肾皮质超声造影定量分析可预测脓毒症发生急性肾损伤的风险
Quantitative analysis of renal cortex contrast-enhanced ultrasound can predict the risk of acute kidney injury in sepsis

左蕾.肾皮质超声造影定量分析可预测脓毒症发生急性肾损伤的风险[J].内科急危重症杂志,2021,27(4):

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DOI：10.11768/nkjwzzzz20210409

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基金项目:新疆维吾尔自治区自然科学基金资助项目（No：2016D01C255）

作者	单位	E-mail
左蕾	新疆医科大学第一附属医院	chedanle@163.com

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中文摘要:

目的：探讨肾皮质超声造影（CEUS）定量分析对脓毒症患者发生急性肾损伤的预测价值。方法：对2016年1月-2018年12月在新疆医科大学第一附属医院诊治的103例脓毒症患者进行前瞻性研究，根据其是否出现急性肾损伤分为急性肾损伤组（48例）及无肾损伤组（55例），比较2组患者年龄、性别等一般资料和肾功能、肾皮质CEUS等临床指标，采用多因素Logistic回归分析影响脓毒症患者发生急性肾损伤的相关因素，并应用受试者工作曲线（ROC）评估各影响因素对脓毒症发生急性肾损伤的预测价值。结果：急性肾损伤组患者的急性生理与慢性健康状况评估（APACHE II）评分、序贯器官衰竭评估（SOFA）评分、血肌酐、尿素、血清胱抑素C及平均渡越时间（mTT）值明显高于无肾损伤组，而24h尿量及灌注指数（PI）明显低于无肾损伤组（P均＜0.05）；多因素Logistic回归分析示高血清胱抑素水平及高mTT值是影响脓毒症患者发生急性肾损伤的独立危险因素（OR=55.788，2.205；P=0.028，0.032），而24h尿量多及高PI是其独立保护因素（OR=0.990，0.860；P=0.002，0.000），且PI预测脓毒症患者发生急性肾损伤的AUC为0.953，显著高于24h尿量、血清胱抑素C及mTT（Z=3.288，3.368，4.620；P均＜0.05），其诊断的最佳截点为156.21，此时其敏感性为91.67%，特异性为90.91%。结论：肾皮质CEUS的PI可有效预测脓毒症患者发生急性肾损伤的风险，灵敏性及特异性较高。

英文摘要:

Objective: To explore the value of quantitative analysis of renal cortical ultrasound (CEUS) in predicting acute kidney injury (AKI) in patients with sepsis. Methods: A prospective study was conducted on 103 patients with sepsis who were diagnosed and treated in the First Affiliated Hospital of Xinjiang Medical University from January 2016 to December 2018, and the patients were divided into AKI group (n=48) and non-AKI group (n=55). The general data such as age, gender and clinical indicators of renal function, renal cortex CEUS findings and other clinical indicators were compared between the two groups. The multivariate Iogistic regression was used to analyze the related factors influencing the occurrence of AKI in patients with sepsis. The receiver operating characteristic (ROC) curve was used to evaluate the value of each influencing factor in predicting the AKI in sepsis. Results: Acute Physiology and Chronic Health Assessment (APACHE II) score, Sequential Organ Failure Assessment (SOFA) score, serum creatinine, urea, serum Cystatin C, and mean time of transit (mTT) of patients in the AKI group were significantly higher than those in the non-AKI group, and the 24-h urine output and perfusion index (PI) in the AKI group were significantly lower than those in the non-AKI group (all P<0.05). The multivariate Logistic analysis showed that high serum cystatin levels and high mTT values were independent risk factors for AKI in sepsis patients (OR = 55.788, 2.205; P= 0.028, 0.032), high 24-h urine output and PI were independent protective factors (OR= 0.990, 0.860; P= 0.002, 0.000), and the AUC of PI predicting AKI in patients with sepsis was 0.953, which was significantly higher than that of the 24-h urine volume, serum cystatin C and mTT (Z=3.288, 3.368, 4.620; all P< 0.05). The best cut-off point for diagnosis was 156.21, and at this time, the sensitivity was 91.67% and the specificity was 90.91%. Conclusion: The PI of renal cortex CEUS can effectively predict the risk of AKI in patients with sepsis, with high sensitivity and specificity.