慢性肾脏病单侧肾切除术后急性肾损伤的危险因素分析

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摘要目的分析慢性肾脏病(CKD)患者行单侧肾切除术后发生急性肾损伤(AKI)的危险因素。方法回顾性分析2010-01至2024-04在中部战区总医院及武警湖北总队医院行慢性肾脏病单侧肾切除术的138例患者的病案资料,肾小球滤过率(GFR)＜90 ml/min。根据术后7 d内是否发生AKI将病例分为AKI组(95例)和非AKI组(43例),比较两组患者年龄、性别、吸烟史、饮酒史、高血压史、糖尿病史、血肌酐、血尿素氮、血红蛋白、健侧分肾GFR(肾动态显像测定)、术前总估算肾小球滤过率(eGFR)(MDRD公式计算)、肾切除部位、手术方式等因素的差异。将差异存在统计学意义(P＜0.05)的因素进行logistic回归分析,筛选出术后发生AKI的危险因素。结果 138例CKD患者中95例术后发生了AKI(发生率68.8%);术前总eGFR(ml/min/1.73 m²):AKI组(72.0±14.1),非AKI组(75.0±17.0),两组差异无统计学意义(P=0.310);术前健侧分肾GFR(ml/min):AKI组 (38.8±9.1),非AKI组(52.6±12.0),两组差异有统计学意义(P=0.000)。术后透析总发生率1.4%。两组在性别、吸烟史、糖尿病史、血红蛋白、健侧分肾GFR等因素上差异存在统计学意义(P＜0.05)。经多因素Logistic回归分析,男性(P=0.003)、健侧分肾GFR低(P=0.000)、糖尿病史(P=0.039)是CKD患者单侧肾切除术后发生AKI的危险因素。结论 CKD患者行单侧肾切除术后发生AKI的风险极高;男性、健侧分肾GFR低、糖尿病史是CKD患者单侧肾切除术后发生AKI的危险因素;术前应通过肾动态显像检查了解健侧分肾的GFR。

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	聂善化
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关键词 ：单侧肾切除, 急性肾损伤, 慢性肾脏病, 危险因素

Abstract：Objective To analyze the occurrence of acute kidney injury (AKI) after unilateral nephrectomy in chronic kidney disease (CKD) patients, and to explore the risk factors of AKI after unilateral nephrectomy in CKD patients. Methods A total of 138 CKD patients (GFR<90 ml/min/1.73 m²) who underwent unilateral nephrectomy operation were reviewed from General Hospital of Central Theater Command and Hubei Provincial Corps Hospital of Chinese People’s Armed Police Force from January 2010 to April 2024. The patients were divided into two groups according to whether AKI occurred within 7 days after operation. The parameters: age, sex, smoking history, drinking history, hypertension history, diabetes history, blood creatinine, blood urea nitrogen, hemoglobin, healthy side renal glomerular filtration rate(GFR) (determination of renal dynamic imaging), preoperative total estimate glomerular filtration rate(eGFR) (calculation of MDRD formula), resection site of renal ,and surgical method were collected and compared between the two groups. Logistic regression analysis was performed on the parameters with statistical significance(P＜0.05)to screen out the risk factors of postoperative AKI. Results A total of 138 patients with CKD were enrolled with 95 patients developed AKI after surgery (68.8% incidence). Preoperative total eGFR (ml/min/1.73 m²): (75.0±17.0) in AKI group and (72.0±14.1) in non-AKI group, there was no significant difference between the two groups (P=0.310). Preoperative GFR (ml/min) of healthy kidney was 38.8±9.1 in AKI group and 52.6±12.0 in non-AKI group, with statistical significance (P=0.000). The total incidence of postoperative dialysis was 1.4%.There were significant differences in gender, smoking history, diabetes history, hemoglobin and GFR parameters of healthy side kidney between the two groups (P<0.05). Multivariate Logistic regression analysis showed that male (P=0.003), low GFR of healthy side kidney (P=0.000), and history of diabetes (P=0.039) were the risk factors for postoperative AKI in CKD patients. Conclusions The risk of AKI after unilateral nephrectomy in CKD patients is very high. Male, low GFR of healthy side kidney, and history of diabetes are risk factors for AKI in CKD patients after unilateral nephrectomy operation. It is necessary to evaluate GFR of healthy side kidney by renal dynamic imaging before operation.

Key words： unilateral nephrectomy acute kidney injury chronic kidney disease risk factors

收稿日期: 2024-05-20

ZTFLH:

R589.7

基金资助:军队某课题资助

通讯作者: 潘德璋,E-mail: smartpande@163.com

作者简介: 聂善化,硕士,副主任医师。

引用本文:

聂善化, 潘德璋, 杨成, 逄玉涛, 陈芬. 慢性肾脏病单侧肾切除术后急性肾损伤的危险因素分析[J]. 武警医学, 2024, 35(9): 784-788. NIE Shanhua, PAN Dezhang, YANG Cheng, PANG Yutao, CHEN Fen. Risk factors of acute kidney injury after unilateral nephrectomy for chronic kidney disease. Med. J. Chin. Peop. Armed Poli. Forc., 2024, 35(9): 784-788.

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https://journal08.magtechjournal.com/Jwk_wjyx/CN/ 或 https://journal08.magtechjournal.com/Jwk_wjyx/CN/Y2024/V35/I9/784

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