急性Standford A型主动脉夹层患者术后急性肾损伤与术前甲状腺激素水平相关性研究  

The relation between preoperative thyroid function and postoperative AKI in patients with ASTAAD

作　　者：王嵘[1] 薛源[2] 姜文剑[2] Wang Rong;Xue Yuan;Jiang Wenjian(Center of Anaesthesia,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China;Department of Cardiac Surgery,Beijing Anzhen Hospital,Capital Medical University,Beijing 100029,China)

机构地区：[1]首都医科大学附属北京安贞医院麻醉中心,100029 [2]首都医科大学附属北京安贞医院心外科,100029

出　　处：《中华胸心血管外科杂志》2021年第6期339-343,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨术前甲状腺激素水平与急性Stanford A型主动脉夹层(ASTAAD)患者术后急性肾损伤(AKI)发生风险的相关性。方法纳入2016年7月至2016年12月在首都医科大学附属北京安贞医院接受手术的ASTAAD患者,对其临床数据进行回顾性队列研究。所有患者术前均检测了甲状腺激素水平。通过多元logistic回归分析和分层分析,探究术前甲状腺激素与术后AKI的关联。结果ASTAAD患者术后AKI的发生率42.0%。多元回归分析显示,调整混杂因素后,TT3(OR=0.08,95%CI:0.01~0.94,P=0.04)和TT4(OR=0.97,95%CI:0.94~1.00,P=0.04)与术后AKI的发生呈负相关。分层分析显示,在TSH正常组中,TT3水平对AKI的发生的影响更为明显(OR=0.004,95%CI:0.001~0.16,P<0.01),在低TSH组中差异无统计学意义(P=0.26)。结论在ASTAAD患者中,术前TT3、TT4水平与术后AKI的发生呈负相关。在TSH正常的患者中,术前TT3与术后AKI的相关性更为显著。Objective To evaluate the association between preoperative thyroid hormones and the postoperative acute kidney injury(AKI)in acute Standford type A aortic dissection(ASTAAD)patients.Methods The patients with ASTAAD,who underwent surgeries in Beijing Anzhen Hospital from July 2016 to December 2016,were included in this retrospective cohort study.Multivariable regression and stratification analyses were used to examine the association of preoperative thyroid hormone with postoperative AKI.Results The overall occurrence of postoperative AKI was 42.0%.Multivariate regression revealed that low level of TT3(OR=0.08,95%CI:0.01-0.94,P=0.04)and TT4(OR=0.97,95%CI:0.94-1.00,P=0.04)was independently associated with postoperative AKI.Subgroup analyses showed that the relation between TT3 and AKI was significantly noticed in patients with normal TSH levels(OR=0.004,95%CI:0.001-0.16,P<0.01)other than in patients with lower TSH levels(P=0.26).Conclusion The present study showed that a low level of TT3 or TT4 was a predictor of postoperative AKI in ASTAAD patients,especially in patients with normal TSH.The thyroid function should be checked before surgical intervention of patients with ASTAAD,and patients with low T3 might be at higher risk of postoperative AKI.

关 键 词：急性A型主动脉夹层 急性肾损伤 甲状腺激素 

分 类 号：R654.3[医药卫生—外科学]