血清电解质联合GFR评估方程对预测重度梗阻性肾损害预后的作用研究

Study on role of serum electrolyte combined with GFR evaluation equation in predicting the prognosis of severe obstructive renal injury

目的:研究血清电解质联合肾小球过滤率(GFR)评估方程对重度梗阻性肾损害预后作用的预测价值。方法:选取本院收治的结石性梗阻性肾损害患者69例为研究对象,收集患者临床资料,根据肾功能损伤状况分为轻中度37例,重度32例,另取同期健康体检者40例为对照组。分离受试者晨起空腹血清,采用Olympus AV640全自动生化仪检测血清电解质及受试者相关指标;所有受试者采用Scr-CysC GFR评估方程计算GFR评分。分析术后不同预后结局重度梗阻性肾损害患者血钠(Na^+)、血钾(K^+)浓度及GFR评分;绘制重度梗阻性肾损害患者预后指标受试者工作特性曲线(ROC),分析血清Na^+、K^+浓度、GFR评分及三者联合对重度梗阻性肾损害患者预后预测价值。结果:与对照组比较,轻中度组、重度组患者术前1 d血清尿微量白蛋白(UmAb)、抑胱素(CysC)、血肌酐(Scr)、尿素氮(BUN)、总胆固醇(TC)水平及血钠、血钾浓度依次升高,GFR评分依次降低(P<0.05);术后1个月血钠、血钾浓度依次升高,GFR评分依次降低(P<0.05)。与术前1 d比较,术后1个月,轻度组、重度组患者血钠、血钾浓度降低,GFR评分升高(P<0.05)。与预后良好组比较,预后不良组重度梗阻性肾损害患者血清血钠、血钾浓度显著增加,GFR评分显著降低(P<0.05)。ROC结果显示,Na^+浓度、K^+浓度、GFR评分三者联合检测对重度肾损害患者预后结局预测ROC曲线的AUC为0.936,显著高于三者单独检测(AUC分别为0.796、0.815、0.810)。结论:重度梗阻性肾损害患者血钠浓度、血钾浓度均升高,GFR评分降低,三者联合检测对预测重度梗阻性肾损害患者预后不良有一定参考价值。

Objective: To study the predictive value of serum electrolyte combined with glomerular filtration rate (GFR) evaluation equation for prognosis of severe obstructive renal injury. Methods: 69 patients with calculous obstructive renal impairment admitted to our hospital from May 2017 to December 2018 were selected as the research objects. Clinical data of the patients were collected, and according to the status of renal function impairment, they were divided into 37 cases of mild to moderate, 32 cases of severe, and 40 cases of health examination in the same period as the control group. The fasting serum of the subjects was separated in the morning, and the serum electrolytes and related indicators were detected by Olympus AV640 automatic biochemical analyzer, Scr-CysC GFR evaluation equation was used to calculate the GFR score of all subjects, the levels of serum sodium, potassium and GFR scores in patients with severe obstructive renal injury with different prognostic outcomes were analyzed, subject operating characteristic curve (ROC) of prognostic indicators in patients with severe obstructive renal impairment was drawn, and the prognostic values of serum Na^+, K ^+, GFR score and their combination in patients with severe obstructive renal damage were analyzed. Results: Compared with the control group, the levels of UmAb, CysC, Scr, BUN, TC, serum sodium and potassium in mild to moderate group and severe group increased in turn, and the GFR score decreased in turn ( P <0.05). The serum sodium and potassium concentrations increased in turn and the GFR score decreased in turn at 1 month after operation ( P <0.05). Compared with the 1 day before operation, the serum sodium and potassium concentrations in mild group and severe group decreased and the GFR score increased 1 month after operation ( P <0.05). Compared with the good prognosis group, the serum sodium and potassium levels in patients with severe obstructive renal damage in the poor prognosis group increased significantly, and the GFR score decreased significantly ( P <0.05). The results of ROC showed that the combined detection of Na^+ concentration, K^+ concentration and GFR score had an AUC of 0.936 for predicting the prognosis and outcomes of patients with severe renal injury, which was significantly higher than that of the single detection (AUC of 0.796, 0.815 and 0.810, respectively). Conclusion: The serum sodium and potassium levels in patients with severe obstructive renal impairment are increased, and the GFR score is decreased. The combined detection of the three factors has certain reference value in predicting the poor prognosis of patients with severe obstructive renal impairment.