肾脏超声联合指标对非脓毒症危重患者急性肾损伤的预测价值  

Predictive value of renal ultrasound joint indicators to acute kidney injury in non-septic critically ill patients

作　　者：支海君[1] 李勇[1] 郭晋平[1] 崔晓雅 张萌 王博[1] 马云杰[1] 聂屾[1] Zhi Haijun;Li Yong;Guo Jinping;Cui Xiaoya;Zhang Meng;Wang Bo;Ma Yunjie;Nie Shen(Emergency Department,Cangzhou Central Hospital,Cangzhou 061000,China)

机构地区：[1]沧州市中心医院急诊医学部,061000

出　　处：《中华急诊医学杂志》2021年第1期64-72,共9页Chinese Journal of Emergency Medicine

基　　金：沧州市重点研发计划指导项目(172302109)。

摘　　要：目的探讨肾动脉阻力指数(renal resistive index,RRI)和肾能量多普勒超声(power Doppler ultrasound,PDU)半定量评分联合指标对入住重症监护室(intensive care unit,ICU)的非脓毒症患者发生急性肾损伤(acute kidney injury,AKI)的预测价值。方法采用前瞻性观察性研究的方法,纳入2018年1月至2019年8月期间于沧州市中心医院急诊ICU住院的非脓毒症危重患者作为研究对象。记录一般资料;于入ICU 6 h内应用医学超声仪完成RRI和PDU半定量评分测量。入ICU第5天依据改善全球肾脏病预后组织(KDIGO)标准评估肾功能,按肾功能情况分为AKI 3期组(入ICU 5 d内进展为AKI 3期)和AKI 0~2期组(未发生AKI或发生AKI 1或2期)。分别在非脓毒症和急性心力衰竭患者中比较不同AKI分期两组间各指标的差异。计量资料两组间比较采用独立样本t检验或Mann-Whiney秩和检验。计数资料两组间比较采用卡方检验。绘制受试者工作特征曲线(receiver operator characteristic,ROC)分析RRI、PDU评分、RRI-RDU/10、RRI/PDU和RRI+PDU对AKI 3期的预测价值。使用Delong检验方法比较每个预测因子之间ROC曲线下面积的差异。结果共纳入110例非脓毒症危重患者(无AKI 51例,AKI 1期21例,AKI 2期11例,AKI 3期27例),其中急性心力衰竭患者63例(无AKI 21例,AKI 1期15例,AKI 2期7例,AKI 3期20例)。在非脓毒症患者及急性心力衰竭患者中,AKI 3期患者的急性生理学与慢性健康状况(APACHEⅡ)评分、序贯器官衰竭(sequential organ failure assessment,SOFA)评分、动脉乳酸水平、机械通气比例、血管活性药物比例、28 d病死率、肌酐、RRI、RRI-PDU/10、RRI/PDU、RRI+PDU及连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)比例均明显高于AKI 0~2期患者(P<0.05);而尿量和PDU评分明显低于AKI 0~2期患者(P<0.05)。非脓毒症患者中,RRI/PDU[曲线下面积(AUC)=0.915,95%可信区间(CI):0.846~0.959,P<0.01)及RRI+PDU(AUC=0.914,95%CI:0.845~0.959,PObjective To explore the predictive value of renal resistive index(RRI)joint with semiquantitative power Doppler ultrasound(PDU)score to acute kidney injury(AKI)in non-septic critically ill patients.Methods This prospective observational study enrolled non-septic critically ill patients admitted to the Emergency Intensive Care Unit of Cangzhou Central Hospital from January 2018 to August 2019.In addition to general data,RRI and PDU scores were measured with medical ultrasonic instrument within 6 h after admission.Renal function was assessed on the 5th day in accordance with kidney disease:Improving Global Outcomes criteria.The patients who progressed to AKI stage 3 within 5 days after admission were classified into the AKI 3 group,and the rest were classified into the AKI 0-2 group.The difference of each index was compared between the two groups in non-septic critically ill patients and patients with acute heart failure(AHF).Normal distributed continuous variables were compared using independent sample t-tests,whereas Mann-Whitney U tests were used to examine the differences in variables without a normal distribution.Categorical data were compared with the Chi-square test.Receiver operator characteristic curves were plotted to examine the values of RRI,PDU score,RRIRDU/10(subtraction of RRI and 1/10 of PDU score),RRI/PDU(the ratio of RRI to PDU score),and RRI+PDU(the prediction probability of the combination of RRI and PDU score for AKI stage 3 obtained by logistic regression analysis)in predicting AKI 3.Delong's test was used to compare the area under the curve(AUC)between predictors.Results A total of 110 non-septic critically ill patients(51 patients with no AKI,21 with AKI stage 1,11 with AKI stage 2,and 27 with AKI stage 3)were recruited.Among them,there were 63 patients with AHF(21 patients with no AKI,15 with AKI stage 1,7 with AKI stage 2,and 20 with AKI stage 3).Among the non-septic critically ill patients as well as its subgroup of AHF,compared with the AKI 0-2 group,acute physiology and chronic health

关 键 词：急性肾损伤 肾动脉阻力指数 肾能量多普勒半定量评分 非脓毒症危重患者 

分 类 号：R692[医药卫生—泌尿科学]