【罂粟摘要】体外循环心血管手术患者围术期血清 Syndecan-1 浓度及其与术后急性肾损伤发生的关系

体外循环（CPB）心血管手术（CVS）期间，多种因素可能导致血管内皮损伤，这被认为与术后并发症有关。然而，很少有研究专门探讨血管内皮损伤程度与术后急性肾损伤（pAKI）之间的关系。本研究的目的是测量接受 CVS 和 CPB 的患者围手术期血清 syndecan-1 浓度，评估其趋势，并确定其与 pAKI 的关联。

这是在国立大学医院进行的一项描述性病例对照研究。纳入2016年3月15日至2020年8月31日期间在国立大学医院接受CVS联合CPB的成年患者。正在接受术前透析、术前血清肌酐浓度大于2.0 mg dl−1的患者以及正在接受降主动脉手术的患者被排除。测量围手术期血清Syndecan-1浓度，并研究其与 pAKI 的关系。

其中18例（34.6%）患者发生了pAKI。CPB 启动后，血清Syndecan-1浓度升高，并呈现双峰值。与麻醉诱导后相比，所有时间点的血清Syndecan-1浓度都明显升高。CPB 断流后30分钟和术后第1天的血清Syndecan-1浓度与pAKI的发生相关（OR=1.10 [1.01 至 1.21]，P=0.03]；OR=1.16 [1.01 至 1.34]，P=0. 04]；导致pAKI的Syndecan-1浓度的切点值为101.0 ng ml-1（灵敏度=0.71，特异性=0.62，曲线下面积（AUC）=0.67（0.51 至 0.83））和 57.1 ng ml-1（灵敏度=0.82，特异性=0.56，AUC=0.71（0.57 至 0.86））。多变量逻辑回归分析显示，术后第 1 天的血清Syndecan-1浓度与pAKI的发生有关（OR=1.02 [1.00 至 1.03]；P=0.03）。

所有时间点的血清Syndecan-1浓度均明显高于麻醉诱导后的浓度。术后第 1 天的血清Syndecan-1 浓度与 pAKI 的发生显著相关。

原始文献来源： Miyazaki A,Hokka M,Obata N, et al. Perioperative serum syndecan-1 concentrations in patients who underwent cardiovascular surgery with cardiopulmonary bypass and its association with the occurrence of postoperative acute kidney injury: a retrospective observational study. BMC Anesthesiol. 2024;24 (1):154. doi:10.1186/s12871-024-02546-1

Perioperative serum syndecan-1 concentrations in patients who underwent cardiovascular surgery with cardiopulmonary bypass and its association with the occurrence of postoperative acute kidney injury: A retrospective observational study

Abstract   

BACKGROUND: Various factors can cause vascular endothelial damage during cardiovascular surgery (CVS) with cardiopulmonary bypass (CPB), which has been suggested to be associated with postoperative complications. However, few

studies have specifcally investigated the relationship between the degree of vascular endothelial damage and postoperative acute kidney injury (pAKI). The objectives of this study were to measure perioperative serum syndecan-1 concentrations in patients who underwent CVS with CPB, evaluate their trends, and determine their association with pAKI.

METHODS: This was a descriptive and case‒control study conducted at the National University Hospital. Adult patients who underwent CVS with CPB at a national university hospital between March 15, 2016, and August 31, 2020, were

included. Patients who were undergoing preoperative dialysis, had preoperative serum creatinine concentrations greater than 2.0 mg dl−1, who were undergoing surgery involving the descending aorta were excluded. The perioperative serum syndecan-1 concentration was measured, and its association with pAKI was investigated.

RESULTS: Fifty-two patients were included. pAKI occurred in 18 (34.6%) of those patients. The serum syndecan-1 concentration increased after CPB initiation and exhibited bimodal peak values. The serum syndecan-1 concentration at all time points was signifcantly elevated compared to that after the induction of anesthesia. The serum syndecan-1 concentration at 30 min after weaning from CPB and on postoperative day 1 was associated with the occurrence of pAKI (OR=1.10 [1.01 to 1.21], P=0.03]; OR=1.16 [1.01 to 1.34], P=0.04]; and the cutof values of the serum syndecan-1 concentration that resulted in pAKI were 101.0 ng ml−1 (sensitivity=0.71, specifcity=0.62, area under the curve (AUC)=0.67 (0.51 to 0.83)) and 57.1 ng ml−1 (sensitivity=0.82, specifcity=0.56, AUC=0.71 (0.57 to 0.86)). Multivariate logistic regression analysis revealed that the serum syndecan-1 concentration on postoperative day 1 was associated with the occurrence of pAKI (OR=1.02 [1.00 to 1.03]; P=0.03).

CONCLUSION:The serum syndecan-1 concentration at all time points was signi cantly greater than that after the induction of anesthesia. The serum syndecan-1 concentration on postoperative day 1 was signi cantly associated with the occurrence of pAKI