative survival rate in the AKI group was significantly lower than that in the non-AKI group(40%vs.66%,P<0.05).With the increase of AKI severity,the cumulative survival rate of lung transplant recipients was decreased.Conclusions AKI develops early after lung transplantation with high incidence and poor clinical prognosis.Preoperative complication with diabetes mellitus and pulmonary hypertension,intraoperative MAP<60 mmHg and massive bloo

关 键 词：肺移植 急性肾损伤(AKI) 他克莫司(Tac) 连续性肾脏替代治疗(CRRT) 平均动脉压(MAP) 血清肌酐 估算肾小球滤过率 重症监护室 

分 类 号：R617[医药卫生—外科学] R692[医药卫生—临床医学]