心脏手术术前血清脑钠肽与术后急性肾损伤的相关性分析

目的:BNP与心脏手术患者术后并发症及死亡率密切相关。然而与急性肾损伤之间关系研究甚少。本研究旨在观察BNP和心脏手术术后急性肾损伤之间的关系。方法:收集第二军医大学附属长海医院胸心外科手术患者182名，手术方式包括冠脉搭桥手术（CABG）、瓣膜置换术、联合手术（瓣膜 CABG）。依据KDIGO 指南最新AKI的定义和分级，记录和统计不同BNP患者的急性肾损伤发病率。并阐述BNP预测AKI的能力和价值。结果:1共入选 182人，平均年龄（68.6±8.9）岁 男性占65.9%，手术方式：CABG45.0%，瓣膜手术36.8%，联合手术23.6% ，按BNP升序入组后发现年龄、基础肾功能和术前BNP有统计学差异。2.术后AKI发病率达33.5%， 1级AKI和总AKI的发病率依BNP增加而增加，趋势有统计学差异（p=0.005，p<0.001）。3.以BNP预测AKI绘制ROC曲线图，曲线下面积AUC为0.687 (95% CI 0.607,0.768)，有一定准确性。结论：心脏手术患者术前BNP与术后AKI发病率呈正相关，是一种可作为危险分层的重要预测因素。

Relationship of pre-operative serum brain natriuretic peptide with risk of acute kidney injury after cardiac surgery

Objective To observe the relationship of pre-operative serum brain natriuretic peptide (BNP) with risk of acute kidney injury (AKI) after cardiac surgery. Methods We collected 182 patients undergoing cardiac surgery at Department of Cardiac Surgery, Changhai Hospital from Jan. 2012 to Jan. 2013. The surgical procedures included coronary artery bypass graft (CABG),valve replacement, and combined surgery (CABG+valve replacement). According to the preoperative BNP levels, the patients were divided into five groups in an ascending order. The definition and classification weres accorded to the latest AKI KDIGO (Kidney Disease: Improving Global Outcomes) guideline; the AKI incidence was obtained from patients with different BNP levels. Receiver operating characteristic (ROC) curves were used to evaluate the value of BNP level as a predictor of AKI. Results The average age of the 182 patients was (68.6±8.9) years old, with male being 65.9% (120/182). The surgery procedures including 82 CABG (45.0%),57 valve replacement (31.3%), and 43 combined surgery (CABG valve replacement) (23.6%). We found that age, basic renal function and pre-operative BNP levels were significantly different between the five BNP groups (P<0.05). The incidence of AKI was 33.5% (61/182) in this study. The incidence rates of stage 1 AKI and total AKI significantly increased with increase of BNP levels in the five BNP groups (P<0.05). As a predictor of AKI ROC curves, BNP area under the curve (AUC) was 0.687 (95% CI: 0.607-0.768). Conclusion Pre-operative BNP level is associated with post-operative AKI in high risk patients undergoing cardiac surgery, and it is a potential predictor of AKI risk stratification after cardiac surgery.