中性粒细胞百分比/白蛋白比值与心脏手术后急性肾损伤的关系  

Association between Neutrophil-percentage-to-albumin ratio and acute kidney injury in patients with cardiac surgery

作　　者：胡鹏华 储虹 蒋芬 陈源汉[3] 吴燕华 宋利 张丽[3] 李锐钊[3] 李志莲[3] 梁馨苓[3] 梁华般 Hu Penghua;Chu Hong;Jiang Fen;Chen Yuanhan;Wu Yanhua;Song Li;Zhang Li;Li Ruizhao;Li Zhilian;Liang Xinling;Liang Huaban(Division of Nephrology,The Affiliated Yixing Hospital of Jiangsu University,Yixing 214200,China;Division of Nephrology,The Third Affiliated Hospital,Southern Medical University,Guangzhou 510610,China;Department of Nephrology,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China;Department of Geriatric Nephrology,Guangdong Provincial Geriatrics Institute,Guangdong Provincial People's Hospital(Guangdong Academy of Medical Sciences),Southern Medical University,Guangzhou 510080,China)

机构地区：[1]江苏大学附属宜兴医院肾内科,无锡214200 [2]南方医科大学第三附属医院肾内科,广州510610 [3]南方医科大学附属广东省人民医院(广东省医学科学院)肾内科,广州510080 [4]南方医科大学附属广东省人民医院(广东省医学科学院)广东省老年病学研究所老年病科,广州510080

出　　处：《中华胸心血管外科杂志》2025年第1期30-35,共6页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(82270712)。

摘　　要：目的探讨中性粒细胞百分比/白蛋白比(NPAR)与心脏手术后急性肾损伤(AKI)之间的关系。方法回顾性分析广东省人民医院2006年1月1日至2018年12月31日期间所有接受体外循环心脏手术的成年患者临床资料。共入组24178例患者,其中7266例(30.1%)发生AKI。根据是否发生AKI将患者分为AKI组(7266例)和非AKI组(16912例),分组研究患者的基线特征,比较各变量间差异。根据NPAR的四分位数,将患者分为4组:Q1组6045例(NPAR≤1.32)、Q2组6044例(1.32<NPAR≤1.55)、Q3组6044例(1.55<NPAR≤1.97)、Q4组6045例(NPAR>1.97)。采用logistic回归分析,以Q3组为参考组,开发多个模型校正混杂变量,评估NPAR与心脏术后AKI间的关系;另采用限制性立方样条(RCS)分析连续性NPAR与AKI的关系。结果与非AKI组比较,AKI组的男性、左心室射血分数(LVEF)≤0.60、估算肾小球滤过率≤90 ml·min-1·1.73 m-2、高血压病、糖尿病、急诊手术、术前危重状态和术后再次手术的比例更高,患者的年龄、血尿酸、体外循环时间、术后机械通气时间更高或更长。采用logisitc回归校正混杂因素后,相较于Q3组,Q1组和Q4组发生AKI的OR值分别为1.395(1.265,1.540)和1.611(1.455,1.785)。RCS示NPAR与AKI呈U型,NPAR为1.77时发生AKI的风险最低。NPAR<1.77时,NPAR每增加1个标准差,AKI的发生风险减少23.2%,反之增加25.9%。结论心脏手术前NPAR过低或过高均提示术后AKI的发生风险增加,二者呈U型关系。NPAR作为一种经济有效的工具,可用于早期识别AKI风险个体。ObjectiveAcute kidney injury(AKI)is a common complication after cardiac surgery,and associated with increased risk of development of chronic kidney disease and mortality in the long term.Neutrophil percentage-to-albumin ratio(NPAR)is a new inflammatory marker that has been used to predict the poor prognosis of patients with cardiovascular disease or shock.However,the relationship between NPAR and AKI in patients with cardiac surgery has not been established.The aim was to evaluate the relationship between NPAR and AKI after cardiac surgery.MethodsData of all adult patients underwent cardiac surgery with cardiopulmonary bypass from January 1,2006 to December 31,2018 were extracted from electronic medical record system of the Guangdong Provincial People's Hospital and retrospectively analyzed.The outcome of interest was AKI diagnosed by using the criteria of Kidney Disease Improving Global Outcomes.Logistic regression was used to assess the relationship between NPAR and postoperative AKI while adjust for potential confounders.In addition,restricted cubic spline(RCS)was utilized to provide a flexible description of the association of the preoperative NPAR and AKI.ResultsTotally,24178 patients were analyzed.The incidence of AKI was 30.1%.Compared with patients without AKI,those with AKI were older and had higher rates of males,left ventricular ejection fraction(LVEF)less than or equal to 0.60,estimated glomerular filtration rate less than 90 ml·min-1·1.73 m-2,hypertension,diabetes,emergency surgery,preoperative critical illness,and reoperation.The baseline serum creatinine,serum uric acid,cardiopulmonary bypass time and postoperative mechanical ventilation time were higher or longer in AKI patients than those in none AKI patients.Then,patients were divided into four groups based on NPAR quartiles.After adjusting for confounding factors using logisitc regression,compared with patients with NPAR in group 3(1.55<NPAR≤1.97),the odds ratios(OR)and 95%confidence intervals(95%CI)of AKI were 1.395(1.265,1.540)in patients

关 键 词：心脏手术 急性肾损伤 中性粒细胞百分比/白蛋白比值 危险因素 

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