特发性肺纤维化肺移植受者术后急性肾损伤对早期预后的影响  

Effect of acute kidney injury on near-term prognosis of the recipients with idiopathic pulmonary fibrosis after lung transplantation

作　　者：胡春兰 王净 李小杉 于慧智 许波 黄东晓 刘峰 胡春晓 陈静瑜 Hu Chunlan;Wang Jing;Li Xiaoshan;Yu Huizhi;Xu Bo;Huang Dongxiao;Liu Feng;Hu Chunxiao;Chen Jingyu(Department of Anesthesiology,The Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China;Wuxi Lung Transplant Center,The Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China;Department of Transplantation Anesthesiology,The Affiliated Wuxi People's Hospital of Nanjing Medical University,Wuxi 214023,China)

机构地区：[1]南京医科大学附属无锡人民医院麻醉科,无锡214023 [2]南京医科大学附属无锡人民医院肺移植中心,无锡214023 [3]南京医科大学附属无锡人民医院移植麻醉科,无锡214023

出　　处：《中华器官移植杂志》2023年第5期283-290,共8页Chinese Journal of Organ Transplantation

基　　金：国家自然科学基金(82070059);江苏省科技计划重点研发项目(BE2022697)。

摘　　要：目的探讨术后急性肾损伤(acute kidney injury, AKI)对特发性肺纤维化(idiopathic pulmonary fibrosis, IPF)肺移植受者术后早期生存的影响。方法回顾性分析2017年1月至2021年4月在南京医科大学附属无锡人民医院进行肺移植的275例IPF受者的临床资料, 根据改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes, KDIGO)制定的AKI的诊断标准, 将受者分为AKI组(169例)和非AKI组(106例)。分析比较两组受者术前、术中相关指标, 并通过单因素及多因素Cox回归模型了解AKI对术后生存结局的影响。同时根据KDIGO将AKI分期, 分别检验1期、2期、3期AKI对术后早期预后的影响。结果全部275例IPF肺移植受者中术后发生AKI的受者169例(61.5%), 其中AKI 1期59例(34.9%), AKI 2期54例(32.0%), AKI 3期56例(33.1%), 未发生AKI的106例(38.5%)。受者性别、肌酐、6分钟步行试验、用力肺活量(forced vital capacity, FVC)、肺分配评分(lung allocation score, LAS)、氧合指数、N端脑钠肽前体(n-terminal pro-brain natriuretic peptide, NT-pro BNP)、激素使用、术中晶体输注量等在两组中的差异有统计学意义(均P<0.05)。单因素分析发现AKI对IPF肺移植受者术后30 d、90 d、180 d和365 d的存活率均有影响(P<0.05)。多因素Cox回归校正相关协变量后, AKI 1期对受者术后1年存活率的影响均无统计学意义(均P<0.05)。AKI 2、3期对术后30 d、90 d、180 d和365 d死亡风险的影响均有统计学意义(均P>0.05)。结论 AKI是IPF肺移植受者术后常见的并发症, 其中AKI 2期和3期对移植受者术后早期生存的影响较大, AKI 1期与死亡率增加无关。Objective To explore the effect of acute kidney injury(AKI)on near-term survival after lung transplantation(LT)in patients with idiopathic pulmonary fibrosis(IPF).Methods Through consulting electronic medical records,anesthetic modes and Chinese Lung Transplant Registration System,clinical data are retrospectively reviewed for 275 IPF patients undergoing LT at Affiliated Wuxi People's Hospital of Nanjing Medical University from January 2017 to April 2021.According to the diagnostic criteria of Kidney Disease:Improving Global Outcomes(KDIGO),they are divided into two groups of AKI(169 cases)and non-AKI(106 cases).Perioperative findings of two groups are recorded.Then univariate and multivariate Cox regression models are employed for determining whether or not inter-group differences existed in survival rates post-LT.Also AKI is staged according to the KDIGO.And the effect of stage 1/2/3 AKI on near-term postoperative prognosis is examined.Results The differences are significantly different in recipient gender,creatinine,6-minute walking test,forced vital capacity(FVC),lung allocation score,oxygenation index,N-terminal pro-brain natriuretic peptide(NT-Pro BNP),preoperative hormone use and volume of crystal infusion(P<0.05).After multivariate Cox regression correcting for covariates,no statistical significance exists in effect of AKI stage 1 on near-term postoperative survival rate(P<0.05).AKI stage 2/3 still has statistical significance in risk of mortality at Day 30/90/180/365 post-operation(P>0.05).Conclusions As a common complication post-LT,AKI significantly affects near-term postoperative prognosis of transplant IPF patients.Stage 2/3 AKI impacts near-term postoperative survival while stage 1 AKI is not associated with higher mortality.

关 键 词：肺移植 急性肾损伤 特发性肺纤维化 

分 类 号：R655.3[医药卫生—外科学] R692[医药卫生—临床医学]