非体外循环冠状动脉旁路移植术后急性肾损伤列线图预测模型的建立  

Nomogram model for predicting acute kidney injury after off-pump coronary artery bypass grafting

作　　者：柯燕容 杨琦[2] 朱家全[2] 胡宁宁 戴选彤 林芙君[1] 蒋更如[1] KE Yan-rong;YANG Qi;ZHU Jia-quan;HU Ning-ning;DAI Xuan-tong;LIN Fu-jun;JIANG Geng-ru(Department of Nephrology,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China;Department of Cardiothoracic Surgery,Xinhua Hospital,Shanghai Jiao Tong University School of Medicine,Shanghai 200092,China)

机构地区：[1]上海交通大学医学院附属新华医院肾脏科,上海200092 [2]上海交通大学医学院附属新华医院心胸外科,上海200092

出　　处：《中华实用诊断与治疗杂志》2023年第5期471-475,共5页Journal of Chinese Practical Diagnosis and Therapy

基　　金：上海市卫生健康委员会卫生行业临床研究专项(201940255)。

摘　　要：目的 分析非体外循环冠状动脉旁路移植术(off-pump coronary artery bypass grafting, OPCABG)后发生急性肾损伤(acute kidney injury, AKI)的危险因素,建立列线图预测模型。方法 409例行OPCABG术患者,根据术后是否发生AKI分为AKI组和非AKI组。比较2组年龄、既往病史、术前血肌酐、术后中心静脉压等临床资料;采用多因素logistic回归分析OPCABG术后发生AKI的影响因素;根据影响因素建立预测OPCABG术后AKI发生风险的列线图模型,采用Bootstrap法对原始队列进行内部验证,分别绘制校准曲线和ROC曲线评估模型的校准度和区分度,并与Cleveland评分、RAKIS评分进行比较。结果 (1)409例患者术后发生AKI 66例(16.1%)。(2)AKI组年龄≥65岁、慢性肾脏病、糖尿病、缺血性脑卒中、术前尿蛋白>300 mg/L、术前血肌酐>97μmol/L、术前应用主动脉内球囊反搏、术后中心静脉压>14 cm H_(2)O比率(71.2%、13.6%、51.5%、22.7%、13.6%、34.8%、21.2%、47.0%)均高于非AKI组(48.1%、1.5%、38.5%、11.4%、5.2%、7.0%、7.9%、25.1%)(P<0.05),术前血红蛋白水平[126.0(112.5,136.5)g/L]、术前估算肾小球滤过率[70.7(49.9,90.6)mL/(min·1.73 m^(2))]、术后左室射血分数[59.0(53.0,65.0)%]均低于非AKI组[137.0(126.0,147.0)g/L、93.8(77.9,110.9)mL/(min·1.73 m^(2))、62.0(57.0,67.0)%](P<0.05),男性、高血压、既往心脏手术、急诊手术、术后中心静脉压<6 cm H_(2)O比率及体质量指数、移植血管数与非AKI组比较差异均无统计学意义(P>0.05)。(3)年龄(OR=2.150,95%CI:1.128~4.096,P=0.020)、缺血性脑卒中(OR=2.172,95%CI:1.027~4.593,P=0.042)、术前血红蛋白(OR=0.981,95%CI:0.965~0.997,P=0.021)、术前血肌酐(OR=5.626,95%CI:2.708~11.689,P<0.001)、术前应用主动脉内球囊反搏(OR=2.440,95%CI:1.086~5.478,P=0.031)、术后中心静脉压(OR=2.178,95%CI:1.170~4.052,P=0.014)是OPCABG术后发生AKI的影响因素。(4)根据影响因素建立预测OPCABG术后AKI发生风险的列线图模型,列线�Objective To analyze the risk factors of acute kidney injury(AKI)after off-pump coronary artery bypass grafting(OPCABG)and to establish a nomogram prediction model.Methods Totally 409patients undergoing OPCABG were divided into AKI and non-AKI groups according to the occurrence of AKI after surgery,and the clinical data such as age,previous medical history,preoperative serum creatinine and postoperative central venous pressure were compared.The influencing factors of AKI after OPCABG were analyzed by multivariate logistic regression.A nomogram model was established based on the influencing factors to predict the risk of AKI after OPCABG.Bootstrap method was used for internal validation of the original cohort.The calibration curves and ROC curves were plotted to assess the calibration and discrimination of the model.The nomogram model was compared with Cleveland score and RAKIS score.Results(1)Postoperative AKI occurred in 66(16.1%)of 409patients.(2)The percentages of patients aged≥65years,and with chronic kidney disease,diabetes mellitus,ischemic stroke,preoperative urine protein300 mg/L,preoperative serum creatinine>97μmol/L,preoperative use of intra-aortic balloon counter-pulsation,and postoperative central venous pressure>14cm H_(2)O were higher in AKI group(71.2%,13.6%,51.5%,22.7%,13.6%,34.8%,21.2%,47.0%)than those in non-AKI group(48.1%,1.5%,38.5%,11.4%,5.2%,7.0%,7.9%,25.1%)(P<0.05),the preoperative hemoglobin level,preoperative estimated glomerular filtration rate,and postoperative left ventricular ejection fraction were lower in AKI group[126.0(112.5,136.5)g/L,70.7(49.9,90.6)mL/(min·1.73 m^(2)),59.0(53.0,65.0)%]than those in non-AKI group[137.0(126.0,147.0)g/L,93.8(77.9,110.9)mL/(min·1.73m^(2)),62.0(57.0,67.0)%](P<0.05),and there were no significant differences in the percentages of male patients and patients with hypertension,previous cardiac surgery,emergency surgery and postoperative central venous pressure6cm H_(2)O,the body mass index,and the number of transplanted vessels between two groups(P<0.

关 键 词：非体外循环冠状动脉旁路移植术 急性肾损伤 列线图模型 

分 类 号：R654.2[医药卫生—外科学] R692[医药卫生—临床医学]