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| 心脏手术术前血清脑钠肽与术后急性肾损伤的相关性分析 |
| 孙丽君1,薛澄1,孙海棚1,徐成钢1,李白翎2,徐志云2,梅长林1* |
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(1. 第二军医大学长征医院肾内科, 解放军肾脏病研究所, 上海 200003;
2. 第二军医大学长海医院胸心外科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 观察心脏手术术前血清脑钠肽(BNP)与术后急性肾损伤(AKI)间的相关性。方法 收集2012年1月至2013年1月182例在第二军医大学长海医院胸心外科行心脏手术的患者的病例资料, 手术方式包括冠状动脉旁路移植术(CABG)、瓣膜置换术、联合手术(瓣膜置换+CABG)。按术前BNP水平升序五分位法对患者进行分组。依据改善全球肾脏病预后(KDIGO) 指南最新AKI的定义和分级, 记录和统计不同BNP水平患者AKI发生率。通过受试者工作特征(ROC)曲线评估BNP水平预测AKI发生率的价值。结果 182例患者平均年龄(68.6±8.9)岁, 男性占65.9%(120/182)。手术方式:CABG 45.0%(82/182), 瓣膜置换术31.3%(57/182), 联合手术23.6%(43/182)。按BNP水平升序排列入组后发现患者年龄、基础肾功能和术前BNP水平差异有统计学意义(P<0.05)。术后AKI发生率达 33.5%(61/182), 1级AKI和总AKI的发生率随BNP水平的升高而增加(P<0.05)。以BNP水平预测AKI发生率绘制ROC曲线, 曲线下面积(AUC)为0.687 (95% CI: 0.607~0.768)。结论 心脏手术患者术前血清BNP水平与术后AKI发生率有关, 是潜在的危险分层预测指标。 |
| 关键词: 脑利钠肽 心脏手术 急性肾损伤 |
| DOI：10.3724/SP.J.1008.2015.00560 |
| 投稿时间：2015-01-13修订日期：2015-04-24 |
| 基金项目:国家自然科学基金(81100487,81000117),国家科技支撑计划(2011BAI10B00). |
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| Relationship of pre-operative serum brain natriuretic peptide with risk of acute kidney injury after cardiac surgery |
| SUN Li-jun1,XUE Cheng1,SUN Hai-peng1,XU Cheng-gang1,LI Bai-ling2,XU Zhi-yun2,MEI Chang-lin1* |
(1. Department of Nephrology, Changzheng Hospital, Second Military Medical University, Nephrology Institute of PLA, Shanghai 200003, China;
2. Department of Cardiac Surgery, Changhai Hospital, Second Military Medical University, Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To observe the relationship of pre-operative serum brain natriuretic peptide (BNP) with risk of acute kidney injury (AKI) after cardiac surgery. Methods We collected 182 patients undergoing cardiac surgery at Department of Cardiac Surgery, Changhai Hospital from Jan. 2012 to Jan. 2013. The surgical procedures included coronary artery bypass graft (CABG),valve replacement, and combined surgery (CABG+valve replacement). According to the preoperative BNP levels, the patients were divided into five groups in an ascending order. The definition and classification weres accorded to the latest AKI KDIGO (Kidney Disease: Improving Global Outcomes) guideline; the AKI incidence was obtained from patients with different BNP levels. Receiver operating characteristic (ROC) curves were used to evaluate the value of BNP level as a predictor of AKI. Results The average age of the 182 patients was (68.6±8.9) years old, with male being 65.9% (120/182). The surgery procedures including 82 CABG (45.0%),57 valve replacement (31.3%), and 43 combined surgery (CABG valve replacement) (23.6%). We found that age, basic renal function and pre-operative BNP levels were significantly different between the five BNP groups (P<0.05). The incidence of AKI was 33.5% (61/182) in this study. The incidence rates of stage 1 AKI and total AKI significantly increased with increase of BNP levels in the five BNP groups (P<0.05). As a predictor of AKI ROC curves, BNP area under the curve (AUC) was 0.687 (95% CI: 0.607-0.768). Conclusion Pre-operative BNP level is associated with post-operative AKI in high risk patients undergoing cardiac surgery, and it is a potential predictor of AKI risk stratification after cardiac surgery. |
| Key words: brain natriuretic peptide cardiac surgery acute kidney injury |
