摘要：

目的: 筛查自发性颅内出血术后急性肾损伤（AKI）的影响因素及预测指标。方法: 纳入2023年3月至2024年6月在天津市环湖医院接受手术治疗的151例自发性颅内出血患者，根据术后是否发生急性肾损伤分为急性肾损伤组（AKI组，100例）和非急性肾损伤组（非AKI组，51例），Logistic回归分析筛查自发性颅内出血术后急性肾损伤的影响因素，绘制受试者工作特征（ROC）曲线评估术后3 d颅内压、血清神经元特异性烯醇化酶（NSE）及二者联合对术后急性肾损伤的预测效能。结果: Logistic回归分析显示，肌钙蛋白升高（OR=1.011，95% CI：1.005~1.017；P=0.001）和术后3 d颅内压升高（OR=1.289，95% CI：1.126~1.477；P=0.000）是自发性颅内出血患者术后发生急性肾损伤的危险因素。ROC曲线显示，术后3 d颅内压、血清NSE及二者联合预测术后急性肾损伤的曲线下面积分别为0.729（95% CI：0.649~0.810，P=0.001）、0.720（95% CI：0.631~0.809，P=0.000）和0.751（95% CI：0.672~0.830，P=0.001），灵敏度为45%、73%和51%，特异度为88.24%、66.67%和90.20%，三者预测效能相当（均P >0.05）。结论: 肌钙蛋白和术后3 d颅内压升高的自发性颅内出血患者术后易发生急性肾损伤，术后3 d颅内压和血清NSE可以作为术后急性肾损伤的预测指标，二者联合并未提高预测效能。

关键词: 脑出血, 急性肾损伤, 颅内压, 磷酸丙酮酸水合酶, 危险因素, Logistic模型, ROC曲线

Abstract:

Objective: To analyze the influencing factors of acute kidney injury (AKI) after surgery in spontaneous intracranial hemorrhage (sICH). Methods: A total of 151 patients with sICH who underwent surgery in Tianjin Huanhu Hospital from March 2023 to June 2024 were selected. According to whether AKI occurred after surgery, they were divided into AKI group (n = 100) and non-AKI group (n = 51). Logistic regression analyses were used to screen the influencing factors of AKI after surgery in patients with sICH. The receiver operating characteristic (ROC) curve was drawn to evaluate the predictive efficacy of intracranial pressure (ICP) and serum neuron-specific enolase (NSE) 3 d after surgery and their combination for AKI. Results: Logistic regression analysis showed that increased cardiac troponin (OR = 1.011, 95%CI: 1.005-1.017; P = 0.001), and increased ICP 3 d after surgery (OR = 1.289, 95%CI: 1.126-1.477; P = 0.000) were the risk factors for AKI after surgery in sICH patients. ROC curve showed that the area under the curve (AUC) of ICP and serum NSE 3 d after surgery and their combination in the prediction of AKI after surgery were 0.729 (95%CI: 0.649-0.810, P = 0.000), 0.720 (95%CI: 0.631-0.809, P = 0.000) and 0.751 (95%CI: 0.672-0.830, P = 0.000), the sensitivity were 45%, 73% and 51%, and the specificity were 88.24%, 66.67% and 90.20%. There was no significant difference in the AUC among the 3 indicators (P > 0.05, for all). Conclusions: The increased cardiac troponin and ICP 3 d after surgery were risk factors for AKI after surgery in sICH. Moreover, the elevated ICP and serum NSE 3 d after surgery can predict the occurrence of AKI, but the combined monitoring does not improve the prediction efficiency.

Key words: Cerebral hemorrhage, Acute kidney injury, Intracranial pressure, Phosphopyruvate hydratase, Risk factors, Logistic models, ROC curve