手术修复腹主动脉瘤后发生急性肾损伤的促血栓形成特性增加：一项前瞻性观察研究。

Increased prothrombotic property as a risk factor of acute kidney injury after surgical repair of abdominal aortic aneurysm: a prospective observational study.

机构信息

Department of Anesthesiology, Keio University School of Medicine, 35 Shinanomachi, Shinjuku 160-8582, Tokyo, Japan.

出版信息

J Intensive Care. 2014 Jul 16;2:46. doi: 10.1186/s40560-014-0046-3. eCollection 2014.

DOI:10.1186/s40560-014-0046-3

PMID:25960882

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC4424765/

Abstract

BACKGROUND

Acute kidney injury (AKI) is one of the major morbidities after surgical repair of abdominal aortic aneurysm (AAA); however, precise pathogenesis of this morbidity has not been well determined. Since prothrombotic coagulation abnormality may precede organ dysfunction in systemic inflammatory state, we examined the kinetics of von Willebrand factor (VWF) and a disintegrin-like metalloprotease with thrombospondin type 1 motif 13 (ADAMTS13), a cleaving enzyme of VWF, on the development of AKI after AAA surgery.

METHODS

The kinetics of ADAMTS13 and VWF were examined in ten patients who underwent surgical repair of AAA. The changes in plasma neutrophil gelatinase-associated lipocalin (NGAL), a novel biomarker for AKI, and serum creatinine concentration were also examined at four points until seventh postoperative day (POD). Clinical diagnosis of AKI was based on the change in serum creatinine concentration and urine output according to Acute Kidney Injury Network (AKIN) criteria.

RESULTS

ADAMTS13 activity was significantly lower than normal level before the surgery and showed a trend of decrease toward 3POD. The VWF/ADAMTS13 ratio showed a significant increase on 1POD, which persisted until 7POD. None of patents was diagnosed as AKI based on AKIN criteria, although two patients received furosemide and/or carperitide therapy because of decreased urine output less than 0.5 ml/kg/h for several hours in ICU. Plasma NGAL showed a trend to increase after the surgery, which was significant on 3POD. The change in plasma NGAL was significantly correlated with VWF/ADAMTS13 ratio (P < 0.01).

CONCLUSIONS

This study has shown that patients undergoing AAA surgery were prothrombotic after the surgery because of high VWF/ADAMTS13 ratio. Correlation between VWF/ADAMTS13 ratio and NGAL might indicate contribution of thrombotic event to subclinical AKI in the patients undergoing AAA surgery.

摘要

背景

急性肾损伤（AKI）是腹主动脉瘤（AAA）修复术后的主要并发症之一；然而，这种发病率的确切发病机制尚未得到很好的确定。由于促凝性凝血异常可能先于全身炎症状态下的器官功能障碍，我们研究了 von Willebrand 因子（VWF）和 a 型血小板反应蛋白 13 金属蛋白酶（ADAMTS13）的动力学，ADAMTS13 是 VWF 的一种裂解酶，在 AAA 手术后 AKI 的发展中。

方法

检查了 10 例行 AAA 手术修复的患者的 ADAMTS13 和 VWF 的动力学变化。还在四个时间点检查了术后第四天（POD）至第七天（POD）的血浆中性粒细胞明胶酶相关脂质运载蛋白（NGAL）和血清肌酐浓度的变化，NGAL 是 AKI 的一种新型生物标志物。根据急性肾损伤网络（AKIN）标准，AKI 的临床诊断基于血清肌酐浓度和尿量的变化。

结果

ADAMTS13 活性在手术前明显低于正常水平，在术后第三天（POD）呈下降趋势。VWF/ADAMTS13 比值在术后第一天（POD）显著升高，并持续至第七天（POD）。尽管有两名患者因 ICU 中数小时尿量小于 0.5 ml/kg/h 而接受呋塞米和/或卡培他滨治疗，但根据 AKIN 标准，没有患者被诊断为 AKI。术后血浆 NGAL 呈升高趋势，术后第三天（POD）有显著差异。血浆 NGAL 的变化与 VWF/ADAMTS13 比值显著相关（P <0.01）。