临床指标对急性肾损伤合并心肾综合征患者行连续性肾脏替代治疗的预测价值

Value of Clinical Parameters in Predicting Possibility of CRRT in Acute Kidney Injury Patients with Cardiorenal Syndrome

目的探讨多项临床指标对急性肾损伤(AKI)合并心肾综合征患者行连续性肾脏替代治疗(CRRT)的预测价值。方法选取青岛市市立医院2010年10月—2012年12月收治的50例合并心肾综合征的AKI住院患者为研究对象。保守治疗3 d后心功能好转者入选对照组(n=24),心功能无好转者继续行CRRT(CRRT组,n=26)。记录两组患者保守治疗前平均动脉压(MAP)、清蛋白(Alb)、血红蛋白(Hb)、尿素氮-Ⅰ、血肌酐-Ⅰ、B型钠尿肽-Ⅰ(BNP-Ⅰ)及第1个24 h尿量(24 h尿量-Ⅰ)和呋塞米用量(呋塞米-Ⅰ);记录保守治疗3 d后尿素氮-Ⅱ、血肌酐-Ⅱ、BNP-Ⅱ及入院第3个24 h尿量(24 h尿量-Ⅱ)、呋塞米用量(呋塞米-Ⅱ)。比较两组上述临床指标间的差异。采用ROC曲线下面积(AUC)评价各指标预测患者是否行CRRT的敏感度和特异度。结果对照组与CRRT组Alb、尿素氮-Ⅱ、血肌酐-Ⅱ、BNP-Ⅰ、BNP-Ⅱ、24 h尿量-Ⅰ、24 h尿量-Ⅱ比较,差异均有统计学意义(P<0.05);ROC曲线显示,BNP-Ⅱ、24 h尿量-Ⅰ与24 h尿量-Ⅱ的AUC均>0.700,具有较好的预测价值;BNP-Ⅱ的ROC曲线显示,取884 ng/L为切点时,其敏感度与特异度分别为92.3%与75.0%;24 h尿量-Ⅰ的ROC曲线显示,取2 395 ml/24 h为切点时,其敏感度与特异度分别为84.6%与75.0%;24 h尿量-Ⅱ的ROC曲线显示,取2 490 ml/24 h为切点时,其敏感度与特异度分别为96.2%与75.0%。结论经短期保守治疗后的24 h尿量与BNP水平可以较好地预测伴心肾综合征的AKI患者是否应该行CRRT。

Objective To investigate the predicting value of clinical parameters in the initiation of CRRT in acute kidney injury （AKI） patients with cardiorenal syndrome （CRS ）. Methods A total of 50 AKI patients with CRS hospitalized in this hospital from October 2010 to December 2012 were divided into groups control （whose heart function improved after 3 - day conservative treatment, n = 24）, CRRT （whose heart function did not imprve, n = 26）. Before treatment, mean arterial pressure （MAP）, serum albumin （Alb）, haemoglobin B （Hb）, blood urea nitrogen （BUN - I ）, serum creatinine （ScrI ）, B type natriuretic peptide （BNP - I ）, and the urine volume （24 h UV - I ） in the first day＇s, furosemide dosage （FD - I ） were recorded. After treatment, the Scr - II, BUN - II, BNP - II, and the FD （FD - II ）, UV （24 h UV - II） in the third day＇s were recorded. The clinical indexes were compared between 2 groups. ROC area under the curve （AUC） was used to evaluate the sensitivity and specificity of the indexes predicting the possibility of CRRT therapy. Results There was significant difference in Alb. Scr - II, BUN - II, BNP - II, BNP - II, 24 h UV - I , 24 h UV - II between two groups （P 〈 0.05）. ROC showed that the AUCs of 24 h UV - I , BNP - II and 24 h UV - II, less than 0. 7, were of good predicting value. By the AUC of BNP - II, taking 884 ngiL as tangency, its sensitivity and specificity were 92.3%, 75.0%; by the AUC of 24 h UV - I , taking 2, 395 ngl24 h as point of tangency, its sensitivity and specificity were 84.6%, 75.0%; by AUC of 24 h UV - II, taking 2, 490 mV24 h as tangency, its sensitivity and specificity were 96. 2%, 75.0%. Conclusion The 24 h UV and BNP levels after short - term conservative therapy can predict the possibility of CRRT in AKI patients combined with CRS.