超声测量下腔静脉直径评估血液透析患者容量负荷的价值  

Assessing degree of volume load in hemodialysis patients by measuring the diameter of inferior vena cava with ultrasound

作　　者：王越[1] 谢庆磊 刘宏[1] 张留平[1] 张思琳 秦波 WANG Yue;XIE Qinglei;LIU Hong;ZHANG Liuping;ZHANG Silin;QIN Bo(Blood Purifcation Center,Zhongda Hospital Afiliated to Southeast University,Nunjing 21009,China)

机构地区：[1]东南大学附属中大医院血液净化中心,南京210009

出　　处：《肾脏病与透析肾移植杂志》2025年第1期27-31,56,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：东南大学附属中大医院护理科研基金(KJZC-HL-202316);东南大学附属中大医院中西医协同医学科研重点项目(2023zxyxt01)。

摘　　要：目的:评估维持性血液透析患者透析后下腔静脉直径指数(VCD)[即下腔静脉直径(IVCD)/体表面积(BSA)]与理想水分比率(ECW/TBW)的相关性,探讨超声测量下腔静脉在评价血液透析患者容量负荷程度中的价值。方法:选取东南大学附属中大医院血液净化中心232例患者,于透析后0.5~1 h内使用InBody720人体成分分析仪测量患者ECW/TBW,完成测量后立即使用超声测量患者的IVCD、呼吸变异率(ΔIVCD),同时收集患者身高、体重数据计算BSA和VCD。分析不同ΔIVCD组ECW/TBW的差异性,分析VCD和ECW/TBW相关性,绘制VCD诊断理想ECW/TBW(数值范围:0.380~0.385)受试者特征曲线(ROC),分析其检测效能。结果:最终收集了210例患者完整资料。71例(33.8%)患者透析后ECW/TBW超过理想范围。30例患者ΔIVCD≤50%,180例患者ΔIVCD>50%,ΔIVCD≤50%组ECW/TBW显著高于ΔIVCD>50%组(0.388±0.011 vs 0.383±0.011,P=0.023);两组VCD也有显著差异(9.083±2.168 vs 6.336±2.131,P<0.001);VCD和ECW/TBW有显著相关性(r=0.321,P<0.001),其中ΔIVCD≤50%组相关系数高于ΔIVCD>50%组(r=0.455 vs r=0.278);VCD检测理想ECW/TBW为0.380时的最佳临界值为6.48 mm/m^(2),曲线下面积为0.805,敏感度和特异度分别为65.6%和86.7%(P<0.001);VCD检测理想ECW/TBW为0.385时的最佳临界值为7.12 mm/m^(2),曲线下面积为0.790,敏感度和特异度分别为66.3%和78.7%(P<0.001)。结论:血液透析患者透析后VCD与ECW/TBW相关,在评估容量负荷程度上具有一定的临床价值。Objective:To evaluate the correlation between inferior vena cava diameter index(VCD),defined as the ratio of the inferior vena cava diameter(IVCD)to body surface area(BSA),and ideal water ratio(ECW/TBW)after dialysis in maintenance hemodialysis patients,and to explore the value of ultrasonic measurement of inferior vena cava in evaluating the volume load degree of hemodialysis patients.Methodology:A total of 232 patients from the Blood Purifcation Center of Zhongda Hospital Afiliated to Southeast University were enrolled and their ECW/TBW was measured within 0.5-1 h after dialysis using InBody720 body composition analysis instrument.After the measurement,the inferior vena cava diameter(IVCD)and respiratory variation rate(ΔIVCD)were measured by ultrasound immediately.Meanwhile,the height and weight data of patients were collected to calculate the body surface area(BSA).The diameter index of inferior vena cava was calculated.The differences of ECW/TBW in differentΔIVCD groups was analyzed.The correlation between VCD and ECW/TBW was analyzed,the receiver characteristic curve(ROC)of ideal ECW/TBW(value range:0.380~0.385)for VCD diagnosis was drawn,and the detection efficiency was analyzed.Results:In the 232 patients,22 cases of inferior vena cava were not clear on ultrasound.Finally,complete data of 210 patients were collected.Among the patients,71 cases had an ECW/TBW ratio exceeding the ideal range after dialysis,accounting for 33.8%.There were 30 patients withΔIVCD≤50%and 180 patients with>50%.ECW/TBW inΔIVCD≤50%group was significantly higher than that inΔIVCD>50%group(0.388±0.011 vs 0.383±0.011,P=0.023).There were significant differences in VCD between the two groups(9.083±2.168 vs 6.336±2.131,P<0.001).VCD was significantly correlated with ECW/TBW(r=0.321,P<0.001),and the correlation coefficient ofΔIVCD≤50%group was higher than that ofΔIVCD>50%group(r=0.455 vs r=0.278).The optimal cut-off value of VCD for ideal ECW/TBW of 0.380 was 6.48 mm/m^(2),with an area under the curve was 0.805,and the sens

关 键 词：超声 维持性血液透析 下腔静脉直径指数 水分比率 容量负荷 

分 类 号：R692.5[医药卫生—泌尿科学]