急性Stanford A型主动脉夹层患者术后发生急性肾损伤的影响因素及术前尿NGAL联合血清β2-MG、Mb的预测价值  

Influencing Factors of Postoperative Acute Kidney Injury in Patients with Acute Stanford Type A Aortic Dissection and the Predictive Value of Preoperative Urine NGAL Combined with Serum β2-MG and Mb

作　　者：陈晴晴 曾智慧 樊小倩 朱童 管玉珍 CHEN Qing-qing;ZENG Zhi-hui;FAN Xiao-qian;ZHU Tong;GUAN Yu-zhen(Department of Cardiovascular Surgery,Jiangsu Provincial People's Hospital/The First Affiliated Hospital of Nanjing Medical University,Nanjing,Jiangsu,221000,China)

机构地区：[1]江苏省人民医院/南京医科大学第一附属医院心脏大血管外科,江苏南京221000

出　　处：《现代生物医学进展》2022年第24期4654-4658,共5页Progress in Modern Biomedicine

基　　金：江苏省自然科学基金项目(BK201506417)。

摘　　要：目的:探讨急性Stanford A型主动脉夹层(TAAD)患者术后发生急性肾损伤(AKI)的影响因素,分析术前尿中性粒细胞明胶酶相关脂质转运蛋白(NGAL)联合血清β2-微球蛋白(β2-MG)、肌红蛋白(Mb)对术后AKI的预测价值。方法:选择2019年1月至2022年1月我院收治的100例TAAD患者,根据术后是否发生AKI将患者分为AKI组(38例)和非AKI组(62例),检测并比较两组术前尿NGAL、血清β2-MG、Mb水平。分析TAAD患者术后发生AKI的影响因素,以及术前尿NGAL联合血清β2-MG、Mb对TAAD患者术后发生AKI的预测价值。结果:AKI组术前尿NGAL、血清β2-MG、Mb水平均高于非AKI组(P<0.05)。AKI组体质量指数(BMI)、肾动脉受累比例、术中尿量、术中输血量、术前血肌酐(Scr)水平均高于非AKI组,体外循环时间、深低温停循环时间长于非AKI组,年龄大于非AKI组(P<0.05)。多因素Logistic回归分析结果显示:肾动脉受累、体外循环时间过长、术前Scr、尿NGAL、血清β2-MG、Mb水平较高是TAAD患者术后发生AKI的危险因素(P<0.05)。术前尿NGAL联合血清β2-MG、Mb预测TAAD患者术后发生AKI的曲线下面积为0.847,明显高于三指标单独检测的0.689、0.678、0.677(P<0.05)。结论:术前尿NGAL、血清β2-MG、Mb水平较高、肾动脉受累、体外循环时间过长是TAAD患者术后发生AKI的危险因素,联合检测术前尿NGAL、血清β2-MG、Mb水平对术后AKI的发生具有一定预测价值。Objective: To investigate the influencing factors of postoperative acute kidney injury(AKI) in patients with acute Stanford Type A aortic dissection(TAAD), and to analyze the predictive value of preoperative neutrophil gelatinase-associated lipid transporter(NGAL) combined with serum β2-microglobulin(β2-MG) and myoglobin(Mb) in postoperative AKI. Methods: 100 patients with TAAD who were treated in our hospital from January 2019 to January 2022 selected, and they were divided into AKI group(38cases) and non-AKI group(62 cases) according to the occurrence of postoperative AKI. Preoperative urinary NGAL and serum β2-MG,Mb levels were detected and compared between the two groups. The influencing factors of the occurrence of postoperative AKI in patients with TAAD were analyzed, and the predictive value of preoperative urinary NGAL combined with serum β2-MG and Mb for the occurrence of postoperative AKI in patients with TAAD was analyzed. Results: The preoperative urinary NGAL, serum β2-MG and Mb levels in AKI group were higher than those in non-AKI group(P <0.05). Body mass index(BMI), renal artery involvement ratio,intraoperative urine volume, intraoperative blood transfusion volume, preoperative serum creatinine(Scr) levels in AKI group were higher than those in non-AKI group, and the time of cardiopulmonary bypass and deep low temperature cycle stop time were longer than those in non-AKI group, and the age was longer than that in non-AKI group(P<0.05). Multivariate Logistic regression analysis showed that renal artery involvement, long time of cardiopulmonary bypass, preoperative Scr, urinary NGAL, high levels of serum β2-MG and Mb were the risk factors for the occurrence of postoperative AKI in patients with TAAD(P<0.05). The area under curve of preoperative urine NGAL combined with serum β2-MG and Mb for predicting the occurrence of postoperative AKI in patients with TAAD was 0.847,which was significantly higher than 0.689, 0.678 and 0.677 of the three indicators alone(P <0.05). Conclusion: High preoperat

关 键 词：急性Stanford A型主动脉夹层 急性肾损伤 NGAL β2-MG MB 危险因素 预测价值 

分 类 号：R543.1[医药卫生—心血管疾病] R692[医药卫生—内科学]