摘要
目的 探讨超声预测慢性肾脏病(CKD)患者肾功能减低的临床价值.方法 选取经我院确诊的CKD住院患者252例,根据临床CKD分期分为CKD轻度减低组(G1～2期,83例)和CKD中度及以上减低组(G3～5期,169例).收集两组临床资料和实验室指标;应用二维超声获得肾脏长度、实质厚度及其回声强度分级,多普勒超声检测肾内动脉阻力指数(RI),并进行超声CKD评分,比较两组上述参数的差异.采用单因素和多因素Logistic回归分析筛选超声参数中预测CKD患者肾功能轻度和重度减低的独立影响因素;绘制受试者工作特征(ROC)曲线分析超声参数预测CKD患者肾功能轻度和重度减低的诊断效能.结果 两组年龄、高血压病、冠心病、估计肾小球滤过率、血尿素氮、血肌酐,以及肾脏长度、实质厚度、实质回声强度分级、超声CKD评分、肾动脉RI比较,差异均有统计学意义(均P<0.05).单因素Logistic回归分析显示,肾脏长度、实质厚度、实质回声强度分级、超声CKD评分、肾动脉RI均为预测CKD患者肾功能轻度和重度减低的影响因素(均P<0.0001).多因素Logistic回归分析显示,肾脏长度、实质回声强度分级均为预测CKD患者肾功能轻度减低的影响因素(均P<0.05);实质厚度、肾动脉RI分级均为预测CKD患者肾功能重度减低的影响因素(均P<0.05).ROC曲线分析显示,肾脏长度、实质厚度、实质回声强度分级、超声CKD评分、肾动脉RI联合应用预测CKD患者肾功能轻度和重度减低的AUC分别为0.867、0.847,均高于各参数单独应用,差异均有统计学意义(均P<0.001).结论 应用超声可以有效预测CKD患者肾功能轻度和重度减低,有一定的临床价值.
Abstract
Objective To investigate the clinical value of ultrasound in predicting reduced renal function in patients with chronic kidney disease(CKD).Methods A total of 252 in-patients with CKD diagnosed in our hospital were selected and divided into mild CKD reduction group(G1～2 stage,83 cases)and moderate/severe CKD reduction group(G3～5 stage,169 cases).Clinical data and laboratory indexes were collected.Renal length,parenchymal thickness and echo intensity classification were measured by two-dimensional ultrasound,and intrarenal arterial resistance index(RI)was measured by Doppler ultrasound,and CKD score was performed,the differences of the above parameters between the two groups were compared.Univariate and multivariate Logistic regression was used to screen the independent influencing factors in predicting mild and severe renal function reduction in patients with CKD.Receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of ultrasound parameters in predicting mild and severe renal function reduction in patients with CKD.Results There were statistically significant differences in age,hypertension,coronary heart disease,estimated glomerular filtration rate,blood urea,blood creatinine,renal length,parenchymal thickness,parenchymal echo intensity classification,ultrasonic CKD score and renal artery RI between the two groups(all P<0.05).Univariate Logistic regression analysis showed that renal length,parenchymal thickness,parenchymal echo intensity classification,ultrasonic CKD score and renal artery RI were influencing factors for predicting mild and severe renal function reduction in patients with CKD(all P<0.0001).Multivariate Logistic regression analysis showed that renal length and parenchymal echo intensity classification were influencing factors for predicting mild renal function reduction in patients with CKD(both P<0.05).Parenchymal thickness and renal artery RI were influencing factors for predicting severe renal function reduction in patients with CKD(both P<0.05).ROC curve analysis showed that the area under the curve of renal length,parenchymal thickness,parenchymal echo intensity classification,ultrasonic CKD score and renal artery RI combined in predicting mild and severe renal function reduction in patients with CKD were 0.867 and 0.847,respectively,which were higher than that of each parameter applied alone(all P<0.0001).Conclusion The application of ultrasound can effectively predict the mild and severe renal function reduction in patients with CKD,which has a certain clinical value.
基金项目
湖北省自然科学基金青年项目(2024AFB186)
维普
万方数据