肾脏超声评估脓毒症合并急性肾损伤患者肾功能可复性  

Ultrasound Evaluating the Reversibility of Renal Function in Septic Patients Complicated with Acute Kidney Injury

作　　者：王泽凯 赵浩天[2] 何佳鹏 龙玲[4] 牛凯[1] 刘冰[1] Wang Zekai;Zhao Haotian;He Jiapeng;Long Ling;Niu Kai;Liu Bing(Department of Nephrology,Hebei General Hospital,Shijiazhuang 050051,China;Department of Ultrasound,Hebei General Hospital,Shijiazhuang 050051,China;Department of 4th Cardiovascular,Hebei General Hospital,Shijiazhuang 050051,China;Department of Intensive Care Unit,Hebei General Hospital,Shijiazhuang 050051,China)

机构地区：[1]河北省人民医院肾内科,石家庄市050051 [2]河北省人民医院超声科,石家庄市050051 [3]河北省人民医院心血管内四科,石家庄市050051 [4]河北省人民医院重症医学科,石家庄市050051

出　　处：《中国超声医学杂志》2024年第2期190-194,共5页Chinese Journal of Ultrasound in Medicine

基　　金：河北省医学科学研究课题计划项目(No.20200714)。

摘　　要：目的探究肾脏超声对脓毒症合并急性肾损伤(AKI)患者肾脏功能可复性的评估价值。方法58例脓毒症合并AKI患者分为可复性AKI组(3 d内血肌酐降低50%基线水平或尿量恢复)和持续性AKI组(3 d内持续血肌酐高水平或少尿)。肾脏超声检查包括肾脏长径、厚径、肾皮质厚度,脉冲多普勒法测量肾主动脉、肾段动脉和肾叶间动脉流速并计算阻力指数(RI),记录临床资料及实验室检查生物标志物指标。绘制ROC曲线评估预测价值并应用二元Logistic回归分析筛选独立影响因素。结果持续性AKI组C-反应蛋白水平、右肾段动脉RI、右肾叶间动脉RI、左肾段动脉RI、左肾叶间动脉RI高于可复性AKI组,左肾皮质厚度低于可复性AKI组(P<0.05);右肾段动脉RI、右肾叶间动脉RI的曲线下面积(AUC)分别为0.705、0.753;二元Logistic回归分析显示,右肾叶间动脉RRI是脓毒症合并AKI患者肾功能可复性的独立影响因素(OR=1.161,P=0.002)。结论脓毒症合并AKI患者的右肾叶间动脉RI对预测肾脏功能可复性价值较高,是其独立影响因素。Objective To explore the predictive value of renal ultrasound in patients with sepsis combined with acute kidney injury(AKI)for renal reversibility.Methods A total of 58 patients with sepsis complicated by AKI were divided into the reversible AKI group(with a 50%reduction in serum creatinine within 3 days or recovery from oliguria)and the persistent AKI group(with sustained high serum creatinine levels or oliguria within 3 days).Renal ultrasound examination included the length and thickness diameters of the kidneys,as well as the thickness of the renal cortex.Pulse Doppler was used to measure the flow velocity of the renal aorta,segmental artery,and interlobular artery,and calculate the resistance index(RI).Clinical data and laboratory biomarker indicators were recorded.ROC curves were drawn to evaluate the predictive value and binary logistic regression analysis was used to screen for independent influencing factors.Results The levels of C-reactive protein,right renal segmental artery RI,right renal interlobular artery RI,left renal segmental artery RI,and left renal interlobular artery RI in the persistent AKI group were higher than those in the reversible AKI group,and the left renal cortex thickness was lower than that in the reversible AKI group(P<0.05).The AUC values of the right renal segmental artery RI and the right renal interlobular artery RI were 0.705 and 0.753,respectively.Binary Logistic regression analysis showed that right renal interlobular artery RI was an independent influencing factor for reversible AKI(OR=1.161,P=0.002).Conclusions The right interlobular artery RI in septic patients with AKI has the highest predictive value for reversible AKI and can serve as an independent predictor.

关 键 词：急性肾损伤 脓毒症 肾阻力指数 肾脏超声 影响因素 

分 类 号：R459.7[医药卫生—急诊医学] R445.1[医药卫生—治疗学] R692[医药卫生—临床医学]