摘要
目的探讨肾动脉阻力指数(RRI)和能量多普勒超声评分(PDU)对ICU患者的脓毒症相关急性肾损伤(SA-AKI)的预测价值及其与感染炎症指标的关系。方法选取2023年4~12月佛山市第二人民医院重症医学科收治的脓毒症患者70例,记录患者的一般临床资料、进入ICU时的生命体征、急性生理和慢性健康评分-Ⅱ(APACHE-Ⅱ)以及超声肾脏灌注指标,并抽血检查肾功能指标肌酐(SCr)及尿素氮(BUN)和感染指标降钙素原(PCT)及炎性指标白介素6(IL-6)。根据48 h内急性肾损伤(AKI)最严重程度将患者分为肾功能正常对照组和AKI 1、2、3期组。根据3 d肾功能是否恢复将患者分为短暂性AKI和持续性AKI组,同时追溯早期指标,比较各组情况。结合各AKI分组,通过ROC曲线分析RRI和PDU评分对AKI的预测能力,并观察感染指标PCT、炎性指标IL-6与RRI及PDU的相关关系。结果无AKI对照组17例,AKI 1~3期组分别为19、15、19例。AKI 2、3期患者的RRI高于无AKI组或AKI 1期患者(P<0.001),而PDU低于无AKI组或AKI 1期患者(P<0.001)。持续性AKI组患者相较于短暂性AKI组患者的RRI更高(P<0.001),PDU更低(P<0.001)。ROC曲线分析显示,PDU及RRI均可作为良好的AKI预测指标。感染指标PCT及炎症指标IL-6都在AKI 2、3期患者中更高,并与RRI及PDU均具有相关性。结论超声肾脏灌注指标RRI和PDU评分对预测AKI的发生具有重要价值,与感染及炎症指标成正相关关系,为临床早期识别高危患者提供了无创、动态的影像学依据。
Objective To investigate the value of renal resistive index(RRI)and power Doppler ultrasound(PDU)score in predicting sepsis-associated acute kidney injury(SA-AKI)in ICU patients and to analyze their correlations with infection and inflammatory markers.Methods A total of 70 sepsis patients admitted to the Department of Critical Care Medicine,The Second People's Hospital of Foshan from April to December 2023 were included.General clinical data,vital signs at ICU admission,Acute Physiology and Chronic Health Evaluation II(APACHE-II)score,and ultrasonic renal perfusion indices including RRI and PDU score were recorded.Venous blood samples were collected to measure renal function markers as serum creatinine(SCr),blood urea nitrogen(BUN),infection marker as procalcitonin(PCT),and inflammatory marker as interleukin-6(IL-6).Patients were classified into two cohorts:Based on the severest degree of AKI within 48 h,they were divided into a normal renal function control group,AKI stage 1,stage 2,and stage 3 groups;According to renal function recovery within 3 days,they were categorized into transient AKI and persistent AKI groups.Early indices were retrospectively reviewed,and inter-group differences were compared.ROC curves were used to assess the predictive efficacy of RRI and PDU score for AKI,while correlations between PCT,IL-6 and RRI,PDU score were analyzed.Results Among the 70 patients,17 patients were in the non-AKI control group,19 patients in AKI stage 1,15 patients in AKI stage 2,and 19 patients in AKI stage 3.Patients with AKI stage 2 and 3 had significantly higher RRI(P<0.001)and lower PDU score(P<0.001)compared with those in the non-AKI group or AKI stage 1.Additionally,patients in the persistent AKI group had a significantly higher RRI(P<0.001)and a significantly lower PDU(P<0.001)compared with those in the transient AKI group.ROC curve analysis demonstrated that both RRI and PDU score were reliable predictors of AKI.Additionally,PCT and IL-6 levels were significantly elevated in patients with AKI stage 2 and 3,and were significantly correlated with RRI and PDU score.Conclusion Ultrasonic renal perfusion indices as RRI and PDU score hold significant value in predicting AKI development in sepsis patients.They are correlated with infection and inflammatory markers,providing a non-invasive,dynamic imaging approach for the early identification of high-risk patients in clinical practice.
作者
袁满涓
沈家航
YUAN Manjuan;SHEN Jiahang(Department of Critical Care Medicine,The Second People's Hospital of Foshan,Foshan 528000,China)
出处
《分子影像学杂志》
2025年第12期1555-1562,共8页
Journal of Molecular Imaging
基金
佛山市科技局科研课题(2220001004578)。
