经胸超声心动图对心脏瓣膜术后患者合并急性肾损伤的影响因素分析  

The Predictive Value of Transthoracic Echocardiography for Acute Kidney Injury in Patients Underwent Cardiac Valve Surgery

作　　者：陈婷 吕蕾 王琦[1] 胡玉刚 郭娟[1] 曹省[1] 周青[1] 陈金玲[1] Chen Ting;LüLei;Wang Qi;Hu Yugang;Guo Juan;Cao Sheng;Zhou Qing;Chen Jinling(Department of Ultrasound Imaging,Renmin Hospital of Wuhan University,Wuhan 430061,China)

机构地区：[1]武汉大学人民医院超声影像科,湖北武汉430061

出　　处：《巴楚医学》2023年第3期68-74,共7页Bachu Medical Journal

基　　金：湖北省卫生和计划生育委员会青年人才项目(No:WJ2015Q016)。

摘　　要：目的:探讨术前经胸超声心动图(TTE)在心脏瓣膜术后患者合并急性肾损伤中的影响因素。方法:回顾性分析2020年1月-2021年12月在武汉大学人民医院行心脏瓣膜术(CVS)的213例患者临床资料,所有患者均于术前7天内进行超声心动图检查并记录其参数。将所有患者分为非急性肾损伤(非AKI)组和AKI组,采用多因素Logistic回归分析影响CVS患者合并AKI的独立危险因素。绘制受试者工作特征曲线(ROC),评估各危险因素对CVS患者合并AKI的预测价值。结果:213例CVS患者中66例(30.99%)术后发生AKI,多因素Logistic回归分析结果显示年龄增大、体外循环时间延长、糖尿病、左室后壁厚度(LVPW)升高、肺动脉收缩压(PASP)升高是CVS患者合并AKI的独立危险因素,肾小球滤过率(eGFR)升高及左室射血分数(LVEF)升高是CVS患者合并AKI的独立保护因素。ROC曲线显示,LVPW、PASP和LVEF对CVS患者术后AKI发病具有一定的预测价值,其AUC分别为:0.689(95%CI:0.579,0.789),0.692(95%CI:0.595,0.800)和0.712(95%CI:0.615,0.822),三者联合预测AKI的AUC为0.758(95%CI:0.689,0.828)。结论:年龄增大、体外循环时间延长、糖尿病、LVPW和PASP升高是CVS患者合并AKI的独立危险因素,而eGFR和LVEF升高则是独立保护因素。TTE作为一种简便易行的检测手段,可用于CVS患者术后合并AKI的诊断和评估。Objective:To investigate the influence factors of preoperative transthoracic echocardiography(TTE)in patients with acute kidney injury after cardiac valve surgery.Methods:A total of 213 patients who underwent cardiac valve surgery(CVS)at Renmin Hospital of Wuhan University from January 2020 to December 2021 were recruited in this retrospective study.TTE assessments were performed within 7 days before surgery.All patients were divided into the non-acute kidney injury(non-AKI)group and the AKI group.The independent risk factors for AKI in CVS patients were analyzed using multivariate Logistic regression.Then the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of these factors.Results:Among 213 patients,there were 66 cases(30.99%)of postoperative AKI.The results of multivariate Logistic regression analysis showed that advanced age,prolonged cardiopulmonary bypass,diabetes,increased left ventricular posterior wall thickness(LVPW),elevated pulmonary artery systolic pressure(PASP)were independent risk factors for AKI in patients underwent CVS.Increased estimated glomerular filtration rate(eGFR)and left ventricular ejection fraction(LVEF)were independent protective factors for AKI in patients with CVS.The ROC curve showed that LVPW,PASP,and LVEF have certain predictive value for postoperative AKI in CVS patients,with AUC values of 0.689(95%CI:0.579,0.789),0.692(95%CI:0.595,0.800),and 0.712(95%CI:0.615,0.822),respectively.The AUC value of LVPW,PASP combined with LVEF for predicting AKI is 0.758(95%CI:0.689,0.828).Conclusion:The advanced age,prolonged cardiopulmonary bypass,diabetes,higher LVPW and PASP are independent risk factors,while elevated eGFR and LVEF are independent protective factors for CVS patients with AKI.TTE,as a simple and feasible detection method,can be used for the diagnosis and evaluation of postoperative AKI in CVS patients.

关 键 词：超声心动图 心脏瓣膜手术 急性肾损伤 预测 

分 类 号：R445.1[医药卫生—影像医学与核医学]