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低白蛋白血症对心脏手术后患儿急性肾损伤发生的影响
Association of hypoalbuminemia with acute kidney injury in children after cardiac surgery
目的 探讨小儿心脏病体外循环（CPB）手术后的低白蛋白血症对术后急性肾损伤（AKI）发生的影响。方法 回顾性分析2012~2016年行心脏病CPB手术患儿1 110例临床资料，按术后48 h内最低白蛋白浓度分为低白蛋白组（≤35 g/L）和正常白蛋白组（> 35 g/L），比较两组患儿的围手术期资料和AKI发生率。对不均衡的围手术期各因素进行倾向评分匹配后再次比较AKI发生率。采用logistic回归分析术后AKI发生的围手术期危险因素。结果 术后AKI发生率为13.78%（153/1 110），病死率为2.52%（28/1 110），AKI患儿病死率为13.1%（20/153），术后白蛋白≤35 g/L 的患儿占44.50%（494/1 110）。匹配前后低白蛋白组AKI发生率均比正常白蛋白组要高（P < 0.05）；匹配前后AKI患儿术后白蛋白浓度均低于非AKI患儿（P < 0.05）；Logistic多因素回归分析结果显示术后白蛋白≤35 g/L是术后AKI发生的独立危险因素之一。结论 术后48 h内白蛋白≤35 g/L是心脏CPB术后患儿AKI发生的独立危险因素，术后加强对白蛋白的检测和补充对控制术后AKI的发生有积极作用。
Objective To study whether hypoalbuminemia after pediatric cardiopulmonary bypass (CPB) for cardiac surgery is a risk factor for postoperative acute kidney injury (AKI). Methods A retrospective analysis was performed on the clinical data of 1 110 children who underwent CPB surgery between 2012 and 2016. According to the minimum serum albumin within 48 hours postoperatively, these patients were divided into hypoalbuminemia group (≤35 g/L) and normal albumin group (> 35 g/L). The two groups were compared in terms of perioperative data and the incidence of AKI. Furthermore, the incidence of AKI was compared again after propensity score matching for the unbalanced factors during the perioperative period. The perioperative risk factors for postoperative AKI were analyzed by logistic regression. Results The overall incidence rate of postoperative AKI was 13.78% (153/1 110), and the mortality rate was 2.52% (28/1 110). The mortality rate of children with AKI was 13.1% (20/153). The patients with hypoalbuminemia after surgery (≤35 g/L) accounted for 44.50% (494/1 110). Before and after propensity score matching, the hypoalbuminemia group had a significantly higher incidence of AKI than the normal albumin group (P < 0.05). The children with AKI had a significantly lower serum albumin level after surgery than those without AKI (P < 0.05). The multivariate logistic regression analysis showed albumin ≤35 g/L was one of the independent risk factors for postoperative AKI. Conclusions Albumin ≤35 g/L within 48 hours postoperatively is an independent risk factor for postoperative AKI in children after CPB surgery.
低白蛋白血症 / 急性肾损伤 / 倾向评分匹配 / 体外循环 / 儿童
Hypoalbuminemia / Acute kidney injury / Propensity score matching / Cardiopulmonary bypass / Child
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