MDA、AOPP、Nrf2、GSH水平与肾细胞癌患者腹腔镜肾部分切除术后急性肾损伤的相关性OA北大核心CSTPCD

Objective To analyze the correlation of malondialdehyde(MDA),advanced oxidation protein products(AOPP),nuclear factor erythroid-2 related factor 2(Nrf2),glutathione(GSH)levels with postoperative acute kidney injury(AKI)among patients undergoing laparoscopic partial nephrectomy(LPN).Methods A total of 110 patients with renal cell carcinoma who were admitted to the Department of Urology,the Third Medical Center of Chinese PLA General Hospital from February to August 2022 were included in the study.Patients were divided into AKI group(n=30)and non-AKI group(n=80)based on the Kidney Disease:Improving Global Outcomes(KDIGO)criteria,and then divided into elderly AKI(>65 years old,n=14),middle-aged AKI(50-65 years old,n=16),elderly non-AKI(>65 years old,n=30),and middle-aged non-AKI(50-65 years old,n=50)four sub-groups based on age.Clinical characteristics and laboratory examination data were recorded.Venous blood was collected from the patients before the operation(T1),immediately after the surgery(T2),and 24 h after surgery(T3),and MDA,AOPP,Nrf2 and GSH levels were measured.MDA,AOPP,Nrf2 and GSH levels were compared between the four subgroups at different time points,and their correlation with the occurrence of AKI after LPN were explored.The risk factors for AKI after LPN were analyzed using the univariate and multivariate logistic regression.Results Spearman correlation analysis revealed that AKI was not associated with the MDA level at each time point(P>0.05),was positively associated with AOPP-T3 level(r=0.315,P=0.037),was negatively associated with the Nrf2-T3 level(r=-0.365,P=0.015)and GSH-T2 level(r=-0.338,P=0.025)in elderly patients after LPN.AKI was not associated with MDA,AOPP,Nrf2,and GSH levels(P>0.05)in middle-aged patients after LPN.Multivariate logistic regression analysis showed that BMI(OR=2.724,P=0.040)and surgically resected kidney volume(OR=1.309,P=0.049)were independent risk factors for AKI in elderly patients after LPN,GSH-T2(OR=0.271,P=0.042)was an independent protective factor for AKI in elderly patients after LPN.Intraoperative colloid fluid intake(OR=1.006,P=0.007)was an independent risk factor for AKI in middle-aged patients after LPN,intraoperative urine output(OR=0.104,P=0.007)was an independent protective factor for AKI in middle-aged patients after LPN.Conclusions The AKI after LPN may be related to the increase of AOPP level and the decrease of Nrf2 and GSH levels in elderly patients,and the postoperative GSH is an independent protective factor for AKI in elderly patients after LPN.The correlation of AKI after LPN is not significant with the levels of MDA,AOPP,Nrf2 and GSH in the middle-aged patients.