α1-抗胰蛋白酶与体外循环心脏手术后急性肾损伤相关性研究  

Research of the correlation between α1-antitrypsin and acute kidney injury after cardiopulmonary bypass

作　　者：林雪峰[1] 朱鹏 杜松林[1] 周鹏宇[1] 郑少忆[1] Lin Xuefeng;Zhu Peng;Du Songlin;Zhou Pengyu;Zheng Shaoyi(Department of Cardiovascular Surgery,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院心血管外科,广州510515

出　　处：《中华胸心血管外科杂志》2021年第6期363-366,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨体外循环心脏手术后急性肾损伤(AKI)与α1抗胰蛋白酶(α1-AT)浓度变化的相关性,以及α1-AT浓度变化预测体外循环后AKI的有效性。方法选取2018年1月至2019年1月期间75例行体外循环下心脏外科手术的患者,其中男41例,女34例;年龄(50.1±12.0)岁。高血压28例,糖尿病15例。按照术后血肌酐情况分为AKI组(27例)和non-AKI组(48例)。对比两组患者围手术期资料,分析术后肾损伤危险因素,及血浆中α1-AT浓度与AKI之间的相关性。结果AKI组体外循环(169.3±56.4)min,non-AKI组(133.5±34.7)min。与non-AKI组相比,AKI组术后1 h血α1-AT显著下降[(0.53±0.53)g/L对(1.46±0.91)g/L,P<0.05]。术后1 h血α1-AT浓度为0.675 g/L时诊断敏感度、特异度最高。体外循环(OR=5.890,95%CI:1.078~32.173)和年龄(OR=4.427,95%Cl:1.113~17.614)是术后发生AKI的独立危险因素,术后1 h血α1-AT是术后AKI独立的保护因素(OR=0.084,95%Cl:0.021~0.333)。结论体外循环心脏手术后早期血α1-AT浓度升高是AKI独立的保护因素,同时可作为术后AKI一项早期预测指标。Objective To figure out variety of the plasma level of Alpha-1-Antitrypsin(α1-AT)in patients who undergo AKI following cardiopulmonary bypass(CPB),and whether this biomarker serve as a competent predictor.Methods We recruited 75 patients undergoing cardiac surgery with CPB from January 2018 to January 2019.Patients were categorized into two groups according to the development of AKI.The relationship between plasma concentration ofα1-AT and renal injury in two groups was analyzed.Results 27 patients in the AKI group were aged(54.3±12.2)years old,including 15 males and 12 females,the time of cardiopulmonary bypass was(133.5±34.7)min.In the non-AKI group,48 cases were aged(47.7±11.3)years old,including 26 males and 22 females,and the time of cardiopulmonary bypass was(133.5±34.7)min.α1-AT was significantly decreased in AKI group at 1 h after operation[(0.53±0.53)g/L vs.(1.46±0.91)g/L,P<0.05]compared with the non-AKI group.The sensitivity and specificity ofα1-antitrypsin level at 1h after operation was the highest whenα1-AT was 0.675 g/L.CPB time(OR=5.890,95%CI:1.078-32.173)and age(OR=4.427,95%CI:1.113-17.614)were independent risk factors for AKI after surgery,andα1-AT at 1h after CPB(OR=0.084,95%CI:0.021-0.333)were protective factors after operation.Conclusion Increased concentration ofα1-AT after cardiopulmonary bypass at early time is a protective factor for AKI and the concentration ofα1-AT in plasma could be used as an early biomarker of AKI after CPB.

关 键 词：Α1-抗胰蛋白酶 急性肾损伤 体外循环 氧化应激反应 

分 类 号：R654.2[医药卫生—外科学]