冠状动脉旁路移植术相关急性肾损伤患者肾脏预后不良的危险因素分析  

Risk factors of poor renal prognosis in coronary artery bypass grafting surgery-associated acute kidney injury patients

作　　者：范晓光[1] 邵泽华 尤针针 霍帅 张翥 邵凤民[1] Fan Xiaoguang;Shao Zehua;You Zhenzhen;Huo Shuai;Zhang Zhu;Shao Fengmin(Department of Nephrology,Henan Provincial People's Hospital,Department of Nephrology of Central China Fuwai Hospital,Henan Provincial Clinical Research Center for Kidney Disease,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450003,China;Heart Center of Henan Provincial People's Hospital,Central China Fuwai Hospital,Central China Fuwai Hospital of Zhengzhou University,Zhengzhou 450003,China)

机构地区：[1]河南省人民医院肾内科华中阜外医院肾内科、河南省肾病临床医学研究中心、河南省肾脏病免疫重点实验室、郑州大学华中阜外医院,郑州450003 [2]河南省人民医院心脏中心华中阜外医院、郑州大学华中阜外医院,郑州450003

出　　处：《中华肾脏病杂志》2023年第8期569-575,共7页Chinese Journal of Nephrology

基　　金：河南省2022年科技发展计划(224000510005);河南省医学科技攻关计划(LHGJ20220116)。

摘　　要：目的探究冠状动脉旁路移植术(coronary artery bypass grafting,CABG)相关急性肾损伤(acute kidney injury,AKI)患者肾脏预后不良的危险因素,初步建立CABG相关AKI进展为慢性肾脏病(chronic kidney disease,CKD)的临床风险预测模型,并评估其预测效能。方法该研究为回顾性、观察性队列研究。研究对象为2018年1月1日至2020年12月31日在华中阜外医院接受CABG、基线估算肾小球滤过率(estimated glomerular filtration rate,eGFR)>60 ml·min^(-1)(1.73 m^(2))^(-1)且术后发生AKI的患者。患者出院后随访至AKI发生后90 d。研究终点事件定义为AKI发生90 d后进展为CKD。按照患者是否发生研究终点事件分为CKD组和非CKD组,比较两组患者临床资料的差异。Logistic回归模型法分析CABG相关AKI进展为CKD的危险因素,并建立临床风险预测模型,用受试者工作特征曲线下面积(AUC)评价模型的预测效能。结果124例CABG相关AKI患者入选该研究,男95例,女29例,年龄(62.57±9.61)岁,其中38例(30.6%)患者在AKI发生90 d后疾病进展为CKD。与非CKD组相比,CKD组患者术前血红蛋白(t=2.778,P=0.006)和基线eGFR(t=3.603,P<0.001)均较低,女性比例(χ^(2)=10.714,P=0.001)、术前血N端脑利尿钠肽前体(NT-proBNP,Z=-2.150,P=0.030)及出院血肌酐(Z=-5.290,P<0.001)均较高。多因素Logistic回归分析结果显示,女性(OR=5.179,95%CI 1.535~17.477,P=0.008)、术前血NT-proBNP高(OR=1.049,95%CI 1.004~1.095,P=0.032)、基线eGFR低(OR=0.928,95%CI 0.889~0.968,P=0.001)及出院时血肌酐高(OR=1.019,95%CI 1.009~1.029,P<0.001)是CABG相关AKI进展为CKD的独立影响因素。纳入性别、术前血NT-proBNP、基线eGFR和出院时血肌酐等因素建立临床风险预测模型,结果提示该模型的预测效能为中等(AUC=0.872,95%CI 0.806~0.939,P<0.001)。结论CABG相关AKI患者为新发CKD的高危人群,由性别、术前血NT-proBNP、基线eGFR及出院时血肌酐建立的临床风险预测模型有助于识别CABG相关AKI进展Objective To explore the risk factors of poor renal prognosis in patients with coronary artery bypass surgery(CABG)-associated acute kidney injury(AKI),and establish a preliminary clinical risk prediction model for chronic kidney disease(CKD)progression in CABG-associated AKI patients,and evaluate its predictive efficacy.Methods It was a retrospective,observational cohort study.The study subjects were patients who underwent CABG at Central China Fuwai Hospital from January 1,2018 to December 31,2020,with a baseline estimated glomerular filtration rate(eGFR)>60 ml·min^(-1)·(1.73 m^(2))^(-1) and postoperative complication of AKI.The patients were followed up for 90 days after discharge from hospital.The endpoint event was defined as progression to CKD after 90 days of the occurrence of CABG-associated AKI.The patients were divided into CKD group and non-CKD group based on whether they experienced endpoint events.The baseline clinical data were compared between the two groups.The logistic regression model was used to analyze the risk factors of endpoint event.The receiver-operating characteristic curve was drawn to evaluate the performance of the clinical risk prediction model for predicting poor renal prognosis in CABG-associated AKI patients.Results A total of 124 CABG-associated AKI patients were enrolled in the study,including 95 males and 29 females,aged(62.57±9.61)years old.Thirty-eight patients(30.8%)progressed to new-onset CKD 90 days after CABG-associated AKI.Compared with non-CKD group,CKD group had lower preoperative hemoglobin(t=2.778,P=0.006)and baseline eGFR(t=3.603,P<0.001),higher proportion of women(χ^(2)=10.714,P=0.001),and higher preoperative blood NT-proBNP(Z=-2.150,P=0.030)and discharged serum creatinine(Z=-5.290,P<0.001).The multivariate logistic regression analysis results revealed that female(OR=5.179,95%CI 1.535-17.477,P=0.008),high preoperative blood NT-proBNP(OR=1.049,95%CI 1.004-1.095,P=0.032),low baseline eGFR(OR=0.928,95%CI 0.889-0.968,P=0.001),and high serum creatinine at discharge(

关 键 词：冠状动脉分流术 急性肾损伤 肾功能不全 慢性 危险因素 预后 

分 类 号：R692[医药卫生—泌尿科学] R654.2[医药卫生—外科学]