目的 对比急性Stanford A型和Stanford B型主动脉夹层患者围手术期发生急性肾损伤的相关危险因素及临床特点。方法 收集2019年1月1日至2021年12月31日在新疆医科大学第一附属医院住院并确诊为急性主动脉夹层的患者资料，按照CTA影像学结果分为TAAAD患者和TBAAD患者，根据KDIGO标准又分别分为AKI组及非AKI组。比较两组间术前、术中、术后资料差异，用二元Logistic回归筛出AKI的独立危险因素，绘制ROC曲线，评估各危险因素对发生AKI的预测价值，描述AAD-AKI的患者出院时肾功能情况，给予AAD-AKI临床指导。结果 共收集464例急性主动脉夹层患者的资料，其中TAAAD患者176例，TBAAD患者288例。TAAAD患者AKI发生率为83.5%（147/176）,TBAAD患者AKI发生率为41%（118/288）。多因素Logistic回归分析显示：体外循环时间、术后首次肌酐、机械通气时间、围手术期使用升压药是TAAAD患者发生AKI的独立危险因素（P＜0.05）。ROC曲线显示，TAAAD-AKI与术后首次肌酐（AUC:0.857,P=0.001）的相关性最大。肾脏灌注不良、入院首次肌酐、术后首次肌酐、围手术期使用袢利尿剂是TBAAD患者发生AKI的独立危险因素（P＜0.05）。ROC曲线显示，TBAAD-AKI与入院首次肌酐（AUC:0.777,P=0.004）的相关性最大。关于出院肾功能结局的研究中，只有一半的患者出院时肾功能完全恢复，TAAAD-AKI患者院内病死率更高。结论 TAAAD-AKI与TBAAD-AKI的独立危险因素有所差异，可能与它们发生AKI的机制不同有关。针对不同的因素，AKI的防治措施也有所不同。对于近一半出院时肾功能未完全恢复的患者，应该在肾病科长期随访。

Objective:To construct and compare the nomogram prediction model of perioperative acute kidney injury (AKI) in Stanford type A and type B acute aortic dissection (AAD) patients.Methods:The data of patients diagnosed with AAD in our hospital from January 2019 to December 2021 were collected. The independent risk factors of TAAAD-AKI and TBAAD-AKI were screened by LASSO regression and multi-factor logistic regression, respectively, and the nomogram prediction model was constructed. Through the internal verification of bootstrapping, the advantages and disadvantages of the model were evaluated from three aspects: accuracy, calibration, and clinical benefit.Results:Data from 464 patients with AAD were collected. The incidence of TAAAD-AKI was 83.5% (147/176), whereas TBAAD-AKI was 41.0% (118/288). First serum creatinine (SCr) on admission, D-dimer value on admission, cardiopulmonary bypass time, mechanical ventilation time, and perioperative use of pressor medications were the independent risk variables for the creation of the TAAAD-AKI nomogram. The variables screened by TBAAD-AKI were first SCr on admission, poor renal perfusion on admission, days of ICU retention, and perioperative use of loop diuretics. The area under the curve (AUC) of receiver operating characteristic curves (ROC) of TAAAD-AKI model was 0.899, which implied a high level of accuracy. The AUC value of the TBAAD-AKI model was 0.825, indicating moderate accuracy. The two nomogram models had good calibration, according to the model's calibration curve and the Hosmer-Lemeshow test. The decision-making curve also found that the model had good clinical benefits.Conclusion:The predictors of TAAAD-AKI and TBAAD-AKI are distinct except for the first SCr on admission. While the majority of the TBAAD-AKI are preoperative, the significant TAAAD-AKI variables are primarily focused during and after the procedure. Constructing and verifying two feasible nomograms is crucial for clinical early warning of AKI.

目的:构建心力衰竭患者AKI(acute kidney injury)发生的临床预测模型,对早期高危患者识别提供依据.方法:回顾性分析新疆医科大学第一附属医院2018年1月至2020年12月明确诊断心力衰竭患者350例,其中AKI患者104名(29.7％),非AKI患者246名(70.3％),将其按7∶3比例随机分为建模队列(n=245)和验证队列(n=105).构建LASSO回归分析建模队列,基于logistic回归结果构建HF-AKI(heart failure-acute kidney injury)患者的诺顿图,同时对模型进行校准,同时验证模型效益.结果:单因素分析得到25个差异变量,LASSO回归、多因素逐步logistics回归,最终得到5个差异变量:年龄、住院天数、入院肌酐、射血分数、是否使用抗生素.构建HF-AKI患者的临床预测模型并绘制成诺顿图.构建训练组和验证组诺顿图的ROC曲线AUC大小分别为0.730和0.794,通过Hosmer-Lemeshow检验,验证组虽然没有训练组的拟合优度优异,但P＞0.05,表明该诺顿图模型同样具有良好的校准度.结论:本研究成功构建了 HF-AKI的临床预测模型,经过系列验证提示该模型的训练组和验证组均具有净收益范围,具有一定的临床价值.

目的 探讨新疆地区单中心妊娠相关急性肾损伤患者的流行病学特点和临床特征.方法 利用新疆医科大学第一附属医院住院患者网络病历系统,回顾性分析2013年1月至2020年11月,在该院住院的妊娠期女性的临床资料.结果 本研究共筛选出妊娠期急性肾损伤(pregnancy-related acute kidney injury,PR-AKI)患者157例,总检出率为0.22％.导致PR-AKI的前3位病因分别为妊娠期高血压疾病(52.9％)、妊娠期急性脂肪肝(11.5％)、产后出血(10.2％).单因素Logistic回归分析显示舒张压(OR=1.022,95％CI:1.005～1.040)、收缩压(OR=1.013,95％CI:1.001～1.026)、血钾(OR=1.942,95％CI:1.066～3.538)、尿素氮(OR=1.331,95％CI:1.200～1.476)、血肌酐(OR=1.033,95％CI:1.200～1.476)、总胆红素(OR=1.010,95％CI:1.001～1.019)是重症PR-AKI患者的危险因素.新生儿出生体重与母体孕周的相关系数最大,与凝血酶原时间相关系数最小.结论 为减少PR-AKI的发生,在基层地区可通过倡导孕期健康生活方式,定时规范全面产检,完善高危孕产妇筛查3方面进行干预,减少不良妊娠结局.