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目的:探讨术前血n D-二聚体水平对心脏手术相关急性肾损伤（cardiac surgery-associated acute kidney injury，CSA-AKI）发生的影响。n 方法:回顾性收集2017年1月至2018年12月于南京医科大学第一附属医院行体外循环的心脏手术患者的病历资料。选取0.55 mg/L作为临界值，将所有患者分为n D-二聚体正常组（n D-二聚体≤0.55 mg/L）和n D-二聚体升高组（n D-二聚体>0.55 mg/L），比较两组之间病历资料的差异。采用Kaplan-Meier生存曲线分析两组间CSA-AKI累积发生率的差异。使用Logistic回归分析法及限制性立方样条函数分析术前n D-二聚体水平与CSA-AKI发生之间的关系。n 结果:共871例心脏手术患者入选本研究，女性427例（49.0%），年龄为（56.6±12.3）岁，CSA-AKI患者259例（29.7%），术前n D-二聚体升高患者有215例（24.7%）。与n D-二聚体正常组相比，n D-二聚体升高组患者基线血肌酐、慢性肾脏病3期比例、国际标准化比值、纤维蛋白原、接受肾脏替代治疗比例和CSA-AKI发生比例均较高（均n P0.55 mg/L) according to then D-dimer threshold of 0.55 mg/L and the differences of clinical data between the two groups were compared. Kaplan-Meier survival analysis method was used to analyze the difference of the cumulative incidence of CSA-AKI between the two groups. Logistic regression analysis and restricted cubic splines analysis were used to analyze the association between serum n D-dimer and the incidence of CSA-AKI.n Results:There were 871 patients enrolled in the study with 427 females (49.0%) and age of (56.6±12.3) years, including 215 patients (24.7%) with high n D-dimer and 259 patients (29.7%) with CSA-AKI. Compared with the normal n D-dimer group, patients with elevated n D-dimer had higher baseline serum creatinine, proportion of chronic kidney disease stage 3, international normalized ratio, fibrinogen, proportion of receiving renal replacement therapy and incidence of CSA-AKI (all n P<0.05). The prothrombin time, operation time, extracorporeal circulation time, aortic occlusion time and hospital stay in the elevatedn D-dimer group were longer (all n P<0.05), and the preoperative estimated glomerular filtration rate (eGFR) and hemoglobin levels were lower than those in the normaln D-dimer group (both n P0.05). Kaplan-Meier survival curve results showed that compared with the normaln D-dimer group, the risk of CSA-AKI in the elevated n D-dimer group was significantly increased (Log-rank n χ2=14.227, n P0.55 mg/L) was still related to CSA-AKI (n OR=1.476, 95% n CI 1.038-2.098, n P=0.030). Restricted cubic splines analysis showed that the incidence of CSA-AKI raised when preoperative serum n D-dimer concentration increased (non-linear n P=0.262).n Conclusion:Patients with high preoperative serum n D-dimer have an increased risk of CSA-AKI.n