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目的：探讨术前经胸超声心动图(TTE)在心脏瓣膜术后患者合并急性肾损伤中的影响因素。方法：回顾性分析2020年1月-2021年12月在武汉大学人民医院行心脏瓣膜术(CVS)的213例患者临床资料，所有患者均于术前7天内进行超声心动图检查并记录其参数。将所有患者分为非急性肾损伤(非AKI)组和AKI组，采用多因素Logistic回归分析影响CVS患者合并AKI的独立危险因素。绘制受试者工作特征曲线(ROC),评估各危险因素对CVS患者合并AKI的预测价值。结果：213例CVS患者中66例(30.99%)术后发生AKI,多因素Logistic回归分析结果显示年龄增大、体外循环时间延长、糖尿病、左室后壁厚度(LVPW)升高、肺动脉收缩压(PASP)升高是CVS患者合并AKI的独立危险因素，肾小球滤过率(eGFR)升高及左室射血分数(LVEF)升高是CVS患者合并AKI的独立保护因素。ROC曲线显示，LVPW、PASP和LVEF对CVS患者术后AKI发病具有一定的预测价值，其AUC分别为：0.689(95%CI:0.579,0.789),0.692(95%CI:0.595,0.800)和0.712(95%CI:0.615,0.822),三者联合预测AKI的AUC为0.758(95%CI:0.689,0.828)。结论：年龄增大、体外循环时间延长、糖尿病、LVPW和PASP升高是CVS患者合并AKI的独立危险因素，而eGFR和LVEF升高则是独立保护因素。TTE作为一种简便易行的检测手段，可用于CVS患者术后合并AKI的诊断和评估。
Abstract：Objective: To investigate the influence factors of preoperative transthoracic echocardiography(TTE) in patients with acute kidney injury after cardiac valve surgery. Methods: A total of 213 patients who underwent cardiac valve surgery(CVS) at Renmin Hospital of Wuhan University from January 2020 to December 2021 were recruited in this retrospective study. TTE assessments were performed within 7 days before surgery. All patients were divided into the non-acute kidney injury(non-AKI) group and the AKI group. The independent risk factors for AKI in CVS patients were analyzed using multivariate Logistic regression. Then the receiver operating characteristic(ROC) curve was drawn to evaluate the predictive value of these factors. Results: Among 213 patients, there were 66 cases(30.99%) of postoperative AKI. The results of multivariate Logistic regression analysis showed that advanced age, prolonged cardiopulmonary bypass, diabetes, increased left ventricular posterior wall thickness(LVPW), elevated pulmonary artery systolic pressure(PASP) were independent risk factors for AKI in patients underwent CVS. Increased estimated glomerular filtration rate(eGFR) and left ventricular ejection fraction(LVEF) were independent protective factors for AKI in patients with CVS. The ROC curve showed that LVPW, PASP, and LVEF have certain predictive value for postoperative AKI in CVS patients, with AUC values of 0.689(95%CI: 0.579,0.789), 0.692(95%CI: 0.595,0.800), and 0.712(95%CI: 0.615,0.822), respectively. The AUC value of LVPW, PASP combined with LVEF for predicting AKI is 0.758(95%CI: 0.689,0.828). Conclusion: The advanced age, prolonged cardiopulmonary bypass, diabetes, higher LVPW and PASP are independent risk factors, while elevated eGFR and LVEF are independent protective factors for CVS patients with AKI. TTE, as a simple and feasible detection method, can be used for the diagnosis and evaluation of postoperative AKI in CVS patients.
[1] Schurle A,Koyner J L.CSA-AKI:incidence,epidemiology,clinical outcomes,and economic impact[J].J Clin Med,2021,10(24):5746.
[2] Wang Y,Bellomo R.Cardiac surgery-associated acute kidney injury:risk factors,pathophysiology and treatment[J].Nat Rev Nephrol,2017,13(11):697-711.
[3] Ostermann M,Kunst G,Baker E,et al.Cardiac surgery associated AKI prevention strategies and medical treatment for CSA-AKI[J].J Clin Med,2021,10(22):5285.
[4] Kinno M,Cantey E P,Rigolin V H.The transition from transesophageal to transthoracic echocardiography during transcatheter aortic valve replacement:an evolving field[J].J Echocardiogr,2019,17(1):25-34.
[5] Heiberg J,El-Ansary D,Royse C F,et al.Transthoracic and transoesophageal echocardiography:a systematic review of feasibility and impact on diagnosis,management and outcome after cardiac surgery[J].Anaesthesia,2016,71(10):1210-1221.
[6] Levey A S,Stevens L A,Schmid C H,et al.A new equation to estimate glomerular filtration rate[J].Ann Intern Med,2009,150(9):604-612.
[7] Recommendations for cardiac chamber quantification by echocardiography in adults:an update from the American society of echocardiography and the European association of,cardiovascular imaging[J].Eur Heart J Cardiovasc Imaging,2016,17(4):412.
[8] Galiè N,Humbert M,Vachiery J L,et al.2015 ESC/ERS Guidelines for the diagnosis and treatment of pulmonary hypertension:the Joint Task Force for the Diagnosis and Treatment of Pulmonary Hypertension of the European Society of Cardiology (ESC) and the European Respiratory Society (ERS):endorsed by:association for European Paediatric and Congenital Cardiology(AEPC),International Society for Heart and Lung Transplantation (ISHLT)[J].Eur Heart J,2016,37(1):67-119.
[9] Kellum J A,Lameire N,AKI Guideline Work Group K D I G O.Diagnosis,evaluation,and management of acute kidney injury:a KDIGO summary (Part 1)[J].Crit Care,2013,17(1):204.
[10] Grayson A D,Khater M,Jackson M,et al.Valvular heart operation is an independent risk factor for acute renal failure[J].Ann Thorac Surg,2003,75(6):1829-1835.
[11] 张芸楠，贾明，潘昱，等.心脏手术术后发生急性肾损伤的相关因素[J].中华医学杂志，2020,100(12):928-932.
[12] Zhou J,Lyu L,Zhu L,et al.Association of overweight with postoperative acute kidney injury among patients receiving orthotopic liver transplantation:an observational cohort study[J].BMC Nephrol,2020,21(1):223.
[13] 于洋，贾维坤.心脏手术相关急性肾损伤的新型生物标志物研究进展[J].河北医药，2020,42(3):457-462.
[14] 雷磊，王长安.尿IL-18早期诊断在心脏手术后急性肾损伤中的价值[J].山西卫生健康职业学院学报，2019,29(6):12-13.
[15] Catalano M,Lin D S,Cassiere H,et al.Incidence of acute kidney injury in patients with chronic renal insufficiency:transcatheter versus surgical aortic valve replacement[J].J Interv Cardiol,2019,2019:9780415.
[16] Remer E M,Papanicolaou N,Casalino D D,et al.ACR appropriateness criteria? on renal failure[J].Am J Med,2014,127(11):1041-1048.e1.
[17] Selby N M,Williams J P,Phillips B E.Application of dynamic contrast enhanced ultrasound in the assessment of kidney diseases[J].Curr Opin Nephrol Hypertens,2021,30(1):138-143.
[18] Watchorn J,Huang D Y,Joslin J,et al.Critically ill COVID-19 patients with acute kidney injury have reduced renal blood flow and perfusion despite preserved cardiac function:a case-control study using contrast-enhanced ultrasound[J].Shock,2021,55(4):479-487.
[19] Wang X Y,Pang Y P,Jiang T,et al.Value of early diagnosis of sepsis complicated with acute kidney injury by renal contrast-enhanced ultrasound[J].World J Clin Cases,2019,7(23):3934-3944.
[20] Michalowska I,Stoklosa P,Milkowska M,et al.The role of cardiac computed tomography in the diagnosis of prosthetic valve endocarditis-A comparison with transthoracic and transesophageal echocardiography and intra-operative findings[J].Eur J Radiol,2021,138:109637.
[21] Aslaner M A,Yasar E,Kili?aslan I,et al.Accuracy of multi-organ point-of-care ultrasound for acute kidney injury etiologies[J].Ultrasound Med Biol,2022,48(10):2009-2018.
[22] Pettey G,Hermansen J L,Nel S,et al.Ultrasound hepatic vein ratios are associated with the development of acute kidney injury after cardiac surgery[J].J Cardiothorac Vasc Anesth,2022,36(5):1326-1335.
[23] Nepal S,Dachsel M,Smallwood N.Point-of-care ultrasound rapidly and reliably diagnoses renal tract obstruction in patients admitted with acute kidney injury[J].Clin Med,2020,20(6):541-544.
[24] Wang J Q,Dong Y H,Zhao B C,et al.Preoperative NT-proBNP and LVEF for the prediction of acute kidney injury after noncardiac surgery:a single-centre retrospective study[J].BMC Anesthesiol,2022,22(1):196.
[25] Khoury S,Steinvil A,Gal-Oz A,et al.Association between central venous pressure as assessed by echocardiography,left ventricular function and acute cardio-renal syndrome in patients with ST segment elevation myocardial infarction[J].Clin Res Cardiol,2018,107(10):937-944.
[26] Hammerer-Lercher A,Neubauer E,Müller S,et al.Head-to-head comparison of N-terminal pro-brain natriuretic peptide,brain natriuretic peptide and N-terminal pro-atrial natriuretic peptide in diagnosing left ventricular dysfunction[J].Clin Chim Acta,2001,310(2):193-197.
[27] Inoue Y,Kawayama T,Iwanaga T,et al.High plasma brain natriuretic peptide levels in stable COPD without pulmonary hypertension or cor pulmonale[J].Intern Med,2009,48(7):503-512.
[28] 程庆砾.肺动脉高压在加速老年慢性肾脏病进展中的作用[J].肾脏病与透析肾移植杂志，2023,32(2):146.
[29] Abbas S,Qayum I,Wahid R,et al.Acute kidney injury in transcatheter aortic valve replacement[J].Cureus,2021,13(5):e15154.
[30] Ramasubbu K,Deswal A,Herdejurgen C,et al.A prospective echocardiographic evaluation of pulmonary hypertension in chronic hemodialysis patients in the United States:prevalence and clinical significance[J].Int J Gen Med,2010,3:279-286.
基本信息:
中图分类号:R540.45;R654.2
引用信息:
[1]陈婷,吕蕾,王琦,等.经胸超声心动图对心脏瓣膜术后患者合并急性肾损伤的影响因素分析[J].巴楚医学,2023,6(03):68-74.
基金信息:
湖北省卫生和计划生育委员会青年人才项目(No:WJ2015Q016)
2023-09-30
2023-09-30