肝移植术后早期急性肾损伤的预测指标

doi:10.3877/cma.j.issn.2095-3232.2014.05.008

目的

探讨肝移植术后早期急性肾损伤（AKI）的预测指标。

方法

本前瞻性研究对象为2007年4月至2012年12月在中山大学附属第三医院接受原位肝移植术的64例终末期肝病患者。所有患者均签署知情同意书，符合医学伦理学规定。其中男59例，女5例；平均年龄（44±11）岁。根据术后3 d有否发生AKI，将患者分为AKI组（30例）和非AKI组（34例）。术前抽取外周静脉血检测胱抑素C，同时留取尿液检测β₂微球蛋白和N-乙酰-β-D-葡萄糖苷酶（NAG）；围手术期检测Scr。两组正态分布数据比较采用t检验，偏态分布数据比较采用非参数秩和检验。

结果

AKI组术前Scr为（80±26） μmol/L，非AKI组为（76±19）μmol/L，两组比较差异无统计学意义（t=0.596，P>0.05）。AKI组术前血胱抑素C、尿β₂微球蛋白、尿NAG分别为（1.06±0.24）mg/L、1.49 （0.19～22.63） mg/L、43(11～188） U/L，明显高于非AKI组的（0.95±0.20） mg/L、0.21（0.19～14.10） mg/L、21（2～101） U/L（t=2.129，Z=1.963，Z=3.840；P<0.05）。

结论

肝移植术前血胱抑素C、尿β₂微球蛋白、尿NAG可作为预测术后早期AKI的敏感指标。

关键词: 肝移植, 急性肾功能不全, 围手术期医护

Objective

To investigate the predictive indicators of early acute kiney injury (AKI) following liver transplantation.

Methods

A total of 64 patients with end-stage liver diseases undergoing orthotopic liver transplantation (OLT) in the Third Affiliated Hospital of Sun Yat-sen University from April 2007 to December 2012 were enrolled in this prospective study. The informed consents of all patients were obtained and the ethical committee approval was received. There were 59 males and 5 females with a mean age of (44±11) years old. According to whether the patients suffered AKI 3 d after OLT, they were divided into AKI group (n=30) and non-AKI group (n=34). Cystatin C in the peripheral venous blood and urine β₂-microglobulin (β₂-MG), urine N-acetyl-β-D-glucosidase (NAG) were detected before operation. And serum creatinine (Scr) was detected during the perioperative period. Normally distributed data were compared between two groups using t test. Skew distributed data were compared using rank sum test.

Results

The Scr was (80±26) μmol/L in AKI group before operation and was (76±19) μmol/L in non-AKI group, where no significant difference was observed between two groups (t=0.596, P>0.05). The blood Cystatin C, urine β₂-MG, urine NAG were (1.06±0.24) mg/L, 1.49 (0.19~22.63) mg/L, 43(11~188) U/L respectively in AKI group before operation, which were significantly higher compared with those in non-AKI group [(0.95±0.20) mg/L, 0.21(0.19~14.10) mg/L, 21(2~101) U/L)] (t=2.129, Z=1.963, Z=3.840; P<0.05).

Conclusion

Preoperative blood Cystatin C, urine β₂-MG and urine NAG can be the sensitive indicators for predicting early AKI following OLT.

Key words: Liver transplantation, Acute kidney injury, Perioperative care

表1 AKI组与非AKI组患者肝移植术前检测指标比较

分组	例数	Scr (μmol/L,±s)	血胱抑素C (mg/L, ±s)	尿β₂微球蛋白[mg/L, M(Q_R)]	尿NAG [U/L, M(Q_R)]
AKI组	30	80±26	1.06±0.24	1.49(0.19～22.63)	43(11～188）
非AKI组	34	76±19	0.95±0.20	0.21(0.19～14.10)	21(2～101)
统计值	?	t=0.596	t=2.129	Z=1.963	Z=3.840
P值	?	>0.05	<0.05	<0.05	<0.05

表1 AKI组与非AKI组患者肝移植术前检测指标比较

分组	例数	Scr (μmol/L,±s)	血胱抑素C (mg/L, ±s)	尿β₂微球蛋白[mg/L, M(Q_R)]	尿NAG [U/L, M(Q_R)]
AKI组	30	80±26	1.06±0.24	1.49(0.19～22.63)	43(11～188）
非AKI组	34	76±19	0.95±0.20	0.21(0.19～14.10)	21(2～101)
统计值	?	t=0.596	t=2.129	Z=1.963	Z=3.840
P值	?	>0.05	<0.05	<0.05	<0.05

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Predictive indicators of early acute renal injury following liver transplantation

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Predictive indicators of early acute renal injury following liver transplantation