摘要
目的 对比急性Stanford A型和Stanford B型主动脉夹层患者围手术期发生急性肾损伤的相关危险因素及临床特点。方法 收集2019年1月1日至2021年12月31日在新疆医科大学第一附属医院住院并确诊为急性主动脉夹层的患者资料,按照CTA影像学结果分为TAAAD患者和TBAAD患者,根据KDIGO标准又分别分为AKI组及非AKI组。比较两组间术前、术中、术后资料差异,用二元Logistic回归筛出AKI的独立危险因素,绘制ROC曲线,评估各危险因素对发生AKI的预测价值,描述AAD-AKI的患者出院时肾功能情况,给予AAD-AKI临床指导。结果 共收集464例急性主动脉夹层患者的资料,其中TAAAD患者176例,TBAAD患者288例。TAAAD患者AKI发生率为83.5%(147/176),TBAAD患者AKI发生率为41%(118/288)。多因素Logistic回归分析显示:体外循环时间、术后首次肌酐、机械通气时间、围手术期使用升压药是TAAAD患者发生AKI的独立危险因素(P<0.05)。ROC曲线显示,TAAAD-AKI与术后首次肌酐(AUC:0.857,P=0.001)的相关性最大。肾脏灌注不良、入院首次肌酐、术后首次肌酐、围手术期使用袢利尿剂是TBAAD患者发生AKI的独立危险因素(P<0.05)。ROC曲线显示,TBAAD-AKI与入院首次肌酐(AUC:0.777,P=0.004)的相关性最大。关于出院肾功能结局的研究中,只有一半的患者出院时肾功能完全恢复,TAAAD-AKI患者院内病死率更高。结论 TAAAD-AKI与TBAAD-AKI的独立危险因素有所差异,可能与它们发生AKI的机制不同有关。针对不同的因素,AKI的防治措施也有所不同。对于近一半出院时肾功能未完全恢复的患者,应该在肾病科长期随访。
Objective To compare the risk factors and clinical characteristics of acute kidney injury(AKI) in patients with Stanford A/B acute aortic dissection(AAD). Methods Between January 1,2019 and December 31,2021,464 hospitalized AAD patients were divided into two types of TAAAAD(n=176) and TBAAD(n=288) according to the imaging results of computed tomography angiography(CTA). And they were assigned into two groups of AKI and non-AKI according to the KDIGO criteria. Preoperative, intraoperative and postoperative data were compared between two groups. Independent risk factors of AKI were screened by binary Logistic regression. And receiver operating characteristic(ROC) curve was plotted for assessing the prognostic value of each risk factor for the development of AKI. Renal functions of AAD-AKI patients were recorded upon discharge.Results The incidence of AKI was 83.5%(147/176) in TAAAD patients and 41%(118/288) in TBAAD patients. Multifactorial Logistic regression analysis revealed that duration of extracorporeal circulation, initial postoperative creatinine, duration of mechanical ventilation and perioperative use of vasopressors were independent risk factors for AKI in TAAAD patients(P<0.05). Receiver operating characteristic(ROC) curve indicated that TAAAD-AKI had the greatest correlation with initial postoperative creatinine(AUC:0.857,P=0.001). Poor renal perfusion, initial creatinine on admission, initial postoperative creatinine and perioperative use of collaterals diuretics were independent risk factors for AKI in TBAAD patients(P<0.05). ROC curve indicated that TBAAD-AKI had the greatest correlation with initial creatinine at admission(AUC:0.777,P=0.004). As for renal functions at discharge, only half of them had a complete recovery of renal function at discharge and hospital mortality was higher in TAAAD-AKI patients. Conclusion Independent risk factors differ between TAAAD-AKI and TBAAD-AKI. Prevention and treatment of AKI also vary with different factors. For nearly half of patients with an incomplete recovery of renal function at discharge, long-term follow-ups should be performed.
作者
李欣赛
黄萱
褚雪倩
蒋绪燕
陈思思
李素华
Li Xin-sai;Huang Xuan;Chu Xue-qian;Jiang Xu-yan;Chen Si-si;Li Su-hua(Center of Nephrology,First Affiliated Hospital,Xinjiang Medical University,Blood Purification Quality Control Center,Xinjiang Uygur Autonomous Region,Quality Control Center of Nephrology,Xinjiang Uygur Autonomous Region,Institute of Nephrology,Xinjiang Uygur Autonomous Region,Urumqi 830011,China)
出处
《临床肾脏病杂志》
2023年第2期110-118,共9页
Journal Of Clinical Nephrology
基金
国家自然科学地区基金(81860125)
新疆医科大学研究生创新创业项目(CXCY2021004)。
