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急性肾损伤危重患者肾功能恢复的危险因素研究 预览

Risk factors for impacting renal function recovery in critically ill patients with acute kidney injury
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摘要 目的预测发生急性肾损伤(AKI)危重患者肾功能恢复的危险因素。方法收集67例诊断为AKI且符合纳入标准的危重患者资料。随访28d后根据患者肾功能恢复情况分为肾功能恢复组和未恢复组,分析和比较两组入院时的实验室参数及预后相关指标。由急性生理与慢性健康状况评分Ⅱ(APACHEⅡ)和序贯器官衰竭评估(SOFA)评分衡量病情严重程度,采用单因素及多因素回归分析肾功能恢复的危险因素,并采用ROC曲线评估不同危险因素在预测肾功能恢复中的效能。结果最终肾功能恢复35例,未恢复32例,肾功能未恢复组的APACHEⅡ、SOFA评分、脓毒症及AKI为Ⅲ期的比例均显著高于肾功能恢复组(均P<0.05);乳酸、肌酐、尿素氮、可溶性血栓调节蛋白(sTM)和中性粒细胞明胶酶相关脂质运载蛋白(NGAL)均显著高于肾功能恢复组(均P<0.05);使用血管活性药物和机械通气的比例均显著高于肾功能恢复组(均P<0.05)。随访28d后,EICU停留时间肾功能未恢复组显著长于肾功能恢复组(P=0.032)。多因素分析结果显示,APACHEⅡ(OR=1.041,95%CI:1.011~1.109,P=0.007),SOFA评分(OR=1.057,95%CI:1.019~1.097,P=0.003),AKIⅢ期(OR=1.078,95%CI:1.023~1.136,P=0.005),NGAL(OR=1.627,95%CI:1.009~2.626,P=0.046),sTM(OR=1.063,95%CI:1.021~1.106,P=0.003)为影响肾功能恢复的相关危险因素。ROC曲线分析结果显示NGAL、sTM的AUC分别为0.843和0.868,均显著高于APACHEⅡ、SOFA评分、AKIⅢ期的AUC(均P<0.01)。结论APACHEⅡ、SOFA评分、AKIⅢ期、NGAL、sTM均可以作为发生AKI的危重患者肾功能恢复的危险因素,其中NGAL、sTM具有较高预测价值。 Objective To investigate the risk factors for impacting renal function recovery in critically ill patients with acute kidney injury(AKI).Methods Sixty seven critically ill AKI patients were enrolled in the study.Patients were followed up 28 days,then divided into recovery group and unrecovered group according to the renal function.The laboratory parameters and prognosis related indexes were compared between two groups.Severity was measured by the Acute Physiology and Chronic Health Status ScoreⅡ(APACHEⅡ)and Sequential Organ Failure Assessment(SOFA)scores.Univariate and multivariate regression analyses were used to assess risk factors for impacting renal function recovery.ROC curves were used to assess the value of different factors in predicting renal function recovery.Results There were 35 patients in the renal function recovery group and 32 patients in the unrecovered group.The APACHEⅡscore,SOFA score,sepsis,and AKI phaseⅢratio were significantly higher in the unrecovery group than those in recovery group(P<0.05).The laboratory results,lactic acid,creatinine,urea nitrogen,sTM and NGAL in unrecovery group were significantly higher than those in recovery group(P<0.05).The proportion of vasoactive drugs and mechanical ventilation in the unrecovery group was significantly higher than that in the recovery group(P<0.05).After 28 days of follow-up,the total EICU retention time was significantly longer in the unrecovery group(12.25±3.54 vs.10.35±3.55,P=0.032).Multivariate analysis showed that APACHEⅡ(OR=1.041,95%CI:1.011~1.109,P=0.007),SOFA(OR=1.057,95%CI:1.019~1.097,P=0.003),AKIⅢ(OR=1.078,95%CI:1.023~1.136,P=0.005),NGAL(OR=1.627,95%CI:1.009~2.626,P=0.046)sTM(OR=1.063,95%CI:1.021~1.106,P=0.003)were risk factor affecting renal function recovery.The ROC curve analysis showed that the area under the curve(AUC)of NGAL and sTMwere 0.843 and 0.868,respectively,which were significantly higher than AUC of APACHEⅡ,SOFA score,and AKI phaseⅢ(P<0.01).Conclusion APACHEⅡ,SOFA score,AKI stageⅢ,NGAL,sTM are the r
作者 董行东 杜旭东 DONG Xingdong;DU Xudong(Department of Emergency,People’s Hospital of Fenghua District,Ningbo 315500,China)
出处 《浙江医学》 CAS 2019年第8期780-784,共5页 Zhejiang Medical Journal
关键词 急性肾损伤 中性粒细胞明胶酶相关脂质运载蛋白 可溶性血栓调节蛋白 Acute renal injury Neutrophil gelatinase-related lipid carrier protein Soluble thrombomodulin
作者简介 通信作者:董行东,E-mail:jiangsx1976@163.com.
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