血清肌酐、血尿素氮、尿酸和β-微球蛋白在评价原位肝移植后急性肾损伤中的预测价值。
Predictive Value of Serum Creatinine, Blood Urea Nitrogen, Uric Acid, and β-Microglobulin in the Evaluation of Acute Kidney Injury after Orthotopic Liver Transplantation.
机构信息
Department of Anaesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020; Department of Anaesthesiology, Beijing You An Hospital, Capital Medical University, Beijing 100069; Department of Anaesthesiology, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China.
Department of Anaesthesiology, Beijing Chao-Yang Hospital, Capital Medical University, Beijing 100020; Department of Anaesthesiology, The General Hospital of the Chinese People's Armed Police Forces, Beijing 100039, China.
出版信息
Chin Med J (Engl). 2018 May 5;131(9):1059-1066. doi: 10.4103/0366-6999.230726.
BACKGROUND
As a major complication after orthotopic liver transplantation (OLT), the occurrence of acute kidney injury (AKI) is frequently defined by serum creatinine (Cr); however, the accuracy of commonly used blood urea nitrogen (BUN), uric acid (UA), and β-microglobulin (β-MG) remains to be explored. This retrospective study compared the accuracy of these parameters for post-OLT AKI evaluation.
METHODS
Patients who underwent OLT in three centers between July 2003 and December 2013 were enrolled. The postoperative AKI group was diagnosed by the Kidney Disease Improving Global Outcomes (KDIGO) criteria and classified by stage. Measurement data were analyzed using the t-test or Wilcoxon rank-sum test; enumerated data were analyzed using the Chi-square test or Fisher's exact test. Diagnostic reliability and predictive accuracy were evaluated using receiver operating characteristic (ROC) curve analysis.
RESULTS
This study excluded 976 cases and analyzed 697 patients (578 men and 119 women); the post-OLT AKI incidence was 0.409. Compared with the no-AKI group, the AKI group showed very significant differences in Model for End-stage Liver Disease score (14.74 ± 9.91 vs. 11.07 ± 9.54, Z = 5.404; P < 0.001), hepatic encephalopathy (45 [15.8%] vs. 30 [7.3%], χ = 12.699; P < 0.001), hemofiltration (28 [9.8%] vs. 0 [0.0%], χ = 42.171; P < 0.001), and 28-day mortality (23 [8.1%] vs. 9 [2.2%], χ = 13.323; P <0.001). Moreover, mean values of Cr, BUN, UA, and β-MG in the AKI group differed significantly at postoperative days 1, 3, and 7 (all P < 0.001). ROC curve area was 0.847 of Cr for the detection of AKI Stage 1 (sensitivity 80.1%, specificity 75.7%, cutoff value 88.23 μmol/L), 0.916 for Stage 2 (sensitivity 87.6%, specificity 82.6%, cutoff value 99.9 μmol/L), and 0.972 for Stage 3 (sensitivity 94.1%, specificity 88.2%, cutoff value 122.90 μmol/L).
CONCLUSION
The sensitivity and specificity of serum Cr might be a high-value indicator for the diagnosis and grading of post-OLT AKI.
背景
作为肝移植（OLT）后的主要并发症之一，急性肾损伤（AKI）的发生通常通过血清肌酐（Cr）来定义；然而，常用的血尿素氮（BUN）、尿酸（UA）和β-微球蛋白（β-MG）的准确性仍有待探讨。本回顾性研究比较了这些参数在评估 OLT 后 AKI 中的准确性。
方法
本研究纳入了 2003 年 7 月至 2013 年 12 月在三个中心接受 OLT 的患者。术后 AKI 组根据肾脏疾病改善全球结局（KDIGO）标准诊断，并按阶段分类。采用 t 检验或 Wilcoxon 秩和检验分析计量资料；采用卡方检验或 Fisher 确切概率法分析计数资料。采用受试者工作特征（ROC）曲线分析评估诊断可靠性和预测准确性。
结果
本研究排除了 976 例患者，分析了 697 例患者（578 例男性和 119 例女性）；OLT 后 AKI 的发生率为 0.409。与无 AKI 组相比，AKI 组患者的终末期肝病模型评分（14.74±9.91 比 11.07±9.54，Z=5.404；P<0.001）、肝性脑病（45[15.8%]比 30[7.3%]，χ=12.699；P<0.001）、血液滤过（28[9.8%]比 0[0.0%]，χ=42.171；P<0.001）和 28 天死亡率（23[8.1%]比 9[2.2%]，χ=13.323；P<0.001）差异均有统计学意义。此外，Cr、BUN、UA 和β-MG 在 AKI 组术后第 1、3 和 7 天的平均值差异均有统计学意义（均 P<0.001）。Cr 检测 AKI 1 期的 ROC 曲线下面积为 0.847（敏感度 80.1%，特异度 75.7%，截断值 88.23μmol/L），2 期为 0.916（敏感度 87.6%，特异度 82.6%，截断值 99.9μmol/L），3 期为 0.972（敏感度 94.1%，特异度 88.2%，截断值 122.90μmol/L）。
结论
血清 Cr 的敏感度和特异度可能是诊断和分级 OLT 后 AKI 的高价值指标。
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