血HCO3-浓度预测急性肾损伤后肾脏的长期预后  

Value of serum bicarbonate in prediction of the long-term prognosis of renal function after acute kidney injury

作　　者：王春林[1] 谢园园[1] 王琴[1] 车霞静[1] 王玲[1] 邵兴华[1] 牟姗[1] 倪兆慧[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,200127

出　　处：《中华肾脏病杂志》2014年第10期732-738,共7页Chinese Journal of Nephrology

基　　金：973课题（2012CB517602）,港澳台科技合作专项资助（2014DFT30090）,国家自然基金（81102700,81373865）,上海市科委中医引领项目（12401906400,13401906100）,上海市中西医结合人才计划（ZYSNXD012-RC-ZXY017）

摘　　要：目的 随访急性肾损伤（AKI）患者肾功能的变化,评价血HCO3-浓度预测肾脏长期预后的价值.方法 入选169例AKI患者,随访12个月,测定患者发生AKI时、3个月、6个月、12个月时血HCO3-浓度值变化,根据肾功能恢复情况分成恢复组和未恢复组,分析比较血HCO3-浓度,评估血HCO3-浓度在AKI患者肾脏长期预后判断中的应用价值.结果 发生AKI时血HCO3-浓度（r=-0.302,P＜0.001）、AKI后3个月时血HCO3-浓度（r=-0.363,P＜0.05）、AKI后6个月时血HCO3-浓度（r=-0.591,P＜0.001）均与Scr均呈负相关.肾功能未恢复组血HCO3-浓度在发生AKI时（21.92 mmol/L比24.58 mmol/L）、AKI后3个月（22.58 mmol/L比25.54 mmol/L）、6个月（21.89 mmol/L比25.42 mmol/L）、12个月（19.85 mmol/L比24.07 mmol/L）时均显著低于恢复组（均P＜ 0.05）.发生AKI时Scr、血HCO3-浓度,以及血Scr与血HCO3-浓度联合值预测肾脏预后的受试者工作特征（ROC）曲线下面积分别为0.840、0.667、0.837,敏感度分别为68.6％、51％、80.4％,特异性分别为88.9％、80.9％、73.6％.AKI后3个月时Scr、血HCO3-浓度,以及Scr与血HCO3-浓度联合值的ROC曲线下面积分别为0.838、0.732、0.848,敏感度分别为83.3％,69.2％、91.7％,特异性分别为79.5％、70.8％、74.4％.AKI后6个月时Scr、血HCO3-浓度,以及Scr与血HCO3-浓度联合值的ROC曲线下面积分别为0.948、0.798、0.952,敏感度分别为100％、80％,100％,特异性分别为84％、80％、88％.联合AKI时、AKI后3个月、AKI后6个月三个时间点血HCO3-浓度ROC曲线下面积0.850,敏感度85.7％,特异性84.2％;联合AKI时、AKI后3个月、AKI后6个月三个时间点Scr值ROC曲线下面积0.940,敏感性100％,特异性84.2％;进一步对AKI时、AKI后3个月、AKI后6个月血Scr与HCO3浓度联合值进行联合分析,ROC曲线下面积0.962,敏感度100％,特异性94.7％.影响AKI患者肾功能的多因素COX回归分析显示,年龄＞ 50.1岁、AKI时Scr＞ 195 mmol/L�Objective To evaluate the value of serum bicarbonate concentration as a prognostic indicator of renal function by following up the renal function in the acute kidney injury （AKI） patients.Methods 169 cases of AKI patients were enrolled in the study.Clinical data were collected prospectively.Risk factors of the renal outcome were evaluated.The patients were followed up for average 19 months.Results The serum bicarbonate concentration on AKI （r=-0.302,P ＜ 0.001）,3 months after AKI （r=-0.363,P ＜ 0.363）,and 6 months after AKI （r=-0.591,P ＜ 0.001） were all negatively correlated with serum creatinine.Compared with renal function recovered group,the serum bicarbonate concentration of renal function unrecovered group on AKI （21.92 mol/L vs 24.58 mol/L）,3 months after AKI （22.58 mol/L vs 25.54 mol/L）,6 months after AKI （21.89 mol/L vs 25.42 mol/L）,12 months after AKI （19.85 mol/L vs 24.07 mol/L） were all significantly decreased （all P ＜ 0.05）.When AKI occurred,the Scr,serum bicarbonate concentration,the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney,area under the receiver-operating characteristic （ROC） curves were 0.840,0.667,0.837,sensitivity were 68.6％,51％,80.4％,specificity were 88.9％,80.9％ and 73.6％,respectively.3 months AKI after,the Scr,serum bicarbonate concentration,the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney,area under the ROC curves were 0.838,0.732,0.848,sensitivity was 83.3％、69.2％、91.7％,specificity were 79.5％,70.8％ and 74.4％,respectively.6 months the after AKI,Scr,serum bicarbonate concentration,the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney,area under the ROC curves were 0.948,0.798,0.952,sensitivity were 100％,80％,100％,specificity were 84％,80％ and 88％,respectively.Combined 3 time points of serum bicarbonate concentration when AKI occurred,3 month and 6 months after AKI,the area under the

关 键 词：血气分析 肾功能不全 急性 预后 

分 类 号：R692[医药卫生—泌尿科学]