血清超氧岐化酶及胱抑素C水平在不停跳冠状动脉旁路移植术患者中的相关性与临床意义研究
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摘要
目的:探讨血清超氧岐化酶(SOD)及胱抑素C(Cys_C)在不停跳冠状动脉旁路移植术(OPCABG)患者中的相关性及临床意义。方法:选取从2014年1月到2017年1月,我院192例择期OPCABG患者,根据术前血清SOD水平将患者分为低SOD组及正常SOD组;检测术前血清Cys_C水平将患者分为低Cys_C组及高Cys_C组。比较两组间临床数据及术后并发症[急性肾损伤(AKI)、低氧血症、延迟脱机及低心排]、ICU停留时间及住院时间;分析SOD与术前、术后Cys_C之间的相关性,SOD及机械通气时间相关性。应用ROC曲线分析血清SOD、术前及术后Cys_C预测延迟脱机及AKI的效价。结果:血清SOD水平与术后Cys-C水平均成呈负相关(r=-0.209,P<0.05);术前Cys_C水平预测延迟脱机(AUC=0.609,95%CI:0.51~0.708;P=0.031);术后Cys_C水平预测AKI(AUC=0.694,95%CI:0.587~0.801;P=0.01)。结论:SOD与术后血清Cys_C水平具有负相关性;术前血清Cys_C水平可作为延迟脱机的早期预测指标;同时术后血清Cys_C水平可作为早期AKI预测指标。
Objective: To investigate the correlation and clinical significance of serum superoxide dismutase( SOD) and cystatin C( Cys_C) in patients with coronary artery bypass grafting( OPCABG). Methods:192 patients with selective OPCABG from January 2014 to January 2017 were divided into low SOD group and normal SOD group according to the preoperative serum SOD level,and the serum Cys_C level before operation was divided into low Cys_C group and high Cys_C group. The clinical data of two groups and postoperative complications( acute renal injury,hypoxemia,delayed and low cardiac output),ICU stay time and hospitalization time were compared,and the correlation between SOD and Cys_C before and after operation,and the correlation between SOD and mechanical ventilation time were compared. ROC curve was used to analyze serum SOD,preoperative and postoperative Cys_C to predict the titers of delayed weaning and acute kidney injury. Results:The level of serum SOD was negatively correlated with the level of Cys-C after operation( r =-0. 209,P <0. 05); Cys_C level before operation was used to predict delayed AUC = 0. 609,95% CI: 0. 51-0. 708; P =0. 031; Cys_ C level after operation was used to predict acute renal injury AUC = 0. 694,95% CI: 0. 587 ~0. 801; P = 0. 01. Conclusion: SOD has a negative correlation with the level of serum Cys_C after operation,and the serum Cys_C level before operation can be used as an early predictor of delayed dislocation,and the level of serum Cys_C after operation can be used as a predictor of early acute renal injury.
Objective: To investigate the correlation and clinical significance of serum superoxide dismutase( SOD) and cystatin C( Cys_C) in patients with coronary artery bypass grafting( OPCABG). Methods:192 patients with selective OPCABG from January 2014 to January 2017 were divided into low SOD group and normal SOD group according to the preoperative serum SOD level,and the serum Cys_C level before operation was divided into low Cys_C group and high Cys_C group. The clinical data of two groups and postoperative complications( acute renal injury,hypoxemia,delayed and low cardiac output),ICU stay time and hospitalization time were compared,and the correlation between SOD and Cys_C before and after operation,and the correlation between SOD and mechanical ventilation time were compared. ROC curve was used to analyze serum SOD,preoperative and postoperative Cys_C to predict the titers of delayed weaning and acute kidney injury. Results:The level of serum SOD was negatively correlated with the level of Cys-C after operation( r =-0. 209,P <0. 05); Cys_C level before operation was used to predict delayed AUC = 0. 609,95% CI: 0. 51-0. 708; P =0. 031; Cys_ C level after operation was used to predict acute renal injury AUC = 0. 694,95% CI: 0. 587 ~0. 801; P = 0. 01. Conclusion: SOD has a negative correlation with the level of serum Cys_C after operation,and the serum Cys_C level before operation can be used as an early predictor of delayed dislocation,and the level of serum Cys_C after operation can be used as a predictor of early acute renal injury.
引文
[1]赵东晖,柳景华.冠状动脉慢性完全闭塞病变研究最新进展[J].心肺血管病杂志,2013,32(3):371-373.
[2]Akila,D'souza B,Vishwanath P,et al.Oxidative injury and antioxidants in coronary artery bypass graft surgery:off-pump CABG significantly reduces oxidative stress.Clin Chim Acta,2007.375(1-2):147-152.
[3]杨光,姚晓伟,梁磊,等.冠心病患者Cys-C、β2-MG水平与患者左心结构及功能的相关性分析[J].中国循证心血管医学杂志,2017,9(6):745-747.
[4]Angelidis,Deftereos S,Giannopoulos G,et al.Cystatin C:an emerging biomarker in cardiovascular disease.Curr Top Med Chem,2013.13(2):164-179.
[5]朱亚彬,石维平,杨岷,等.不停跳冠状动脉搭桥术治疗霍奇金病胸部放疗后继发冠心病1例[J].东南大学学报(医学版),2008,27(4):287-288.
[6]何静,周玲珍,赵凤琴.杂交手术治疗冠心病冠状动脉多支病变患者围手术期的护理[J].现代医学,2012,40(6):722-724.
[7]Puskas JD,williams WH,O’Donnell R,et al.off-pump and onpump coronary artery bypass grafting are associated with similar graft patency,myocardial ischemia,and freedom from reintervention:long-term followup of randomized trial[J].Ann Thorac surgery,2011,91(6):1836-1842.
[8]王莉,孙媛.依达拉奉对不停跳冠状动脉搭桥术患者围术期心肌损伤及氧化应激指标的影响观察.现代预防医学,2013,40(7):1357-1358.
[9]李芸芸,李玉琳,王绿娅,等.微小核糖核酸-223-3p对心脏缺血/再灌注损伤后心脏重构的影响[J].心肺血管病杂志,2018,37(3):231-234,243.
[10]艾世辉,林兰梅.Cys C联合SOD诊断早期糖尿病肾病的临床意义.中国现代医生,2012.50(5):36-37,40.
[2]Akila,D'souza B,Vishwanath P,et al.Oxidative injury and antioxidants in coronary artery bypass graft surgery:off-pump CABG significantly reduces oxidative stress.Clin Chim Acta,2007.375(1-2):147-152.
[3]杨光,姚晓伟,梁磊,等.冠心病患者Cys-C、β2-MG水平与患者左心结构及功能的相关性分析[J].中国循证心血管医学杂志,2017,9(6):745-747.
[4]Angelidis,Deftereos S,Giannopoulos G,et al.Cystatin C:an emerging biomarker in cardiovascular disease.Curr Top Med Chem,2013.13(2):164-179.
[5]朱亚彬,石维平,杨岷,等.不停跳冠状动脉搭桥术治疗霍奇金病胸部放疗后继发冠心病1例[J].东南大学学报(医学版),2008,27(4):287-288.
[6]何静,周玲珍,赵凤琴.杂交手术治疗冠心病冠状动脉多支病变患者围手术期的护理[J].现代医学,2012,40(6):722-724.
[7]Puskas JD,williams WH,O’Donnell R,et al.off-pump and onpump coronary artery bypass grafting are associated with similar graft patency,myocardial ischemia,and freedom from reintervention:long-term followup of randomized trial[J].Ann Thorac surgery,2011,91(6):1836-1842.
[8]王莉,孙媛.依达拉奉对不停跳冠状动脉搭桥术患者围术期心肌损伤及氧化应激指标的影响观察.现代预防医学,2013,40(7):1357-1358.
[9]李芸芸,李玉琳,王绿娅,等.微小核糖核酸-223-3p对心脏缺血/再灌注损伤后心脏重构的影响[J].心肺血管病杂志,2018,37(3):231-234,243.
[10]艾世辉,林兰梅.Cys C联合SOD诊断早期糖尿病肾病的临床意义.中国现代医生,2012.50(5):36-37,40.