实用临床医药杂志2025，Vol.29Issue(24)：24-29,6.DOI:10.7619/jcmp.20255552
肺移植术后早期急性肾损伤的危险因素以及血清脂肪酸结合蛋白3和乳脂球表皮生长因子8蛋白水平的预测价值
Risk factors for early acute kidney injury after lung transplantation and predictive values of serum levels of heart-type fatty acid binding protein 3 and milk fat globule epidermal growth factor 8 protein
摘要
Abstract
Objective To explore the risk factors for early acute kidney injury(AKI)after lung transplantation and the predictive values of serum heart-type fatty acid binding protein 3(H-FABP)and milk fat globule epidermal growth factor 8 protein(MFG-E8)levels.Methods A total of 92 patients with lung transplantation in the hospital were selected and divided into AKI group(n=62)and non-AKI group(n=30)according to the occurrence of AKI within 7 days after surgery.The clinical data of the two groups were compared.Multivariate Logistic regression analysis was used to screen independent risk factors.The receiver operating characteristic(ROC)curve was used to ana-lyze the predictive value of serum H-FABP and MFG-E8 alone and their combination,and bootstrap resampling(1 000 times)was used to verify the stability of the model.Results The preoperative creatinine,intraoperative blood transfusion volume,and intraoperative urine volume in the AKI group were(58.52±14.02)μmol/L,1 500.00(1 000.00,2 050.00)mL,and(320.50±85.22)mL respectively,which were all significantly higher than(51.75±13.39)μmol/L,1 000.00(700.00,1 250.00)mL and(182.10±50.41)mL in the non-AKI group(P＜0.05).The proportions of patients with pulmonary hypertension,postoperative extracorporeal membrane oxygenation(ECMO)≥2 days,and the use of≥5 potentially nephrotoxic drugs in the AKI group were 70.97％,45.16％and 63.33％respectively,which were all significantly higher than 50.00％,23.33％and 23.33％in the non-AKI group(P＜0.05).The serum H-FABP level in the AKI group was(24.12±3.09)ng/mL,which was significantly higher than(12.19±2.93)ng/mL in the non-AKI group(P＜0.05);the MFG-E8 level in the AKI group was(64.82±18.84)pg/mL,which was significantly lower than(141.60±31.65)pg/mL in the non-AKI group(P＜0.05).Multivariate Logistic regression analysis showed that pulmonary hypertension,postoperative ECMO≥2 days,elevated preoperative creatinine,the use of ≥5 potentially nephrotoxic drugs,and increased intraoperative urine volume were independent risk factors for early AKI after lung transplantation(P＜0.05).The areas under the curve(AUCs)for the prediction by serum H-FABP,MFG-E8 alone and in combination were 0.764,0.801,and 0.929,respectively.The combined prediction had a sensitivity of 90.32％and a specificity of 83.33％,showing the best performance(Z=4.002,3.751,P＜0.05).After verification by the bootstrap method,the bias-corrected AUC of the model was 0.912(95％CI,0.835 to 0.948),indicating good stability of the model prediction.Conclusion Pulmonary hypertension,postoperative ECMO ≥2 days,elevated preoperative creati-nine,the use of ≥ 5 potentially nephrotoxic drugs,and increased intraoperative urine volume are independent risk factors for early AKI after lung transplantation.Serum H-FABP and MFG-E8 provide complementary information from the perspectives of injury and protection,respectively.Combined detection may improve early warning ability and provide a reference for early clinical intervention.关键词
肺移植/急性肾损伤/危险因素/生物标志物/脂肪酸结合蛋白3/乳脂球表皮生长因子8蛋白/预测模型/并发症Key words
lung transplantation/acute kidney injury/risk factors/biomarkers/heart-type fatty acid binding protein 3/milk fat globule epidermal growth factor 8 protein/predictive model/complications分类
医药卫生引用本文复制引用
焦健方,张广健..肺移植术后早期急性肾损伤的危险因素以及血清脂肪酸结合蛋白3和乳脂球表皮生长因子8蛋白水平的预测价值[J].实用临床医药杂志,2025,29(24):24-29,6.基金项目
国家自然科学基金(82172280) （82172280）
陕西省自然科学基金(2024JC-YBQN-0972) （2024JC-YBQN-0972）
