Value of bedside ultrasound in evaluating acute kidney injury in patients with severe trauma
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摘要:
目的探讨床旁超声对严重创伤后急性肾损伤（AKI）的评估价值。 方法选取2018年12月~2020年7月入住本院ICU病房的严重创伤患者90例，根据患者入ICU后AKI的发生情况分为AKI组（n=39）和非AKI组（n=51）。所有患者均接受床旁超声检查，比较两组患者的一般临床资料，不同时间点的肾功能指标、肾动脉阻力指数（RRI）和搏动指数（PI）；分析RRI、PI与肾功能指标的相关性，采用ROC曲线评估RRI、PI对AKI的诊断价值。 结果AKI组患者的急性生理与慢性健康状况评分Ⅱ、序贯器官衰竭评分和28 d病死率均高于非AKI组（P < 0.05）；入ICU后第1、3、5、7天，AKI组患者的血清胱抑素C、β2微球蛋白（β2-MG）水平均高于非AKI组（P < 0.05），AKI组患者组内不同时间点血清β2-MG水平比较，差异有统计学意义（P < 0.05）；入ICU后第1天，两组患者的RRI、PI水平差异无统计学意义（P>0.05），入ICU后第3、5、7天，AKI组患者的RRI和PI均高于非AKI组（P < 0.05）；AKI组患者组内不同时间点RRI、PI比较，差异有统计学意义（P < 0.05）；患者RRI、PI与血清胱抑素C、β2-MG水平均呈正相关（P < 0.05）；RRI、PI对严重创伤后患者并发AKI的诊断均具有良好的评估效果，其AUC值分别为0.838和0.809。 结论床旁超声对严重创伤后AKI具有良好的评估价值，RRI、PI水平可在一定程度上反应AKI的严重程度，二者可作为临床AKI诊断的有益补充。 Abstract:ObjectiveTo explore the value of bedside ultrasound in evaluating acute kidney injury (AKI) after severe trauma. MethodsNinety patients with severe trauma treated in ICU of the hospital between December 2018 and July 2020 were enrolled. The patients were divided into AKI group (n=39) and non-AKI group (n=51), according to the occurrence of AKI after entering the ICU. All patients received bedside ultrasound examination. The general clinical data, renal function indexes, renal resistive index (RRI) and pulsatility index (PI) at different time points were compared between two groups. Meanwhile, the correlations among RRI, PI and renal function indexes were analyzed. The receiver operating characteristic (ROC) curve was used to evaluate the diagnostic value of RRI and PI in AKI. ResultsThe AKI group had higher APACHE Ⅱ score, SOFA score and 28-day mortality rate than the non-AKI group (P < 0.05). AKI group had significantly higher serum CysC and β2-MG levels than the non-AKI group on the 1st, 3rd, 5th and 7th day (P < 0.05). Besides, there were significant differences in serum β2-MG levels in AKI group at different time points (P < 0.05). On the first day after entering the ICU, no significant differences were found in RRI and PI between the 2 groups (P>0.05). However, on the 3rd, 5th, and 7th day after entering the ICU, AKI group had significantly higher RRI and PI than the non-AKI group (P < 0.05). The significant differences were found in RRI and PI in AKI group at different time points (P < 0.05). RRI and PI were significantly positively correlated with serum CysC and β2-MG levels (P < 0.05). Both RRI and PI had good effect in the diagnosis of AKI in patients with severe trauma, and their AUC values were 0.838 and 0.809, respectively. ConclusionThe ultrasound has good value in evaluating AKI after severe trauma. RRI and PI levels can reflect the severity of AKI to a certain extent, which can be used to assist clinical diagnosis of AKI. -
Key words:
- severe trauma /
- acute kidney injury /
- ultrasound /
- renal resistive index /
- pulsatility index
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图 1 超声检测肾脏肾动脉阻力指数的方法
A: 肾脏彩色多普勒超声显像; B: 彩色多普勒定位叶间动脉，设置脉冲多普勒取样门, 获取肾动脉多普勒频谱, 测量VS、VD和PI, 计算机自动显示RRI.
Figure 1. Methods for ultrasonic detection of renal arterial resistive index.
图 2 RRI、PI评估严重创伤患者并发AKI的ROC曲线
Figure 2. ROC curves of RRI and PI for evaluating AKI in patients with severe trauma.
表 1 两组患者一般临床资料比较
Table 1. Comparison of general clinical data between the two groups
指标 AKI组（n=39） 非AKI组（n=51） t/χ2 P 性别[n(%)] 男 22（56.41） 31（60.78） 0.175 0.676 女 17（43.59） 20（39.22） 年龄（岁, Mean±SD） 54.27±8.43 53.35±7.21 0.557 0.579 BMI（kg/m2, Mean±SD） 23.15±1.18 22.87±1.03 1.199 0.234 基础疾病[n(%)] 高血压 12（30.77） 17（33.33） 0.067 0.796 糖尿病 16（41.03） 23（45.10） 0.149 0.699 ISS评分（分, Mean±SD） 30.28±6.31 29.35±5.22 0.764 0.446 APACHEⅡ评分（分, Mean±SD） 22.17±7.25 12.83±4.46 7.530 ＜0.001 SOFA评分（分, Mean±SD） 10.21±2.28 7.32±2.53 5.602 ＜0.001 机械通气时间（d, Mean±SD） 10.65±3.32 9.36±3.58 1.748 0.084 28 d病死率[n(%)] 10（25.64） 3（5.88） 6.982 0.008 AKI: 急性肾损伤; ISS: 损伤严重程度评分; APACHEⅡ: 急性生理与慢性健康状况; SOFA: 序贯器官衰竭. 
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表 2 两组患者不同时间点血清CysC、β2-MG水平比较
Table 2. Comparison of serum CysC and β2-MG levels at different time points between the two groups (mg/L, Mean±SD)
组别 AKI组（n=39） 非AKI组（n=51） t P CysC 第1天 2.06±0.58 1.03±0.28 11.114 < 0.001 第3天 2.13±0.61 1.05±0.31 10.942 < 0.001 第5天 2.03±0.52 0.98±0.25 12.649 < 0.001 第7天 2.25±0.64 1.02±0.22 12.791 < 0.001 F 1.074 0.619 P 0.362 0.603 β2-MG 第1天 6.83±1.17 1.58±0.56 28.139 < 0.001 第3天 6.97±1.32 1.61±0.62 25.574 < 0.001 第5天 7.28±1.64 1.57±0.66 22.615 < 0.001 第7天 10.52±2.25 1.59±0.41 27.793 < 0.001 F 44.318 0.046 P ＜0.001 0.987 CysC: 血清胱抑素; β2-MG: β2微球蛋白.
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表 3 两组患者不同时间点RRI、PI水平比较
Table 3. Comparison of RRI and PI at different time points between the two groups (Mean±SD)
组别 AKI组（n=39） 非AKI组（n=51） t P RRI 第1天 0.71±0.23 0.65±0.27 1.223 0.269 第3天 0.78±0.16 0.63±0.22 3.591 < 0.001 第5天 0.83±0.22 0.64±0.25 3.761 < 0.001 第7天 0.85±0.28 0.66±0.28 3.190 0.002 F 2.957 0.130 P 0.034 0.942 PI 第1天 1.38±0.43 1.33±0.31 0.641 0.523 第3天 1.43±0.27 1.31±0.26 2.134 0.036 第5天 1.51±0.37 1.34±0.28 2.482 0.015 第7天 1.63±0.44 1.35±0.31 3.541 0.001 F 3.153 0.176 P 0.027 0.913 RRI: 肾动脉阻力指数; PI: 搏动指数.
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表 4 RRI、PI对严重创伤患者并发AKI的预测价值分析
Table 4. The predictive value of RRI and PI for AKI in patients with severe trauma
指标 AUC P 最佳阈值 Younden's指数 敏感度（%） 特异度（%） RRI 0.838 < 0.001 0.68 0.587 85.71 72.97 PI 0.809 < 0.001 1.42 0.676 85.46 78.41
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