目的 探究肾阻力指数(RRI)联合舌下微循环对创伤相关急性肾损伤(AKI)的早期预测价值.方法 前瞻性研究2023年9月——2024年3月重庆两江新区人民医院重症医学科收治创伤患者45例,男性26例,女性19例;年龄18～94岁,平均64.8岁;道路交通伤18例,摔伤15例,高处坠落伤8例,挤压伤2例,刀刺伤2例.根据伤后72 h内是否发生AKI分为AKI组(25例)和非AKI组(20例);利用床旁超声获取叶间动脉多普勒血流频谱并测量RRI,舌下微循环仪观察并获取舌下区域的微循环图像以测量微循环指标,包括微血管血流指数(MFI)、血流不均一指数(FHI)、灌流血管比例(PPV)、灌流血管密度(PVD)、总血管密度(TVD).对各指标进行统计分析,采用二元Logistic回归分析筛选创伤患者发生AKI的相关因素,受试者工作(ROC)曲线评估RRI、MFI、PVD预测AKI的效能.结果 与非AKI组比较,AKI组RRI值明显升高,差异有统计学意义[0.65(0.62,0.70)vs.0.74(0.70,0.76),P＜0.001];AKI组舌下微循环指标中,除 FHI 升高外[0.04(0,2.22)vs.0.56(0.35,1.07),P＜0.05],MFI、PPV、PVD 均较非 AKI 组呈下降趋势[2.98(2.84,3.00)分 vs.2.18(1.4,2.55)分,100(99.2,100)％vs.78.9(40.3,100)％,(14.47±3.76)mm/mm2 vs.(11.00±5.43)mm/mm2,P＜0.05];两组患者 TVD 则无明显统计学差异[(15.12±3.40)mm/mm2 vs.(14.63±3.54)mm/mm2,P＞0.05];二元 Logistic 回归分析发现,休克、RRI、MFI、FHI、PPV、PVD 对 AKI 的影响差异有统计学意义(P＜0.05).ROC曲线下面积(AUC)显示,RRI、MFI、PVD三者预测AKI的AUC(95％CI)分别为 0.851(0.713～0.939)、0.754(0.550～0.860)、0.781(0.631～0.891),其截断值分别为0.72、2.70、10.80;三者联合预测 AKI 的 AUC(95％CI)为 0.872(0.736,0.953),其灵敏度 88％,特异度 84％.结论 肾脏超声参数RRI和舌下微循环参数MFI、PVD与创伤相关AKI的发生有关,三个指标联合时预测效能最高,可能成为创伤相关AKI的潜在预测指标.
Early predictive value of renal resistance index combined with sublingual microcirculation for trauma-related acute kidney injury
Objective To explore the value of renal resistance index(RRI)combined with sublingual mi-crocirculation in early prediction of trauma-related acute kidney injury(AKI).Methods This prospective study analyzed 45 trauma patients admitted to the ICU of People's Hospital of Chongqing Liangjiang New Area from Sep.2023 to Mar.2024.Among them,26 were males and 19 were females.Patients aged 18-94 years,mean 64.8 years.There were 18 cases of road traffic accidents,15 falls from height,8 ground-level falls,2 crush injuries,and 2 stab wounds.Doppler flow spectrum of the interlobar artery was obtained and RRI was measured.Sublingual microcircu-lation was monitored to obtain microcirculation images of the sublingual region to measure microcirculation indexes,including microvascular flow index(MFI),flow heterogeneity index(FHI),proportion of perfused vessels(PPV),perfused vascular density(PVD),and total vascular density(TVD).Depending on whether AKI occurred within 72 h after injury,patients were divided into AKI group(25 cases)and non-AKI group(20 cases).SPSS 22.0 was used to compare each index between the two groups.Binary Logistic regression analysis was adopted to screen rele-vant factors of AKI in trauma patients.ROC curve was drawn to evaluate the efficacy of these indicators to predict AKI.Results It was found that RRI in AKI group was significantly higher than that in non-AKI group[0.74(0.70,0.76)vs.0.65(0.62,0.70),P＜0.001].As for the indicators of sublingual microcirculation,the AKI group re-vealed much higher FHI[0.56(0.35,1.07)vs.0.04(0,2.22),P＜0.05]and much lower MFI[2.18(1.4,2.55)vs.2.98(2.84,3.00)],PPV[78.9％(40.3％,100％)vs.100％(99.2％,100％)]and PVD(mm/mm2,11.00±5.43 vs.14.47±3.76,all P＜0.05),but non-significant difference for TVD(mm/mm2,15.12±3.40 vs.14.63±3.54,P=0.640).Binary Logistic regression analysis showed that shock,RRI,MFI,FHI,PPV and PVD were statis-tically significant influencing factors for AKI(all P＜0.05).The AUC(95％CI)to predict AKI in trauma patients was 0.851(0.713,0.939)for RRI,0.754(0.550,0.860)for MFI and 0.781(0.631,0.891)for PVD,and their optimal cut-off were 0.72,2.70 and 10.80,respectively.When the three factors were used combinedly,the AUC(95％CI)reached 0.872(0.736,0.953),with a sensitivity of 88％and specificity of 84％.Conclusion The renal ultrasound index of RRI and sublingual microcirculation indexes of MFI and PVD are associated with the incidence of trauma-related AKI.Combined use of the three indexes shows a high predictive value and can be a potential pre-dictor of trauma-related AKI.
万方数据
维普
