肾脏超声造影定量参数预测脓毒症患者器官功能障碍的临床价值

Clinical value of quantitative parameters of renal contrast-enhanced ultrasound in predicting organ dysfunction in patients with sepsis

目的探讨肾脏超声造影定量参数预测脓毒症患者器官功能障碍的临床价值。方法连续纳入我院重症医学科收治的51例脓毒症患者(脓毒症组),另选同期17例行肾脏超声造影检查且无肾脏疾病的健康体检者(对照组)。比较两组肾脏超声造影定量参数包括达峰时间(TTP)、峰值强度(PI)、曲线下面积(AUC),以及临床资料的差异。根据序贯器官衰竭(SOFA)评分对脓毒症患者进行分组,定义入ICU 0~24 h SOFA>6分为器官功能严重衰竭,将患者分为严重组与非严重组;定义入ICU 24~48 h SOFA评分增加(ΔSOFA评分≥1)为器官功能恶化,将患者分为恶化组与未恶化组;同时根据入ICU后的存活情况分为死亡组与存活组。比较各亚组间TTP、AUC、PI的差异。绘制受试者工作特征(ROC)曲线分析各指标预测脓毒症患者器官功能严重衰竭的诊断效能。结果脓毒症组与对照组血乳酸(Lac)、氧合指数、SOFA评分、使用血管活性药物、估算肾小球滤过率、尿素氮,以及TTP、AUC、PI比较差异均有统计学意义(均P<0.05)。脓毒症患者中,严重组27例,非严重组24例;恶化组14例,非恶化组37例;严重组与非严重组、恶化组与未恶化组AUC、PI比较差异均有统计学意义(均P<0.05)。脓毒症患者中,死亡组14例,存活组37例;两组各超声造影参数比较差异均无统计学意义。ROC曲线分析显示,AUC、PI、Lac预测脓毒症患者器官功能严重衰竭的曲线下面积分别为0.81、0.75、0.73。结论肾脏超声造影定量参数可用于监测脓毒症患者器官功能衰竭的严重程度及进展,对脓毒症患者器官功能障碍有一定的预测价值。

Objective To investigate the clinical value of quantitative parameters of renal contrast-enhanced ultrasound in predicting organ dysfunction in patients with sepsis.Methods Fifty-one patients with sepsis(sepsis group)admitted to our hospital and 17 healthy individuals who did not have kidney disease and underwent renal contrast-enhanced ultrasound examination during the same period(control group)were enrolled in this study.The quantitative parameters of renal contrast-enhanced ultrasound between the two groups was compared,including time to peak(TTP),peak intensity(PI),and area under the curve(AUC).The differences of above parameters and clinical data were compared.Sepsis patients were divided into two groups according to SOFA score:severe organ failure group with SOFA score>6 and non-severe organ failure group with SOFA score≤6 within 0~24 h of ICU admission.Patients with increased SOFA score(ΔSOFA score≥1)within 24~48 h of ICU admission were defined as deterioration group,and patients withΔSOFA score<1 were defined as non-deterioration group.Patients with sepsis were divided into death group and survival group according to the survival after ICU admission.The differences of TTP,AUC and PI among the subgroups were compared.The receiver operating characteristic(ROC)curve was drawn to analyze the diagnostic efficacy of different indicators in predicting severe organ failure in patients with sepsis.Results There were significant differences in Lac,PaO2/FiO2,SOFA score,use of vasoactive substance,BUN,eGFR,TTP,AUC and PI between the sepsis group and the control group(all P<0.05).Among patients with sepsis,there were 27 cases in the severe organ failure group and 24 cases in the non-severe organ failure group.14 cases in the deterioration group and 37 cases in the non-deterioration group.There were significant differences in AUC and PI between the severe organ failure group and the non-severe organ failure group,the deterioration group and the non-deterioration group(all P<0.05).There were 14 cases in the death group and 37 cases in the survival group.There were no significant difference in parameters of contrast-enhanced ultrasound between the death group and the survival group.ROC curve analysis showed that the area of AUC,PI and Lac in predicting severe organ failure in sepsis patients were 0.81,0.75 and 0.73,respectively.Conclusion Quantitative parameters of renal contrast-enhanced ultrasound can be used to monitor renal perfusion in patients with sepsis,which is related to the severity and progression of organ failure,and has a certain predictive value for organ dysfunction in patients with sepsis.