肾动脉血流动力学参数与老年糖尿病酮症酸中毒严重程度的关系及对急性肾损伤的预测价值研究  

Study on the relationship between renal artery hemodynamic parameters and the severity of elderly diabetes ketoacidosis and its predictive value for acute renal injury

作　　者：张晓蓓 廖琦[1] 徐雷 李斌[1] ZHANG Xiao-bei;LIAO Qi;XU Lei(Department of General Medicine,Panzhihua Central Hospital,Panzhihua Sichuan 617000,China)

机构地区：[1]攀枝花市中心医院全科医学科,四川攀枝花617000

出　　处：《临床和实验医学杂志》2024年第5期493-497,共5页Journal of Clinical and Experimental Medicine

基　　金：四川省医学会医学科研青年创新项目(编号:Q15007)。

摘　　要：目的探讨肾动脉血流动力学参数与老年糖尿病酮症酸中毒严重程度的关系及对急性肾损伤的预测价值。方法前瞻性选取2020年1月到2023年1月攀枝花市中心医院收治的130例老年2型糖尿病酮症酸中毒患者作为研究对象,依照酮症酸中毒严重程度将其分为3组,即轻度组(n=57)、中度组(n=48)和重度组(n=25),对所有患者应用彩色多普勒超声仪进行肾血流测定,对比3组患者肾小球血流参数[弹性指数(PI)、阻力指数(RI)、舒张末期血流速度(Vdmin)、收缩期最大血流速度(Vsmax)]。通过门诊复查随访,参考全球肾脏病预后组织(KDIGO)的急性肾损伤诊断标准,130例2型糖尿病酮症酸中毒患者发生急性肾损伤25例。对老年糖尿病酮症酸中毒合并急性肾损伤进行单因素分析,并采用Logistics回归模型分析老年糖尿病酮症酸中毒急性肾损伤的独立影响因素,并建立受试者工作(ROC)曲线明确肾动脉血流动力学参数对急性肾损伤的评估价值。结果重度组患者PI、RI水平分别为1.79±0.18、0.77±0.12均高于中度组(1.68±0.23、0.68±0.15)和轻度组(1.53±0.29、0.63±0.14),随着疾病严重程度增加PI、RI水平亦明显升高;重度组Vdmin、Vsmax水平分别为(10.83±0.37)、(27.26±0.42)cm/s,均低于中度组[(12.11±0.52)、(29.25±0.32)cm/s]和轻度组[(13.43±0.35)、(30.12±0.24)cm/s],随着疾病严重程度增加Vdmin、Vsmax水平亦明显降低,差异均有统计学意义(P<0.05)。PI、RI、Vdmin、Vsmax、合并高血压、合并高脂血症为老年糖尿病酮症酸中毒患者急性肾损伤的危险因素(P<0.05)。PI、RI、Vdmin、Vsmax水平是影响老年糖尿病酮症酸中毒患者急性肾损伤的独立危险因素(P<0.05)。肾动脉血流动力学参数联合对老年糖尿病酮症酸中毒患者急性肾损伤的评估敏感度、特异度分别为91.53%、83.14%,曲线下面积为0.835。结论超声诊断肾动脉血流动力学参数为老年糖尿病酮症酸中毒�Objective To explore the relationship between renal artery hemodynamics parameters and the severity of elderly diabetes ketoacidosis,and to predict the value of acute renal injury.Methods A total of 130 patients with type 2 diabetes ketoacidosis admitted to Panzhihua Central Hospital from January 2020 to January 2023 were selected as the study subjects.They were divided into three groups according to the severity of ketoacidosis,namely,mild group(n=57),moderate group(n=48)and severe group(n=25).All patients were measured by color Doppler ultrasound,and the glomerular blood flow parameters[perfusion index(PI),resistance index(RI),end diastolic blood flow velocity(Vdmin),maximum systolic blood flow velocity(Vsmax)]of the three groups were compared.Through outpatient follow-up,acute renal injury occurred in 25 of 130 patients with type 2 diabetes ketoacidosis based on the diagnostic criteria of the Global Kidney Disease Prognosis Organization(KDIGO)for acute kidney injury.A single factor analysis were conducted on elderly diabetes ketoacidosis with acute renal injury.Then,the independent influencing factors of elderly diabetes ketoacidosis with acute renal injury were analyzed using Logistic regression model and the receiver operating characteristic(ROC)curve were established to determine the evaluation value of renal artery blood flow mechanics parameters on acute renal injury.Results The levels of PI and RI in the severe group were 1.79±0.18,0.77±0.12,which were higher than those in the moderate group(1.68±0.23,0.68±0.15)and mild group(1.53±0.29,0.63±0.14),as the severity of the disease increased,the levels of PI and RI also significantly increased;the levels of Vdmin and Vsmax in the severe group were(10.83±0.37),(27.26±0.42)cm/s,lower than those in the moderate group[(12.11±0.52),(29.25±0.32)cm/s],and mild group[(13.43±0.35),(30.12±0.24)cm/s],as the severity of the disease increased,the levels of Vdmin and Vsmax also significantly decreased,the differences were statistically significant(P<0.05).PI,RI

关 键 词：2型糖尿病 酮症酸中毒 急性肾损伤 肾动脉血流动力学 独立影响因素 预测价值 

分 类 号：R587.2[医药卫生—内分泌] R692[医药卫生—内科学]