非心脏手术对术中胰岛及肾功能影响的初步研究：一项单中心前瞻性队列研究
Preliminary investigation of the effect of non-cardiac surgery on intraoperative islet and renal function: a single-center prospective cohort study.
作者信息
Sun Yongtao, Zhang Xiaoning, Zhang Min, Guo Yongle, Sun Tao, Liu Mengjie, Gao Xiaojun, Liu Yang, Gao Zhongquan, Chen Lina, Du Xiaoyan, Wang Yuelan
机构信息
Department of Anesthesiology, The First Affiliated Hospital of Shandong First Medical University and Shandong Provincial Qianfoshan Hospital, Shandong Institute of Anesthesia and Respiratory Critical Medicine, Jinan, China.
Shandong First Medical University and Shandong Academy of Medical Sciences, Jinan, China.
出版信息
Front Med (Lausanne). 2024 Feb 13;11:1235335. doi: 10.3389/fmed.2024.1235335. eCollection 2024.
BACKGROUND
The effect of different non-cardiac surgical methods on islet and renal function remains unclear. We conducted a preliminary investigation to determine whether different surgical methods affect islet function or cause further damage to renal function.
METHODS
In this prospective cohort study, the clinical data of 63 adult patients who underwent non-cardiac surgery under general anesthesia were evaluated from February 2019 to January 2020. Patients were divided into the abdominal surgery group, the laparoscopic surgery group, and the breast cancer surgery group. The primary outcome was the difference between the effects of different surgical methods on renal function.
RESULTS
Islet and renal function were not significantly different between the groups. The correlation analysis showed that hematocrit (HCT) and hemoglobin (HB) were negatively correlated with fasting plasma glucose (FPG) ( < 0.05), MAP was positively correlated with C-peptide ( < 0.05), and HCT and Hb were positively correlated with serum creatinine (SCr) ( < 0.05). Fasting insulin (FINS) and C-peptide were negatively correlated with SCr ( < 0.05), and the homeostatic model assessment of insulin resistance (HOMA-IR) was positively correlated with SCr ( < 0.05). FINS, C-peptide, HOMA-IR, and the homeostatic model assessment of β-cell function (HOMA-β) were positively correlated with cystatin C (Cys C) ( < 0.05).
CONCLUSION
FINS, C-peptide, and HOMA-IR had positive effects on beta-2-microglobulin (β-MG). FINS, C-peptide, and HOMA-IR were positively correlated with Cys C and β-Mg. While FINS and C-peptide were negatively correlated with SCr, HOMA-IR was positively correlated with SCr.
背景
不同非心脏手术方法对胰岛和肾功能的影响尚不清楚。我们进行了一项初步调查，以确定不同手术方法是否会影响胰岛功能或对肾功能造成进一步损害。
方法
在这项前瞻性队列研究中，对2019年2月至2020年1月期间63例在全身麻醉下接受非心脏手术的成年患者的临床资料进行了评估。患者分为腹部手术组、腹腔镜手术组和乳腺癌手术组。主要结局是不同手术方法对肾功能影响的差异。
结果
各组间胰岛和肾功能无显著差异。相关性分析显示，血细胞比容（HCT）和血红蛋白（HB）与空腹血糖（FPG）呈负相关（<0.05），平均动脉压（MAP）与C肽呈正相关（<0.05），HCT和Hb与血清肌酐（SCr）呈正相关（<0.05）。空腹胰岛素（FINS）和C肽与SCr呈负相关（<0.05），胰岛素抵抗稳态模型评估（HOMA-IR）与SCr呈正相关（<0.05）。FINS、C肽、HOMA-IR和β细胞功能稳态模型评估（HOMA-β）与胱抑素C（Cys C）呈正相关（<0.05）。
结论
FINS、C肽和HOMA-IR对β2微球蛋白（β-MG）有正向影响。FINS、C肽和HOMA-IR与Cys C和β-Mg呈正相关。虽然FINS和C肽与SCr呈负相关，但HOMA-IR与SCr呈正相关。
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