摘要
目的探究冠状动脉旁路移植(CABG)术患者术前亚甲减(SCH)和术后急性肾损伤(AKI)的关系,并分析术前SCH对临床预后的影响。方法回顾性分析2016年1月至2022年12月泰达国际心血管病医院ICU收治的101例术前诊断为SCH,并在体外循环下行CABG术患者的临床资料。在数据库中经倾向性匹配分析,匹配出101例非SCH患者,以是否术前诊断为SCH为分组依据,对两组患者的临床资料进行对比分析探究术前SCH和术后AKI的关系,分析SCH对CABG术后临床预后的影响。结果单因素分析显示,倾向性匹配后,SCH组和非SCH组在促甲状腺素(TSH)水平、游离甲状腺素(FT4)水平、术前尿酸(Ur)及术前中性粒/淋巴细胞比值(NLR)、术中乳酸(Lac)上有差异(均P<0.05)。在两组术后预后比较中,SCH组术后Lac、术后48 h肌酐(Scr)及总住院时间、AKI的发生率(29.7%比5.0%)及CRRT的使用率(15.8%比5.9%)均高;最高Na+和NLR低于非SCH组;差异均具有统计学意义(均P<0.05)。以发生AKI为阳性指标,对所有因素进行单因素分析,有差异的纳入二元logistic回归,分析AKI的危险因素,得出术前SCH(OR=35.477,P<0.001)、术前高Ur(OR=1.006,P=0.004)、手术时间长(OR=1.017,P=0.002)、术后高BNP(OR=1.006,P=0.042)均为AKI的独立危险因素。将术前SCH纳入ROC曲线分析,术前SCH对于AKI的AUC面积为0.716,P<0.001。结论术前SCH是CABG术后AKI发生的危险因素,具有一定的预测价值。术前SCH患者术后AKI发生率高,预后不良,对于心脏外科手术术前SCH患者应引起临床早期关注。
Objective To investigate the relationship between preoperative subhypothyroidism(SCH)and postoperative acute kidney injury(AKI)in patients undergoing coronary artery bypass transplantation(CABG)and the influence of SCH on clinical prognosis.Methods The clinical data of 101 patients with SCH and CABG under cardiopulmonary bypass admitted to ICU of Teda International Cardiovascular Hospital from January 2016 to December 2022 were retrospectively analyzed.The other data of 101 non-SCH patients were matched in the database through the orientation matching analysis.The clinical data of the two groups were compared and analyzed to explore the relationship between SCH before the surgery and AKI,and to analyze the influence of SCH on the postoperative clinical prognosis of CABG.Results Unifactor analysis showed that there were differences in the levels of thyrotropin(TSH),free thyroxine(FT4),preoperative uric acid(Ur),preoperative neuter/lymphocyte ratio(NLR)and intraoperative lactic acid(Lac)between SCH and non-SCH groups after propensity matching(all P<0.05).In the comparison of postoperative prognosis between the two groups,the incidence of Lac,creatinine(Scr),total length of hospital stay,incidence of CSA-AKI(29.7%vs.5.0%)and utilization rate of CRRT(15.8%vs.5.9%)were higher but the highest Na+and NLR were lower in SCH group,and the differences were statistically significant(all P<0.05).Taking the occurrence of AKI as a positive indicator,univariate analysis of all the factors was performed,then the factors with differences were included into binary logistic regression to analyze the risk factors of AKI;the results showed that preoperative SCH(OR=35.477,P<0.001),preoperative higher Ur(OR=1.006,P=0.004),longer operation time(OR=1.017,P=0.002),postoperative higher BNP(OR=1.006,P=0.042)were the independent risk factors for AKI.The AUC area of preoperative SCH for AKI was 0.716,P<0.001.Conclusion Preoperative SCH is a risk factor for AKI after CABG and has a certain predictive value.SCH patients have a higher incidence of AKI and poorer prognosis and they should be given early clinical attention.
作者
张倩倩
王伟
ZHANG Qian-qian;WANG Wei(Graduate School of Chengde Medical University,Chengde 067000,China;The ICU of Teda International Cardiovascular Hospital,Tianjin 300459,China)
出处
《中国心血管病研究》
CAS
2023年第9期835-841,共7页
Chinese Journal of Cardiovascular Research
基金
天津市医学重点学科(专科)建设项目(TJYXZDXK-019A)。
关键词
亚临床甲减
冠状动脉旁路移植术
急性肾损伤
倾向性匹配
Subclinical hypothyroidism
Coronary artery bypass grafting
Acute kidney injury
Propensity matching
