【摘要】：目的：1）動態(tài)觀察心臟手術患者術前及術后血液及尿液中Klotho蛋白的濃度，探討Klotho蛋白與心臟手術后AKI發(fā)生的關系；2）了解心臟手術后AKI患者中血液及尿液中Klotho蛋白濃度與患者預后的關系； 方法：1）選擇上海交通大學醫(yī)學院附屬仁濟醫(yī)院心胸外科心臟手術患者91例，收集其術前及術后多個時間點的血尿標本，記錄患者術前，術中及術后的一般情況、實驗室資料及預后情況，ELISA法檢測血和尿液標本中Klotho蛋白的濃度，比較術后AKI與非AKI患者間各時間點的Klotho蛋白濃度，并與尿NGAL進行比較，多元逐步回歸法分析心臟手術后AKI發(fā)生的危險因素，觀察Klotho蛋白水平與AKI發(fā)生之間的關系及其作為AKI診斷標志物的意義。2）隨訪患者的預后，比較不同預后患者間各個時間點的血和尿液的Klotho濃度，運用Logistic回歸方法分析影響AKI預后的危險因素，分析Klotho蛋白水平與AKI患者預后的關系。 結果：1）91例心臟手術后患者，平均年齡（61.08±9.69）歲，其中男性占63.7%，糖尿病15.4%，高血壓36.3%。其中33例（36.3%）患者發(fā)生了AKI，AKI和非AKI患者的術前一般情況相似，AKI組患者手術時間、CPB時間較非AKI組顯著延長（P0.05），術前胱抑素C水平明顯高于非AKI組（P0.05），住院時間，住院費用均明顯高于非AKI組患者（P0.05）。2）AKI組患者術前血、尿Klotho水平與非AKI患者相比無明顯差異（P0.05）。術后0h AKI患者的血Klotho水平下降幅度顯著大于非AKI組（0.177±0.155vs0.456±0.327，P0.05）。術后0h AKI患者的尿Klotho水平上升幅度顯著大于非AKI組（1.690[1.026，2.677] vs0.526[0.230，0.891]，P0.05）。3）多因素Logistic回歸分析顯示：手術時間延長、尿Klotho蛋白升高、血Klotho蛋白降低是心臟手術患者發(fā)生AKI的獨立危險因素。4）術后0h，腎功能未恢復組患者血Klotho水平明顯低于完全恢復組患者，，差異有統(tǒng)計學意義（0.104±0.126vs0.237±0.169，P0.05）。影響AKI患者腎功能完全恢復的獨立危險因素包括：心臟停搏時間、升主動脈阻斷時間、基礎eGFR、術后0小時尿Klotho蛋白水平、術前血紅蛋白含量。5）術后0h血Klotho水平預測AKI發(fā)生的ROC曲線下面積為0.788，95%的可信區(qū)間為0.692-0.884，P=0.001。當術后0h血Klotho蛋白濃度為0.234ng/μmol時，預測AKI發(fā)生的敏感性為0.707，特異性為0.788。術后0h尿Klotho水平預測AKI發(fā)生的ROC曲線下面積為0.853，95%的可信區(qū)間為0.776-0.930，P=0.001。當術后0h尿Klotho蛋白濃度為0.858ng/μmol時，預測AKI發(fā)生的敏感性為0.909，特異性為0.759。 結論：心臟手術后AKI患者術后早期血、尿Klotho蛋白水平即存在顯著改變，其變化早于NGAL，可能可以作為AKI的早期檢測指標。手術時間延長、尿Klotho蛋白水平升高、血Klotho蛋白水平降低可能是心臟手術患者發(fā)生AKI的獨立危險因素。血Klotho蛋白水平降低可能與AKI患者的腎臟預后相關。
[Abstract]:Objective: 1) to observe the concentration of Klotho protein in blood and urine before and after cardiac surgery, and to explore the relationship between Klotho protein and AKI after cardiac surgery. 2) to investigate the relationship between the concentration of Klotho protein in blood and urine and the prognosis of patients with AKI after cardiac surgery. Methods: 1) 91 patients undergoing cardiothoracic heart surgery in Renji Hospital affiliated to Shanghai Jiaotong University Medical College were selected. Blood and urine samples were collected at various time points before and after operation, and the general situation of the patients before, during and after operation was recorded. Laboratory data and prognosis. ELISA method was used to detect the concentration of Klotho protein in blood and urine samples, and to compare the concentration of Klotho protein between AKI and non-AKI patients at different time points after operation, and to compare it with urine NGAL. Multivariate stepwise regression method was used to analyze the risk factors of AKI after cardiac surgery, and to observe the relationship between the level of Klotho protein and the occurrence of AKI and its significance as a diagnostic marker of AKI. 2) the prognosis of the patients followed up. The concentrations of Klotho in blood and urine were compared among patients with different prognosis. The risk factors affecting the prognosis of AKI were analyzed by Logistic regression, and the relationship between Klotho protein level and prognosis of AKI patients was analyzed. Results: 1) the mean age of 91 patients after cardiac surgery was (61.08 鹵9.69) years, of which the male accounted for 63.7%, diabetes 15.4m, hypertension 36.3%. 33 cases (36.3%) had AKI,AKI and non-AKI. The operation time and CPB time in AKI group were significantly longer than those in non-AKI group (P0.05), and the time of CPB in AKI group was significantly longer than that in non-AKI group (P0.05). The preoperative level of cystatin C was significantly higher than that of non-AKI group (P0.05), and the hospitalization time and hospitalization cost were significantly higher than those of non-AKI group (P0.05). 2) the preoperative blood of AKI group was significantly higher than that of AKI group. There was no significant difference between urinary Klotho level and non-AKI patients (P0.05). The decrease of serum Klotho level in AKI group was significantly higher than that in non-AKI group (0.177 鹵0.155vs0.456 鹵0.327 P 0.05) at 0 h after operation. The increase of urinary Klotho level in patients with AKI at 0 h after operation was significantly higher than that in non-AKI group (1.690 [1.0262.677] vs0.526 [0.2300.8091, P0.05) .3Multivariate Logistic regression analysis showed that the time of operation was prolonged and the urine Klotho protein was increased. The decrease of serum Klotho protein was an independent risk factor for the occurrence of AKI in patients undergoing cardiac surgery. 4) at 0 h after operation, the level of serum Klotho in patients with no recovery of renal function was significantly lower than that in patients with complete recovery, and the difference was statistically significant (0.104 鹵0.126vs0.237 鹵0.169). P0.05). Independent risk factors affecting the complete recovery of renal function in patients with AKI included cardiac arrest time, ascending aorta occlusion time and urinary Klotho protein level at 0 hours after basic eGFR,. Preoperative hemoglobin content was 0.5) the serum Klotho level predicted the area under the ROC curve of AKI was 0.78895% and the confidence interval was 0.692-0.884P0. 001. When the serum Klotho protein concentration was 0.234ng/ 渭 mol at 0 h after operation, the sensitivity and specificity of predicting the occurrence of AKI were 0.707 and 0.788 respectively. At 0 h after operation, the confidence interval of the area under the ROC curve of 0.85395% for predicting the incidence of AKI was 0.776-0.930g / P0. 001for urine Klotho level. When the concentration of urinary Klotho protein was 0.858ng/ 渭 mol at 0 h after operation, the sensitivity and specificity of predicting the occurrence of AKI were 0.909 and 0.75959 respectively. Conclusion: the changes of Klotho protein in blood and urine of AKI patients after cardiac surgery are significant, which may be used as an early detection index of AKI. Prolonged operation time, elevated urinary Klotho protein level and decreased serum Klotho protein level may be independent risk factors for AKI in patients undergoing cardiac surgery. The decrease of serum Klotho protein level may be associated with renal prognosis in patients with AKI.
【學位授予單位】：上海交通大學
【學位級別】：碩士
【學位授予年份】：2014
【分類號】：R654.2;R692

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