神经药理学报

神经药理学报 ›› 2025, Vol. 15 ›› Issue (6): 28-.DOI: 10.3969/j.issn.2095-1396.2025.06.004

• 研究论文 • 上一篇    下一篇

高密度脂蛋白胆固醇与体外循环心脏手术后急性肾损伤相关性分析

刘柳，刘福岗，谢恺庆   

  1. 1. 南华大学附属第一医院肾内科，衡阳，421000，中国 

    2. 广西医科大学第二附属医院肾内科，南宁，530007，中国 

    3. 广西医科大学附属肿瘤医院肾内科，南宁，530021，中国

  • 出版日期:2025-12-26 发布日期:2026-03-30
  • 通讯作者: 谢恺庆，主任医师，博士；研究方向：急性肾损伤
  • 作者简介:刘柳，住院医师，博士；研究方向：急性肾损伤
  • 基金资助:
    广西壮族自治区自然科学基金项目（No.2018GXNSFAA050057）

Association of High-Density Lipoprotein Cholesterol with Acute Kidney Injury after Cardiac Surgery with Cardiopulmonary Bypass

LIU Liu, LIU Fu-gang, XIE Kai-qing   

  1. 1. Department of Nephrology, The First Afffliated Hospital, University of South China, Hengyang, 421000, China 

    2. Department of Nephrology, The Second Afffliated Hospital of Guangxi Medical University, Nanning, 530007, China 

    3. Department of Nephrology, The Affiliated Tumor Hospital of Guangxi Medical University, Nanning, 530021, China

  • Online:2025-12-26 Published:2026-03-30

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摘要：

目的：分析术前高密度脂蛋白胆固醇（high-density lipoprotein cholesterol，HDL-C）水平与体外循 环心脏手术后急性肾损伤（acute kidney injury，AKI）的相关性。方法：回顾性分析行体外循环心脏手术的成 年患者临床资料，以术前末次血脂水平分为低水平高密度脂蛋白胆固醇组（＜ 1.04 mmol·L-1）和正常水平高 密度脂蛋白胆固醇组（≥ 1.04 mmol·L-1），比较2 组患者术后7 天内AKI 的发生情况，采用单因素分析和二分 类Logistic 回归评估术前不同水平高密度脂蛋白胆固醇对术后AKI 的影响。结果：共纳入903 例患者，低水 平HDL-C 者326 例（36.1%），正常HDL-C 者577 例（63.9%），心脏手术后发生AKI 351 例（38.9%），其中低水 平HDL-C 组156 例（47.9%），正常水平HDL-C 组195 例（33.8%），差异有统计学意义（P ＜ 0.001）。与正常 水平HDL-C 组相比，低水平HDL-C 组患者术后的AKI 发生率高（P ＜ 0.001），且呼吸机使用时间、重症监护 室停留时间和住院时间均延长（均P ＜ 0.05）。在校正了年龄、性别、伴发疾病（高血压、糖尿病）、贫血、高尿酸 血症、低白蛋白血症、蛋白尿、术前肾功能、术前心功能、术前1 周内行冠状动脉造影(coronary angiography， CAG）、体外循环时间、主动脉阻断时间、心脏手术类型、术后低血压等影响因素后，二分类Logistic 回归分析 显示术前低水平HDL-C 是体外循环心脏手术后发生AKI 的独立危险因素（OR=1.413，95%CI 1.023~1.950， P=0.036）。 结论：AKI 是体外循环心脏手术后常见的并发症之一，术前低水平HDL-C 是体外循环心脏手术后 AKI 发生的独立危险因素。

关键词: 高密度脂蛋白胆固醇, 心脏手术, 体外循环, 急性肾损伤

Abstract:

Objective: To analyze the association between preoperative high-density lipoprotein cholesterol (HDL-C) and acute kidney injury (AKI) in patients after cardiac surgery with cardiopulmonary bypass (CPB). Methods: We conducted a retrospective analysis of clinical data from adult patients who underwent cardiac surgery with CPB. The patients were divided into low HDL-C level group (<1.04 mmol·L-1) and normal HDL-C level group (≥ 1.04 mmol·L-1) according to the preoperative blood lipid level. The clinical data and the incidence of postoperative AKI within 7 days after surgery were compared between the two groups. Univariate analysis and binary Logistic regression analysis were used to evaluate the effect of preoperative HDL-C concentration on postoperative AKI. Results: Among the 903 patients included, 326 cases in the low level HDL-C group (36.1%) and 577 cases (63.9%) in the normal level HDL-C group. 351 cases (38.9%) had AKI after cardiac surgery with CPB, of which 156 cases (47.9%) in the low level HDL-C group and 195 cases (33.8%) in the normal level HDL-C group, and the difference was statistically significant (P<0.001). Compared with the normal level HDL-C group, the incidence of postoperative AKI in the low level HDL-C group was higher (P<0.001), and the ventilator use time, the duration of ICU and the length of stay were prolonged (P<0.001). After adjusted for age, gender, comorbidities (hypertension, diabetes), anemia, hyperuricemia, hypoalbuminemia, proteinuria, preoperative renal function, preoperative cardiac function, preoperative coronary angiography, cardiopulmonary bypass time, aortic clamping time, type of cardiac surgery, postoperative hypotension and other influencing factors, binary Logistic regression analysis showed that preoperative low level HDL-C was an independent risk factor for AKI in patients after cardiac surgery with CPB (OR=1.413，95%CI 1.023~1.950，P=0.036). Conclusion: AKI is a common complication after cardiac surgery with CPB, and identify preoperative low HDL-C is an independent risk factor for AKI.

Key words: high-density lipoprotein cholesterol, acute kidney injury, cardiac surgery, cardiopulmonary bypass

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