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肺移植术后早期急性肾损伤的危险因素及预后分析

陈奥 练巧燕 张建恒 徐鑫 韦兵 蔡宇航 黄丹霞 何建行 巨春蓉

陈奥, 练巧燕, 张建恒, 等. 肺移植术后早期急性肾损伤的危险因素及预后分析[J]. 器官移植, 2021, 12(2): 220-225, 231. doi: 10.3969/j.issn.1674-7445.2021.02.014
引用本文: 陈奥, 练巧燕, 张建恒, 等. 肺移植术后早期急性肾损伤的危险因素及预后分析[J]. 器官移植, 2021, 12(2): 220-225, 231. doi: 10.3969/j.issn.1674-7445.2021.02.014
Chen Ao, Lian Qiaoyan, Zhang Jianheng, et al. Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(2): 220-225, 231. doi: 10.3969/j.issn.1674-7445.2021.02.014
Citation: Chen Ao, Lian Qiaoyan, Zhang Jianheng, et al. Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation[J]. ORGAN TRANSPLANTATION, 2021, 12(2): 220-225, 231. doi: 10.3969/j.issn.1674-7445.2021.02.014

肺移植术后早期急性肾损伤的危险因素及预后分析

doi: 10.3969/j.issn.1674-7445.2021.02.014
基金项目: 

广东省自然科学基金 2018A030313107

详细信息
    作者简介:

    陈奥,女,硕士研究生,研究方向为肺移植术后并发症,Email:1131343416@qq.com

    通讯作者:

    巨春蓉,女,主任医师,教授,硕士研究生导师,研究方向为终末期肺疾病肺移植术前评估与术后并发症诊治,Email:juchunrong@126.com

  • 中图分类号: R617, R692

Analysis of risk factors and clinical prognosis of acute kidney injury early after lung transplantation

More Information
  • 摘要:   目的  分析肺移植术后早期急性肾损伤(AKI)的危险因素及预后。  方法  回顾性分析155例肺移植或心肺联合移植受者的临床资料,根据2012年改善全球肾脏病预后组织指南分为AKI组(104例)及非AKI组(51例)。总结肺移植术后早期AKI发生情况;收集受者的主要指标,对肺移植术后早期发生AKI的危险因素进行单因素和多因素分析;分析肺移植受者的预后情况并绘制生存曲线。  结果  肺移植术后早期AKI的发生率为67.1%(104/155),其中AKI 1期47例,AKI 2期34例,AKI 3期23例,术后早期需要连续性肾脏替代治疗(CRRT)的受者16例。术前合并糖尿病、术前合并肺动脉高压、术中平均动脉压(MAP) < 60 mmHg、术中大量输血、术后1周内他克莫司(Tac)超治疗浓度为肺移植术后早期发生AKI的独立危险因素。截止至随访终点,共66例(42.6%)受者死亡,其中AKI组50例,非AKI组16例。AKI组累积生存率低于非AKI组(40%比66%,P < 0.05),随着AKI严重程度增加,肺移植受者累积生存率降低。  结论  肺移植术后早期AKI发生率高、预后差,术前合并糖尿病、肺动脉高压,术中MAP < 60 mmHg、大量输血和术后1周内Tac超治疗浓度为肺移植术后早期发生AKI的独立危险因素。

     

  • 图  1  AKI 1期、AKI 2~3期及非AKI组受者住院时间和ICU入住时间的比较

    注:与非AKI组比较,aP < 0.05;与AKI 1期比较,bP < 0.05。

    Figure  1.  Comparison of hospital stay and ICU stay of recipients among AKI 1, AKI 2-3 and non-AKI group

    图  2  肺移植受者的Kaplan-Meier生存曲线

    注:A图为非AKI组受者与AKI组受者生存率比较;B图为非AKI组受者与AKI 1~3期受者生存率比较。

    Figure  2.  Kaplan-Meier survival curves of lung transplant recipients

    表  1  AKI分期标准

    Table  1.   Staging criteria of AKI

    分期 血清肌酐 尿量
    1期 48 h内上升≥0.3 mg/dL(≥26.5 μmol/L),或7 d内升至1.5~1.9倍基础值 尿量 < 0.5 mL/(kg·h),持续6~12 h
    2期 7 d内升至2.0~2.9倍基础值 尿量 < 0.5 mL/(kg·h),持续 > 12 h
    3期 48 h内上升至≥4 mg/dL(353.6 µmol/L),或7 d内升至 > 3倍基础值,或开始CRRT 尿量 < 0.3 mL/(kg·h),持续24 h或无尿12 h
    下载: 导出CSV

    表  2  肺移植术后早期AKI的危险因素分析

    Table  2.   Analysis of risk factors of AKI early after lung transplantation

    变量 单因素分析 多因素分析
    HR 95%CI P HR 95%CI P
    术前合并糖尿病 2.548 1.033~6.289 0.042 3.489 1.159~10.500 0.026
    术前合并肺动脉高压 2.367 1.091~5.134 0.029 3.311 1.291~8.492 0.013
    术前尿蛋白阳性 2.389 1.009~5.656 0.048 - - 0.546
    术前IMV支持 4.408 1.140~14.284 0.030 - - 0.635
    手术方式-单肺 参考值 - - - - 0.425
    手术方式-双肺 3.187 1.486~6.836 0.003 - - 0.821
    手术方式-心肺联合 1.205 0.280~5.575 0.770 - - 0.213
    手术时间 1.006 1.003~1.009 < 0.001 - - 0.961
    术中MAP < 60 mmHg 5.707 1.900~17.145 0.002 3.845 1.105~13.377 0.034
    术中大量输血 1.652 1.306~2.589 < 0.001 1.578 1.299~2.026 < 0.001
    术中ECMO支持 2.942 1.156~5.681 0.021 - - 0.199
    术后APACHEⅡ评分高 1.102 1.038~1.171 0.002 - - 0.174
    术后1周内Tac超治疗浓度 2.093 1.048~4.182 0.036 3.557 1.492~8.480 0.004
    注:①HR为风险比。
    CI为可信区间。
    ③-为无数据。
    ④大量输血指手术期间输血总量超过自身血容量。
    下载: 导出CSV
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出版历程
  • 收稿日期:  2020-10-20
  • 网络出版日期:  2021-03-19
  • 刊出日期:  2021-03-15

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