改良衰弱指数与老年患者腹腔镜肾癌根治术后发生急性肾损伤的相关性  

Correlation between modified frailty index and acute kidney injury after laparoscopic radical nephrectomy in elderly patients

作　　者：余泽森 吴文举 刘东来 陈仁富 刘俊杰 YU Zesen;WU Wenju;LIU Donglai;CHEN Renfu;LIU Junjie(Graduate School,Xuzhou Medical University,Xuzhou 221004;Department of Urology,The Affiliated Hospital of Xuzhou Medical University,Xuzhou 221002,China)

机构地区：[1]徐州医科大学研究生学院,江苏徐州221004 [2]徐州医科大学附属医院泌尿外科,江苏徐州221002

出　　处：《现代泌尿外科杂志》2024年第10期869-874,共6页Journal of Modern Urology

基　　金：江苏省“六大人才高峰”资助项目(No.WSW-051)。

摘　　要：目的探讨改良衰弱指数(mFI-5)与老年患者腹腔镜肾癌根治术后发生急性肾损伤(AKI)的相关性,为术后AKI的预防和治疗提供参考。方法回顾性分析2018年12月—2021年12月于徐州医科大学附属医院泌尿外科行腹腔镜肾癌根治术的214例老年(≥60岁)患者的临床资料,根据术前mFI-5评分将患者分为衰弱组(n=75,mFI-5≥2分)和非衰弱组(n=139,mFI-5<2分),比较两组患者术后AKI的发生率及mFI-5子项之间的差异,再根据术后早期是否发生AKI将其分为AKI组(n=77)和非AKI(n=137)组。采用单因素及多因素logistic回归分析影响术后发生AKI的危险因素,并绘制受试者工作特征(ROC)曲线检验mFI-5预测术后发生AKI的效能。结果衰弱组患者的术后AKI发生率显著高于非衰弱组(64.00%vs.20.86%,P<0.05)。单因素分析显示术后AKI发生与性别、糖尿病、高血压、非功能独立状态、衰弱和分肾肾小球滤过率(GFR)相关,多因素logistic回归分析显示,男性(OR=2.454,95%CI:1.193~5.047)、合并衰弱(OR=6.580,95%CI:3.380~12.811)、分肾GFR低(OR=0.945,95%CI:0.911~0.980)是老年患者腹腔镜肾癌根治术后发生AKI的独立危险因素(P<0.05)。mFI-5预测腹腔镜肾癌根治术后AKI的ROC曲线下面积为0.711。结论术前mFI-5评分是预测老年肾癌患者根治术后AKI发生与否的有效指标,衰弱患者术后发生AKI的风险较高,应加强术前评估和术后监测,及时干预,改善预后。Objective To explore the correlation between the 5-factor modified frailty index(mFI-5)and acute kidney injury(AKI)after laparoscopic radical nephrectomy in elderly patients with renal cancer,so as to provide reference for the prevention and treatment of postoperative AKI.Methods A retrospective analysis was conducted on the clinical data of 214 elderly patients(≥60 years)who underwent laparoscopic radical nephrectomy at our hospital during Dec.2018 and Dec.2021.Patients were divided into frail group(n=75,mFI-5≥2)and non-frail group(n=139,mFI-5<2).The incidence of AKI and sub items of mFI-5 were compared between the two groups.According to the occurrence of AKI,patients were divided into AKI group(n=77)and non-AKI group(n=137).Univariate and multivariate logistic analyses were conducted to identify risk factors of AKI.Receiver operating characteristic(ROC)curves were plotted to test the effectiveness of mFI-5 in predicting AKI.Results The incidence of AKI was significantly higher in the frail group than in the non-frail group(64.00%vs.20.86%,P<0.05).Univariate analysis showed that the incidence of AKI was related to gender,diabetes,hypertension,nonfunctional independent status,weakness and split kidney glomerular filtration rate(GFR).Multivariate logistic regression analysis showed that male(OR=2.454,95%CI:1.193—5.047),complicated weakness(OR=6.580,95%CI:3.380—12.811),and low split kidney GFR(OR=0.945,95%CI:0.911—0.980)were independent risk factors of AKI(P<0.05).The area under the ROC curve of AKI predicted by mFI-5 was 0.711.Conclusion Preoperative mFI-5 score is an effective predictor of AKI in elderly patients undergoing laparoscopic radical nephrectomy.As patients with frailty have a higher risk of AKI,preoperative evaluation and monitoring should be strengthened and timely intervention should be taken to improve the prognosis.

关 键 词：老年人 改良衰弱指数 腹腔镜肾癌根治术 急性肾损伤 

分 类 号：R692[医药卫生—泌尿科学]