Metzsch Carsten, Lindahl Oscar, Klarén Martina, Grins Edgars, Ekroth Annika, Hansson Stefan R, Åkerström Bo, Dardashti Alain
Department of Cardiothoracic Surgery, Anaesthesia, Perfusion, and Intensive Care, Skåne University Hospital, Lund, Sweden.
Lund University, Faculty of Medicine, Department of Clinical Sciences Lund, Section of Obstetrics and Gynaecology, Lund, Sweden and Skane University Hospital (SUS), /Lund, Sweden.
Scand J Clin Lab Invest. 2024 Nov-Dec;84(7-8):557-563. doi: 10.1080/00365513.2024.2442022. Epub 2024 Dec 27.
Haemolysis occurring during cardiac surgery with cardiopulmonary bypass (CPB) is assumed to be a risk factor for postoperative acute kidney injury (AKI). Plasma alpha-1 microglobulin (A1M) may have a protective role as haem scavenger. The aim of this study was to evaluate the association between AKI and the degree of haemolysis and the course of A1M concentrations during cardiac surgery, respectively. We analysed plasma concentrations of free haemoglobin (pfHb) and A1M in 25 patients undergoing cardiac surgery: before CPB; during CPB in 15 min intervals; after CPB; and at four additional time points until 24 h after surgery. Markers of kidney function were followed until 4 days after surgery. Detection of AKI was based on the KDIGO (Kidney Disease, Improving Global Outcome) criteria. The plasma concentration of free haemoglobin during CPB was found to be significantly higher in patients with postoperative AKI at 60 min after start of CPB [mean 1379 µg/mL (95% CI: 1037-1721)]; compared to [820 µg/mL (622-1018)]; = 0.034, in patients without AKI, and at one hour post-CPB [2600 µg/mL (969-4230)] vs [1037 µg/mL (722-1353)]; = 0.044]. There was no significant difference found for pA1M levels between the groups with and without postoperative AKI development. Haemolysis during cardiac surgery with CPB increases the risk of postoperative AKI. Levels of pA1M did not differ for patients who developed postoperative AKI compared with those who did not. The data did not allow conclusions regarding the hypothesis that pA1M has a reno-protective effect.
在体外循环（CPB）心脏手术期间发生的溶血被认为是术后急性肾损伤（AKI）的一个危险因素。血浆α-1微球蛋白（A1M）可能作为血红素清除剂发挥保护作用。本研究的目的是分别评估心脏手术期间AKI与溶血程度以及A1M浓度变化过程之间的关联。我们分析了25例接受心脏手术患者的血浆游离血红蛋白（pfHb）和A1M浓度：体外循环前；体外循环期间每隔15分钟；体外循环后；以及术后24小时内的另外四个时间点。肾功能指标随访至术后4天。AKI的检测基于KDIGO（改善全球肾脏病预后）标准。发现术后发生AKI的患者在体外循环开始后60分钟时的血浆游离血红蛋白浓度显著高于未发生AKI的患者[平均值1379μg/mL（95%CI：1037 - 1721）]；相比之下，未发生AKI的患者为[820μg/mL（622 - 1018）]；P = 0.034，且在体外循环后1小时[2600μg/mL（969 - 4230）]对比[1037μg/mL（722 - 1353）]；P = 0.044]。术后发生AKI和未发生AKI的两组之间pA1M水平没有显著差异。CPB心脏手术期间的溶血会增加术后AKI的风险。发生术后AKI的患者与未发生的患者相比，pA1M水平没有差异。这些数据无法就pA1M具有肾脏保护作用这一假设得出结论。
