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严俊, 闻勇, 曹葆强. 肾阻力指数联合血液指标对急性胰腺炎并发急性肾损伤的预测价值[J]. 中国临床医学, 2024, 31(3): 457-462. DOI: 10.12025/j.issn.1008-6358.2024.20240413
引用本文: 严俊, 闻勇, 曹葆强. 肾阻力指数联合血液指标对急性胰腺炎并发急性肾损伤的预测价值[J]. 中国临床医学, 2024, 31(3): 457-462. DOI: 10.12025/j.issn.1008-6358.2024.20240413
YAN Jun, WEN Yong, CAO Baoqiang. Predictive values of renal resistance index combined with blood indices in acute pancreatitis complicated with acute kidney injury[J]. Chinese Journal of Clinical Medicine, 2024, 31(3): 457-462. DOI: 10.12025/j.issn.1008-6358.2024.20240413
Citation: YAN Jun, WEN Yong, CAO Baoqiang. Predictive values of renal resistance index combined with blood indices in acute pancreatitis complicated with acute kidney injury[J]. Chinese Journal of Clinical Medicine, 2024, 31(3): 457-462. DOI: 10.12025/j.issn.1008-6358.2024.20240413

肾阻力指数联合血液指标对急性胰腺炎并发急性肾损伤的预测价值

Predictive values of renal resistance index combined with blood indices in acute pancreatitis complicated with acute kidney injury

  • 摘要:
    目的 探讨肾阻力指数(renal resistance index, RRI)联合血液指标对急性胰腺炎(acute pancreatitis, AP)并发急性肾损伤(acute kidney injury, AKI)的预测价值。
    方法 选择安徽省第二人民医院2021年6月至2024年1月收治的AP患者,根据其入院7 d内是否发生AKI分为AKI组和non-AKI组。收集患者基本信息,入院24 h内急性生理学与慢性健康状况评分Ⅱ(Acute Physiology and Chronic Health Evaluation Ⅱ, APACHE Ⅱ)、序贯器官衰竭评分(Sequential Organ Failure Assessment, SOFA),血肌酐(serum creatinine, sCr)、尿素氮(blood urea nitrogen, BUN)、血清胱抑素C(cystatin C, Cys C)、红细胞分布宽度(red blood cell distribution width, RDW)、C反应蛋白(C-reactive protein, CRP)等血液指标;采用超声评估RRI。采用单因素和多因素logistic回归分析AKI的危险因素。绘制受试者工作特征(receiver operating characteristic, ROC)曲线,分析RRI联合血液指标对AP并发AKI的预测价值。
    结果 共纳入145例AP患者,37例发生AKI,108例未发生AKI。AKI组患者APACHE Ⅱ评分、SOFA评分、Cys C水平、RDW、CRP水平、RRI大于non-AKI组(P<0.05)。多因素logistic回归分析结果显示,Cys C(OR=5.458,95%CI 1.275~23.369)、CRP(OR=5.296,95%CI 1.676~16.734)、RRI(OR=6.114,95%CI 2.966~12.602)升高是AP患者并发AKI的危险因素(P<0.05)。ROC曲线结果显示,Cys C、CRP、RRI预测AP患者并发AKI的曲线下面积(area under curve, AUC)分别为0.648(95%CI 0.540~0.756,P=0.011)、0.777(95%CI 0.694~0.859,P<0.001)和0.802(95%CI 0.710~0.893,P<0.001);三者联合预测的AUC最高,为0.909,灵敏度为96.55%、特异度为72.41%。
    结论 Cys C、CRP、RRI升高为AP并发AKI的独立危险因素,且均有一定的预测价值,三者联合预测的价值较高。

     

    Abstract:
    Objective To explore the predictive value of renal resistance index (RRI) evaluated by ultrasound combined with blood indices in acute pancreatitis (AP) complicated with acute kidney injury (AKI).
    Methods Patients with AP admitted to the Second People's Hospital of Anhui Province from June 2021 to January 2024 were divided into AKI group and non-AKI group according to whether AKI occurred within 7 d after admission. RRI was evaluated by ultrasonography after collecting the basic information, scores of Acute Physiologic Assessment and Chronic Health Evaluation Ⅱ (APACHE Ⅱ) and Sequential Organ Failure Assessment (SOFA) within 24 h after admission, blood indices such as serum creatinine (sCr), blood urea nitrogen (BUN), serum cystatin C (Cys C), red blood cell distribution width (RDW) and C-reactive protein (CRP) within 24 h after admission were collected. Univariate analysis and multivariate logistic regressions were used to analyze the risk factors of AKI. The receiver operating characteristic (ROC) curves were drawn to analyze the predictive values of RRI combined with blood indices.
    Results A total of 145 patients were included, including 37 patients with AKI and 108 patients without AKI. APACHE Ⅱ score, SOFA score, Cys C, RDW, CRP and RRI in AKI group were higher than those in non-AKI group (P<0.05). Multivariate logistic regression analysis showed that Cys C (OR=5.458, 95%CI 1.275-23.369), CRP (OR=5.296, 95%CI 1.676-16.734) and RRI (OR=6.114, 95%CI 2.966-12.602) increased were the risk factors of AKI in patients with AP (P<0.05). ROC curve analysis showed that the area under curve (AUC) of Cys C, CRP and RRI for predicting AKI in patients with AP were 0.648 (95%CI 0.540-0.756, P=0.011), 0.777 (95%CI 0.694-0.859, P<0.001) and 0.802 (95%CI 0.710-0.893, P<0.001), respectively. AUC of combination of the three indices was 0.909, the sensitivity was 96.55%, and the specificity was 72.41%.
    Conclusions Cys C, CRP and RRI increasing are all risk factors of AP patients complicating with AKI, and all of them have certain predictive value. The combination of the three indices is of high value in predicting AP patients complicating with AKI.

     

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