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术前氨基末端脑钠肽前体(NT-proBNP)与肝移植术后急性肾损伤的关系探讨

潘乃凡 宋雪松

引用本文:
Citation:

术前氨基末端脑钠肽前体(NT-proBNP)与肝移植术后急性肾损伤的关系探讨

DOI: 10.12449/JCH240823
基金项目: 

吴阶平医学基金 (320.6750.2022-3-34)

伦理学声明:本研究方案于2022年10月28日经由吉林大学第一医院伦理委员会审批,批号:(2022年)临审第2022-525号。
利益冲突声明:本文不存在任何利益冲突。
作者贡献声明:潘乃凡负责课题设计,收集数据,资料分析,撰写论文;宋雪松负责拟定写作思路,指导撰写文章并最后定稿。
详细信息
    通信作者:

    宋雪松, songxs@jlu.edu.cn (ORCID: 0000-0003-4206-8583)

Association between preoperative N-terminal pro-brain natriuretic peptide and acute kidney injury after liver transplantation

Research funding: 

Wu Jieping Medical Foundation (320.6750.2022-3-34)

More Information
    Corresponding author: SONG Xuesong, songxs@jlu.edu.cn (ORCID: 0000-0003-4206-8583)
  • 摘要:   目的  探究术前氨基末端脑钠肽前体(NT-proBNP)与肝移植术后急性肾损伤(AKI)的关系,明确肝移植术后AKI发生的影响因素,为早期预防肝移植术后AKI的发生提供诊断学参考指标。  方法  回顾性收集吉林大学第一医院2020年9月13日—2022年6月30日行肝移植手术的成年患者病历资料。根据肝移植术后是否发生AKI将患者分为AKI组和非AKI组,采用倾向性评分匹配法(PSM)按照1∶4匹配两组患者基本信息。计量资料两组间比较采用成组t检验或Mann-Whitney U检验;计数资料两组间比较采用χ2检验或Fisher确切概率法。通过多因素Logistic回归分析肝移植术后AKI发生的独立危险因素。  结果  共纳入144例肝移植患者,术后发生AKI者22例(15.3%),未发生AKI者122例(84.7%)。经PSM平衡后共纳入93例患者,其中AKI组19例,非AKI组74例。多因素Logistic回归分析结果显示:术前NT-proBNP水平(OR=7.692,95%CI:1.473~40.159,P=0.016)、术前纤维蛋白原水平(OR=5.520,95%CI:1.160~26.267,P=0.032)、手术时长(OR=15.802,95%CI:2.418~103.268,P=0.004)和术中出血量(OR=13.246,95%CI:2.291~76.594,P=0.004)是肝移植术后患者发生AKI的独立危险因素。  结论  术前NT-proBNP水平可作为肝移植术后AKI发生的预测指标,同时能够为构建肝移植术后AKI的风险预测模型提供一定的参考价值。

     

  • 表  1  PSM前AKI组与非AKI组基本情况比较

    Table  1.   Comparison of the basic situation of the AKI and the non-AKI groups before PSM

    项目 非AKI组(n=122) AKI组(n=22) 统计值 P
    年龄(岁) 49.48±8.07 60.55±10.56 t=-5.627 0.001
    性别[例(%)] χ2=0.970 0.325
    95(77.9) 15(68.2)
    27(22.1) 7(31.8)
    BMI(kg/m2 22.80±3.29 24.73±3.33 t=-2.535 0.012
    血型[例(%)] χ2=0.445 0.931
    A型 37(30.3) 6(27.3)
    B型 39(32.0) 7(31.8)
    O型 35(28.7) 6(27.3)
    AB型 11(9.0) 3(13.6)
    合并高血压[例(%)]1) χ2=2.472 0.116
    114(94.2) 18(81.8)
    7(5.8) 4(18.2)
    合并糖尿病[例(%)]1) χ2=23.069 0.001
    98(81.0) 7(31.8)
    23(19.0) 15(68.2)
    合并冠心病[例(%)] >0.05
    119(97.5) 22(100.0)
    3(2.5) 0(0.0)
    合并肺部疾病[例(%)] χ2=0.025 0.875
    112(91.8) 21(95.5)
    10(8.2) 1(4.5)
    脂肪性肝病[例(%)] χ2=0.420 0.517
    109(89.3) 18(81.8)
    13(10.7) 4(18.2)
    病毒性肝炎[例(%)] 0.414
    甲型 46(37.7) 10(45.5)
    乙型 73(59.8) 11(50.0)
    丙型 3(2.5) 1(4.5)
    自身免疫性肝病[例(%)] χ2=1.443 0.230
    109(89.3) 22(100.0)
    13(10.7) 0(0.0)
    中毒性肝病[例(%)] χ2=0.014 0.905
    115(94.3) 20(90.9)
    7(5.7) 2(9.1)
    其他病因[例(%)] χ2=1.195 0.274
    108(88.5) 17(77.3)
    14(11.5) 5(22.7)
    既往腹部手术史[例(%)] χ2=2.317 0.128
    103(84.4) 15(68.2)
    19(15.6) 7(31.8)
    合并肝性脑病[例(%)] χ2=2.262 0.133
    107(87.7) 16(72.7)
    15(12.3) 6(27.3)

    注:1),非AKI组在数据收集过程中1例患者缺失此项数据。

    下载: 导出CSV

    表  2  PSM后AKI组与非AKI组基本情况比较

    Table  2.   Comparison of the basic situation of the AKI and the non-AKI groups after PSM

    项目 非AKI组(n=74) AKI组(n=19) 统计值 P
    年龄(岁) 49.64±8.72 51.42±6.27 t=-0.838 0.404
    性别[例(%)] χ2=0.228 0.633
    57(77.0) 13(68.4)
    17(23.0) 6(31.6)
    BMI(kg/m2 22.66±2.93 23.23±1.76 t=-0.800 0.426
    血型[例(%)] χ2=0.006 >0.05
    A型 20(27.0) 5(26.3)
    B型 23(31.1) 6(31.6)
    O型 23(31.1) 6(31.6)
    AB型 8(10.8) 2(10.5)
    合并高血压[例(%)] χ2=2.928 0.087
    70(94.6) 15(78.9)
    4(5.4) 4(21.1)
    合并糖尿病[例(%)] χ2=1.847 0.174
    60(81.1) 12(63.2)
    14(18.9) 7(36.8)
    合并冠心病[例(%)] >0.05
    72(97.3) 19(100.0)
    2(2.7) 0(0.0)
    合并肺部疾病[例(%)] χ2=0.000 >0.05
    70(94.6) 18(94.7)
    4(5.4) 1(5.3)
    脂肪性肝病[例(%)] χ2=0.000 >0.05
    64(86.5) 16(84.2)
    10(13.5) 3(15.8)
    病毒性肝炎[例(%)] 0.368
    甲型 30(40.5) 10(52.6)
    乙型 42(56.8) 8(42.1)
    丙型 2(2.7) 1(5.3)
    自身免疫性肝病[例(%)] χ2=0.822 0.365
    67(90.5) 19(100.0)
    7(9.5) 0(0.0)
    中毒性肝病[例(%)] χ2=0.000 >0.05
    70(94.6) 18(94.7)
    4(5.4) 1(5.3)
    其他病因[例(%)] χ2=1.391 0.238
    65(87.8) 14(73.7)
    9(12.2) 5(26.3)
    既往腹部手术史[例(%)] χ2=0.647 0.421
    66(89.2) 15(78.9)
    8(10.8) 4(21.1)
    合并肝性脑病[例(%)] χ2=0.093 0.761
    63(85.1) 15(78.9)
    11(14.9) 4(21.1)
    下载: 导出CSV

    表  3  PSM后AKI组与非AKI组围手术期临床资料比较

    Table  3.   Comparison of perioperative clinical data of the AKI and the non-AKI groups after PSM

    项目 非AKI组(n=74) AKI组(n=19) 统计值 P
    术前临床资料
    eGFR(mL·min-1·1.73m-2 112.13±13.88 109.66±12.91 t=1.721 0.087
    BUN(mmol/L) 4.84±1.88 5.26±2.11 t=-0.842 0.402
    Scr(μmol/L) 58.77±14.98 65.57±14.37 t=-1.780 0.078
    TBil(μmol/L) 47.15(23.45~164.20) 54.90(38.50~188.00) Z=-1.077 0.282
    AST(U/L) 40.25(29.33~74.43) 44.70(39.10~61.20) Z=-0.634 0.526
    ALT(U/L) 22.70(17.15~41.50) 26.80(17.20~39.00) Z=-0.400 0.689
    白蛋白(g/L) 109.93±47.62 129.47±60.96 t=-1.503 0.136
    血红蛋白(g/L) 101.18±29.63 110.05±26.53 t=-1.187 0.238
    血小板(109/L) 55.00(39.00~81.25) 64.00(43.00~126.00) Z=-1.452 0.146
    CRP(mg/L) 8.92(3.26~18.41) 8.69(3.07~23.58) Z=-1.306 0.192
    NT-proBNP(pg/mL) 89.60(53.65~164.25) 388.90(319.00~454.00) Z=-5.584 0.001
    纤维蛋白原(g/L) 1.93±0.81 1.13±0.40 t=4.205 <0.001
    INR 1.42±0.31 1.58±0.46 t=-0.610 0.543
    空腹血糖(mmol/L) 7.16±2.97 6.88±2.32 t=0.393 0.695
    Cl(mmol/L) 104.52±5.17 105.16±5.41 t=-0.478 0.634
    Na(mmol/L) 137.83±5.65 137.46±4.49 t=0.267 0.790
    Ca(mmol/L) 2.19±0.14 2.14±0.12 t=1.514 0.133
    K(mmol/L) 3.87±0.43 4.00±0.43 t=-1.166 0.247
    血氨(μmol/L) 38.00(24.75~55.25) 37.00(26.00~55.00) Z=-0.534 0.593
    术中临床资料
    手术时长(min) 497.77±66.61 595.47±102.99 t=-5.051 0.001
    CVP(cmH2O) 10.28±1.89 10.82±2.50 t=-1.051 0.296
    MAP(mmHg) 83.30±6.30 84.93±6.31 t=-1.009 0.316
    心率(次/min) 83.02±6.84 86.31±7.82 t=-1.819 0.072
    输液总量(mL) 6 321.62±1 570.32 7 271.05±2 232.86 t=-1.746 0.094
    人血清白蛋白(g) 115.00(97.50~140.00) 130.00(100.00~160.00) Z=-1.584 0.113
    红细胞(U) 10.00(5.38~14.00) 14.00(6.00~22.00) Z=-1.902 0.057
    血浆(mL) 1 225.00(817.50~1 907.50) 1 720.00(840.00~2 200.00) Z=-1.536 0.124
    血小板(U) 1.00(0.00~2.00) 1.00(0.00~1.00) Z=-0.327 0.744
    凝血酶原复合物(IU) 500.00(0.00~925.00) 600.00(0.00~1 200.00) Z=-0.716 0.474
    纤维蛋白原(g) 1.50(0.00~2.50) 2.00(0.00~2.50) Z=-1.236 0.216
    冷沉淀(U) 9.00(0.00~16.38) 10.00(0.00~19.50) Z=-0.730 0.465
    自体血(mL) 0.00(0.00~401.25) 0.00(0.00~0.00) Z=-1.046 0.296
    出血量(mL) 2 000.00(1 175.00~3 000.00) 3 900.00(3 000.00~6 000.00) Z=-4.506 0.001
    尿量(mL) 1 900.00(1 500.00~2 225.00) 1 600.00(1 200.00~2 000.00) Z=-1.533 0.125
    麻醉方法[例(%)] >0.05
    全凭静脉麻醉 4(5.4) 1(5.3)
    静吸复合麻醉 70(94.6) 18(94.7)
    吸入麻醉 0(0.0) 0(0.0)
    ASA分级[例(%)] χ2=1.618 0.445
    3(4.1) 1(5.3)
    61(82.4) 12(63.2)
    10(13.5) 6(31.6)
    麻醉时长(min) 579.41±76.61 634.68±120.32 t=-1.906 0.070
    葡萄糖酸钙(g) 0.00(0.00~0.00) 0.00(0.00~1.00) Z=-1.340 0.180
    KCl(g) 0.00(0.00~0.00) 0.00(0.00~0.00) Z=-0.246 0.806
    CaCl2(g) 2.05(1.43~2.93) 2.10(1.50~2.70) Z=-0.521 0.603
    5%碳酸氢钠(mL) 100.00(0.00~170.00) 150.00(70.00~250.00) Z=-1.712 0.087
    胰岛素(IU) 0.00(0.00~0.00) 0.00(0.00~0.00) Z=-1.932 0.053
    呋塞米(mg) 10.00(0.00~20.00) 20.00(10.00~40.00) Z=-1.460 0.144
    甘露醇(mL) 0.00(0.00~0.00) 0.00(0.00~0.00) Z=-0.573 0.567
    术后临床资料
    术后48 h Scr(μmol/L) 73.00(59.68~96.65) 79.30(72.50~88.80) Z=-0.920 0.358
    术后7 d Scr(μmol/L) 77.55(66.23~99.83) 79.30(72.50~108.20) Z=-0.562 0.574
    术后NT-proBNP(pg/mL) 932.50(496.00~1 807.50) 1 440.00(568.00~4 250.00) Z=-1.472 0.141
    术后机械通气时间(d) 1.00(1.00~1.00) 1.00(1.00~2.00) Z=-1.794 0.073
    术后感染[例(%)] χ2=1.391 0.238
    65(87.8) 14(73.7)
    9(12.2) 5(26.3)
    术后转入ICU[例(%)] χ2=0.995 0.318
    67(90.5) 15(78.9)
    7(9.5) 4(21.1)
    术后普通病房住院时间(d) 16.00±5.70 18.79±8.10 t=-1.414 0.171
    术后ICU住院时间(d) 0.00(0.00~0.00) 0.00(0.00~2.00) Z=-1.636 0.102
    下载: 导出CSV

    表  4  影响肝移植术后AKI发生的多因素Logistic分析

    Table  4.   Multivariate Logistic analysis of the occurrence of AKI after liver transplantation

    项目 β SE Wald P OR 95%CI
    术前纤维蛋白原 1.708 0.796 4.608 0.032 5.520 1.160~26.267
    术前NT-proBNP 2.040 0.843 5.854 0.016 7.692 1.473~40.159
    手术时长 2.760 0.958 8.305 0.004 15.802 2.418~103.268
    术中出血量 2.584 0.895 8.327 0.004 13.246 2.291~76.594
    常量 -7.155 1.541 21.565 0.001 0.001
    下载: 导出CSV
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  • 收稿日期:  2023-11-08
  • 录用日期:  2024-01-02
  • 出版日期:  2024-08-25
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