血清胱抑素C联合肾动脉阻力指数对VA-ECMO患者急性肾损伤的预测价值  

Value of serum cystatin C combined with renal artery resistance index in predicting acute kidney injury of VA-ECMO patient

作　　者：郑卫涛 王生超 朱莉 童洪杰 陈琨 ZHENG Weitao;WANG Shengchao;ZHU Li;TONG Hongjie;CHEN Kun(Department of Critical Care Medicine,Affiliated Jinhua Hospital,Zhejiang University School of Medicine,Jinhua321099,CHINA)

机构地区：[1]浙江大学医学院附属金华医院重症医学科,浙江金华321099

出　　处：《江苏医药》2024年第6期554-558,共5页Jiangsu Medical Journal

基　　金：浙江省科技计划项目(2020C03019);金华市科技计划项目(2023-4-071)。

摘　　要：目的探讨血清胱抑素C(sCysC)和肾动脉阻力指数(RRI)对静脉-动脉体外膜肺氧合(VA-ECMO)患者发生急性肾损伤(AKI)的预测价值。方法68例VA-ECMO患者依据VA-ECMO上机7d内是否发生AKI分为AKI组(45例)和非AKI组(23例)。AKI组患者进一步依据改善全球肾脏病预后组织(KDIGO)分期分为轻症AKI组(20例)和重症AKI组(25例)。比较各组患者血清肌酐、sCysC水平及RRI。绘制ROC曲线评价sCysC、RRI及两者联合对VA-ECMO患者发生AKI及重症AKI的预测价值。结果AKI组患者sCysC水平和RRI高于非AKI组(P<0.05)。轻症AKI组和重症AKI组sCysC水平和RRI均高于非AKI组(P<0.05),且重症AKI组sCysC水平和RRI亦高于轻症AKI组(P<0.05)。sCysC和RRI预测VA-ECMO患者发生AKI的AUC分别为0.836和0.791;预测发生重症AKI的AUC分别为0.880和0.878;两者联合预测发生AKI和重症AKI的AUC分别为0.918和0.916,均高于单一指标(P<0.05)。结论sCysC和RRI对VA-ECMO患者发生AKI的预测价值良好,两者联合应用的预测价值更好。Objective To investigate the value of serum cystatin C(sCysC)and renal artery resistance index(RRI)in predicting acute kidney injury(AKI)in the patients undergoing venoarterial extracorporeal membrane oxygenation(VA-ECMO).Methods A total of 68 VA-ECMO patients were divided into AKI group(45 cases)and non-AKI group(23 cases)according to whether AKI occurred within 7 days after VA-ECMO.AKI patients were further divided into mild AKI group(20 cases)and severe AKI group(25 cases)according to the Kidney Disease Improving Global Outcomes(KDIGO).Serum creatinine,sCysC and RRI were compared among the three groups.ROC curve was drawn to evaluate the predictive value of sCysC,RRI and their combination for AKI and severe AKI in VA-ECMO patients.Results The sCysC level and RRI in AKI group were higher than those in non-AKI group(P<0.05).The sCysC level and RRI in mild AKI group and severe AKI group were higher than those in non-AKI group(P<0.05),and sCysC level and RRI in severe AKI group were higher than those in mild AKI group(P<0.05).The AUC values of AKI predicted by sCysC and RRI were 0.836 and 0.791,respectively.The AUC values of severe AKI predicted by sCysC and RRI were 0.880 and 0.878,respectively.The AUC values of AKI and severe AKI predicted by combination of sCysC and RRI were 0.918 and 0.916,which were higher than those predicted by sCysC or RRI alone(P<0.05).Conclusion sCysC and RRI have good predictive value for AKI in VA-ECMO patients.Combined use of sCysC and RRI has better predictive value than sCysC or RRI alone.

关 键 词：胱抑素C 肾动脉阻力指数 静脉-动脉体外膜肺氧合 急性肾损伤 

分 类 号：R692[医药卫生—泌尿科学]