床旁超声造影定量评价脓毒症早期急性肾损伤的肾脏微循环灌注  

Quantitative Evaluation of Renal Microcirculation Perfusion in Early Sepsis-induced Acute Kidney Injury by Contrast-enhanced Ultrasound at Bedside

作　　者：刘娜[1] 余芬 江贵军 钟振通 詹丽英[2] 周青[1] LIU Na;YU Fen;JIANG Gui-jun;ZHONG Zhen-tong;ZHAN Li-ying;ZHOU Qing(Department of Ultrasound Imaging,Renmin Hospital of Wuhan University,Wuhan 430060,China;Department of Critical Care Medicine,Renmin Hospital of Wuhan University,Wuhan 430060,China)

机构地区：[1]武汉大学人民医院超声影像科,武汉430060 [2]武汉大学人民医院重症医学科,武汉430060

出　　处：《微循环学杂志》2024年第4期45-51,共7页Chinese Journal of Microcirculation

基　　金：国家自然科学基金项目(82271999)。

摘　　要：目的:探讨床旁超声造影技术(CEUS)对脓毒症早期急性肾损伤(AKI)患者肾脏微血管灌注变化的动态评价和临床应用价值。方法:纳入本院重症监护室收治的脓毒症患者45例,依据诊断标准分为早期AKI组(S-EAKI组,n=25)和无AKI组(S-NAKI组,n=20)。记录患者基本临床资料和生化指标检查结果,于入院当日(第0天)和第3天行床旁肾脏CEUS检查,测量肾脏大小、实质厚度、肾段动脉阻力指数(RI)、肾皮质及髓质的CEUS定量参数:达峰时间(TTP)、峰值强度(PI)及曲线下面积(AUC)。以同期在院行CEUS的无泌尿系统疾病患者为对照组(n=20),对比观察上述指标的差异。结果:肾脏常规超声结果显示,与对照组相比,脓毒症患者肾脏大小、实质厚度及RI无统计学差异;但CEUS显示S-EAKI组及S-NAKI组皮质PI、AUC与髓质AUC均显著降低(P<0.01)、皮髓质TTP显著延长(P<0.01),且S-EAKI组较S-NAKI组变化明显(P<0.01)。受试者工作特征(ROC)曲线分析皮质TTP、PI、AUC及髓质TTP预测脓毒症早期AKI的曲线下面积分别为0.71、0.78、0.75、0.74(P<0.01)。随病程时间变化,与第0天比较,S-EAKI组在第3天时皮髓质AUC降低(P<0.05),S-NAKI组造影参数显示灌注改善(P<0.05)。结论:床旁CEUS能在重症监护室有效评估脓毒症早期AKI的肾脏微循环灌注状况。Objective:To explore the dynamic evaluation and clinical application value of contrast-enhanced ultrasound(CEUS)at bedside in renal microvascular perfusion in septic patients with early acute kidney injury(AKI).Method:45 patients with sepsis in the intensive care unit of our hospital were included and divided into early AKI group(S-EAKI group,n=25)and no AKI group(S-NAKI group,n=20)according to diagnostic criteria.The kidney size,parenchymal thickness,renal segment arterial resistance index(RI),CEUS quantitative parameters of renal cortex and medulla including time to peak(TTP),peak intensity(PI)and area under the curve(AUC)were measured on the day of admission and the third day.Patients without kidney disease who underwent contrast-enhanced ultrasound in the same period were selected as the control group(n=20)to observe the above indexes.Results:Compared with control group,kidney size,parenchymal thickness and RI were not significantly different in septic patients.However,CEUS indicated that cortical PI,AUC and medullary AUC in S-EAKI group and S-NAKI group significantly decreased(P<0.01),and cortical and medullary TTP significantly prolonged(P<0.01),and the changes in S-EAKI group were more obvious than those in S-NAKI group(P<0.01).ROC curve analysis showed that cortical TTP,PI,AUC and medullary TTP predicted early acute kidney injury in sepsis by 0.71,0.78,0.75 and 0.74(P<0.01).With the change of time,the cortical and medullary AUC in the S-EAKI group decreased at day 3 compared with day 0(P<0.05),and the contrast parameters in the S-NAKI group showed improved perfusion(P<0.05).Conclusion:CEUS at bedside can effectively evaluate renal microcirculation perfusion status in early renal injury in sepsis in intensive care unit.

关 键 词：脓毒症 超声造影 早期急性肾损伤 肾脏微循环 

分 类 号：R445.1[医药卫生—影像医学与核医学]