Klotho蛋白对心脏手术后急性肾损伤早期诊断及预后评估价值的临床研究
发布时间：2018-11-13 20:59
【摘要】：目的：1）动态观察心脏手术患者术前及术后血液及尿液中Klotho蛋白的浓度，探讨Klotho蛋白与心脏手术后AKI发生的关系；2）了解心脏手术后AKI患者中血液及尿液中Klotho蛋白浓度与患者预后的关系； 方法：1）选择上海交通大学医学院附属仁济医院心胸外科心脏手术患者91例，收集其术前及术后多个时间点的血尿标本，记录患者术前，术中及术后的一般情况、实验室资料及预后情况，ELISA法检测血和尿液标本中Klotho蛋白的浓度，比较术后AKI与非AKI患者间各时间点的Klotho蛋白浓度，并与尿NGAL进行比较，多元逐步回归法分析心脏手术后AKI发生的危险因素，观察Klotho蛋白水平与AKI发生之间的关系及其作为AKI诊断标志物的意义。2）随访患者的预后，比较不同预后患者间各个时间点的血和尿液的Klotho浓度，运用Logistic回归方法分析影响AKI预后的危险因素，分析Klotho蛋白水平与AKI患者预后的关系。 结果：1）91例心脏手术后患者，平均年龄（61.08±9.69）岁，其中男性占63.7%，糖尿病15.4%，高血压36.3%。其中33例（36.3%）患者发生了AKI，AKI和非AKI患者的术前一般情况相似，AKI组患者手术时间、CPB时间较非AKI组显著延长（P0.05），术前胱抑素C水平明显高于非AKI组（P0.05），住院时间，住院费用均明显高于非AKI组患者（P0.05）。2）AKI组患者术前血、尿Klotho水平与非AKI患者相比无明显差异（P0.05）。术后0h AKI患者的血Klotho水平下降幅度显著大于非AKI组（0.177±0.155vs0.456±0.327，P0.05）。术后0h AKI患者的尿Klotho水平上升幅度显著大于非AKI组（1.690[1.026，2.677] vs0.526[0.230，0.891]，P0.05）。3）多因素Logistic回归分析显示：手术时间延长、尿Klotho蛋白升高、血Klotho蛋白降低是心脏手术患者发生AKI的独立危险因素。4）术后0h，肾功能未恢复组患者血Klotho水平明显低于完全恢复组患者，，差异有统计学意义（0.104±0.126vs0.237±0.169，P0.05）。影响AKI患者肾功能完全恢复的独立危险因素包括：心脏停搏时间、升主动脉阻断时间、基础eGFR、术后0小时尿Klotho蛋白水平、术前血红蛋白含量。5）术后0h血Klotho水平预测AKI发生的ROC曲线下面积为0.788，95%的可信区间为0.692-0.884，P=0.001。当术后0h血Klotho蛋白浓度为0.234ng/μmol时，预测AKI发生的敏感性为0.707，特异性为0.788。术后0h尿Klotho水平预测AKI发生的ROC曲线下面积为0.853，95%的可信区间为0.776-0.930，P=0.001。当术后0h尿Klotho蛋白浓度为0.858ng/μmol时，预测AKI发生的敏感性为0.909，特异性为0.759。 结论：心脏手术后AKI患者术后早期血、尿Klotho蛋白水平即存在显著改变，其变化早于NGAL，可能可以作为AKI的早期检测指标。手术时间延长、尿Klotho蛋白水平升高、血Klotho蛋白水平降低可能是心脏手术患者发生AKI的独立危险因素。血Klotho蛋白水平降低可能与AKI患者的肾脏预后相关。
[Abstract]:Objective: 1) to observe the concentration of Klotho protein in blood and urine before and after cardiac surgery, and to explore the relationship between Klotho protein and AKI after cardiac surgery. 2) to investigate the relationship between the concentration of Klotho protein in blood and urine and the prognosis of patients with AKI after cardiac surgery. Methods: 1) 91 patients undergoing cardiothoracic heart surgery in Renji Hospital affiliated to Shanghai Jiaotong University Medical College were selected. Blood and urine samples were collected at various time points before and after operation, and the general situation of the patients before, during and after operation was recorded. Laboratory data and prognosis. ELISA method was used to detect the concentration of Klotho protein in blood and urine samples, and to compare the concentration of Klotho protein between AKI and non-AKI patients at different time points after operation, and to compare it with urine NGAL. Multivariate stepwise regression method was used to analyze the risk factors of AKI after cardiac surgery, and to observe the relationship between the level of Klotho protein and the occurrence of AKI and its significance as a diagnostic marker of AKI. 2) the prognosis of the patients followed up. The concentrations of Klotho in blood and urine were compared among patients with different prognosis. The risk factors affecting the prognosis of AKI were analyzed by Logistic regression, and the relationship between Klotho protein level and prognosis of AKI patients was analyzed. Results: 1) the mean age of 91 patients after cardiac surgery was (61.08 卤9.69) years, of which the male accounted for 63.7%, diabetes 15.4m, hypertension 36.3%. 33 cases (36.3%) had AKI,AKI and non-AKI. The operation time and CPB time in AKI group were significantly longer than those in non-AKI group (P0.05), and the time of CPB in AKI group was significantly longer than that in non-AKI group (P0.05). The preoperative level of cystatin C was significantly higher than that of non-AKI group (P0.05), and the hospitalization time and hospitalization cost were significantly higher than those of non-AKI group (P0.05). 2) the preoperative blood of AKI group was significantly higher than that of AKI group. There was no significant difference between urinary Klotho level and non-AKI patients (P0.05). The decrease of serum Klotho level in AKI group was significantly higher than that in non-AKI group (0.177 卤0.155vs0.456 卤0.327 P 0.05) at 0 h after operation. The increase of urinary Klotho level in patients with AKI at 0 h after operation was significantly higher than that in non-AKI group (1.690 [1.0262.677] vs0.526 [0.2300.8091, P0.05) .3Multivariate Logistic regression analysis showed that the time of operation was prolonged and the urine Klotho protein was increased. The decrease of serum Klotho protein was an independent risk factor for the occurrence of AKI in patients undergoing cardiac surgery. 4) at 0 h after operation, the level of serum Klotho in patients with no recovery of renal function was significantly lower than that in patients with complete recovery, and the difference was statistically significant (0.104 卤0.126vs0.237 卤0.169). P0.05). Independent risk factors affecting the complete recovery of renal function in patients with AKI included cardiac arrest time, ascending aorta occlusion time and urinary Klotho protein level at 0 hours after basic eGFR,. Preoperative hemoglobin content was 0.5) the serum Klotho level predicted the area under the ROC curve of AKI was 0.78895% and the confidence interval was 0.692-0.884P0. 001. When the serum Klotho protein concentration was 0.234ng/ 渭 mol at 0 h after operation, the sensitivity and specificity of predicting the occurrence of AKI were 0.707 and 0.788 respectively. At 0 h after operation, the confidence interval of the area under the ROC curve of 0.85395% for predicting the incidence of AKI was 0.776-0.930g / P0. 001for urine Klotho level. When the concentration of urinary Klotho protein was 0.858ng/ 渭 mol at 0 h after operation, the sensitivity and specificity of predicting the occurrence of AKI were 0.909 and 0.75959 respectively. Conclusion: the changes of Klotho protein in blood and urine of AKI patients after cardiac surgery are significant, which may be used as an early detection index of AKI. Prolonged operation time, elevated urinary Klotho protein level and decreased serum Klotho protein level may be independent risk factors for AKI in patients undergoing cardiac surgery. The decrease of serum Klotho protein level may be associated with renal prognosis in patients with AKI.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.2;R692
本文编号：2330403
[Abstract]:Objective: 1) to observe the concentration of Klotho protein in blood and urine before and after cardiac surgery, and to explore the relationship between Klotho protein and AKI after cardiac surgery. 2) to investigate the relationship between the concentration of Klotho protein in blood and urine and the prognosis of patients with AKI after cardiac surgery. Methods: 1) 91 patients undergoing cardiothoracic heart surgery in Renji Hospital affiliated to Shanghai Jiaotong University Medical College were selected. Blood and urine samples were collected at various time points before and after operation, and the general situation of the patients before, during and after operation was recorded. Laboratory data and prognosis. ELISA method was used to detect the concentration of Klotho protein in blood and urine samples, and to compare the concentration of Klotho protein between AKI and non-AKI patients at different time points after operation, and to compare it with urine NGAL. Multivariate stepwise regression method was used to analyze the risk factors of AKI after cardiac surgery, and to observe the relationship between the level of Klotho protein and the occurrence of AKI and its significance as a diagnostic marker of AKI. 2) the prognosis of the patients followed up. The concentrations of Klotho in blood and urine were compared among patients with different prognosis. The risk factors affecting the prognosis of AKI were analyzed by Logistic regression, and the relationship between Klotho protein level and prognosis of AKI patients was analyzed. Results: 1) the mean age of 91 patients after cardiac surgery was (61.08 卤9.69) years, of which the male accounted for 63.7%, diabetes 15.4m, hypertension 36.3%. 33 cases (36.3%) had AKI,AKI and non-AKI. The operation time and CPB time in AKI group were significantly longer than those in non-AKI group (P0.05), and the time of CPB in AKI group was significantly longer than that in non-AKI group (P0.05). The preoperative level of cystatin C was significantly higher than that of non-AKI group (P0.05), and the hospitalization time and hospitalization cost were significantly higher than those of non-AKI group (P0.05). 2) the preoperative blood of AKI group was significantly higher than that of AKI group. There was no significant difference between urinary Klotho level and non-AKI patients (P0.05). The decrease of serum Klotho level in AKI group was significantly higher than that in non-AKI group (0.177 卤0.155vs0.456 卤0.327 P 0.05) at 0 h after operation. The increase of urinary Klotho level in patients with AKI at 0 h after operation was significantly higher than that in non-AKI group (1.690 [1.0262.677] vs0.526 [0.2300.8091, P0.05) .3Multivariate Logistic regression analysis showed that the time of operation was prolonged and the urine Klotho protein was increased. The decrease of serum Klotho protein was an independent risk factor for the occurrence of AKI in patients undergoing cardiac surgery. 4) at 0 h after operation, the level of serum Klotho in patients with no recovery of renal function was significantly lower than that in patients with complete recovery, and the difference was statistically significant (0.104 卤0.126vs0.237 卤0.169). P0.05). Independent risk factors affecting the complete recovery of renal function in patients with AKI included cardiac arrest time, ascending aorta occlusion time and urinary Klotho protein level at 0 hours after basic eGFR,. Preoperative hemoglobin content was 0.5) the serum Klotho level predicted the area under the ROC curve of AKI was 0.78895% and the confidence interval was 0.692-0.884P0. 001. When the serum Klotho protein concentration was 0.234ng/ 渭 mol at 0 h after operation, the sensitivity and specificity of predicting the occurrence of AKI were 0.707 and 0.788 respectively. At 0 h after operation, the confidence interval of the area under the ROC curve of 0.85395% for predicting the incidence of AKI was 0.776-0.930g / P0. 001for urine Klotho level. When the concentration of urinary Klotho protein was 0.858ng/ 渭 mol at 0 h after operation, the sensitivity and specificity of predicting the occurrence of AKI were 0.909 and 0.75959 respectively. Conclusion: the changes of Klotho protein in blood and urine of AKI patients after cardiac surgery are significant, which may be used as an early detection index of AKI. Prolonged operation time, elevated urinary Klotho protein level and decreased serum Klotho protein level may be independent risk factors for AKI in patients undergoing cardiac surgery. The decrease of serum Klotho protein level may be associated with renal prognosis in patients with AKI.
【学位授予单位】：上海交通大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R654.2;R692
【参考文献】
相关期刊论文 前1条
1 王怀斌;甄文俊;佟宏峰;欧阳小康;孙耀光;马玉健;;两种冠状动脉旁路手术方式对老年患者肾功能的影响[J];中华老年医学杂志;2006年06期
本文编号：2330403
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