肾脏彩色多普勒超声结果对儿童重症医学科急性肾损伤患儿的辅助诊断价值

Predictive value of renal color Doppler ultrasound parameters in children with acute renal injury in Pediatric Intensive Care Unit

目的探讨肾脏彩色多普勒超声结果对儿童重症医学科(PICU)急性肾损伤(AKI)患儿的辅助诊断价值。方法选择2022年1至12月四川大学华西第二医院PICU收治的74例患儿为研究对象。采取回顾性分析法,按照患儿于PICU治疗过程中是否发生AKI,将其分别纳人观察组(n=34,发生AKI的患儿)和对照组(n=40,未发生AKI的患儿)。对2组患儿均进行肾脏彩色多普勒超声检查。对2组患儿的临床病例资料、肾脏彩色多普勒超声结果进行统计学分析。采用成组t检验、χ^(2)检验分别比较2组患儿一般临床资料及双肾实质回声强度、彩色多普勒血流(CDFI)评分,肾动脉阻力指数(RRI)、搏动指数(PI)等指标,并采用多因素非条件logistic回归分析方法,分析PICU患儿发生AKI的独立影响因素。采用受试者工作特征(ROC)曲线,分析肾脏彩色多普勒超声指标,对PICU患儿发生AKI的辅助诊断价值。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求,与患儿家属均签署临床研究知情同意书。结果①2组患儿性别构成比、年龄、人体质量指数(BMI)等一般临床资料比较,差异均无统计学意义(P>0.05)。②观察组患儿双肾实质回声增强率、肾动脉RRI和PI值,均显著高于对照组[67.6%(23/34)vs5.0%(2/40),(0.76士0.04)s(0.56±0.04),(1.56±0.05)vs(1.27±0.05)],2组比较,差异均有统计学意义(x²=32.24,t=20.51,t=23.04;P<0.001)。③观察组AKI患儿的CDFI评分,显著低于对照组[0(0,1)us 2(0,3)],并且差异有统计学意义(Z=8.08,P=0.001)。④多因素非条件logistic回归分析结果显示,双肾实质回声增强(OR=7.320,95%CI:5.478~11.845,P<0.001),CDFI评分减低(OR=0.447,95%CI:0.359~0.837,P<0.001),肾动脉RRI值增高(OR=5.117,95%CI:3.622~10.451 P<0.001),肾动脉PI值增高(OR=4.727,95%CI:1.855~20.862,P<0.001),均是导致PICU患儿发生AKI的独立影响因素。③对ROC曲线分析结果显示,双肾实质回声强度、CDFI评分、肾动脉RRI值、肾动脉PI值,预测PICU患儿发生AKI的曲线下面积(AUC),分别为0.667(95%CI:0.541~0.792 P<0.001),0.766(95%CI:0.643~0.860,P<0.001),0.840(95%CI:0.750~0.934,P<0.001)和0.783(95%CI:0.658~0.884,P<0.001)。结论双肾实质回声强度、CDFI评分、肾动脉RRI和PI值,对PICU患儿发生AKI的辅助诊断,具有较好临床价值。

Objective To explore the predictive value of renal color Doppler ultrasound parameters in children with acute renal injury(AKI)in Pediatric Intensive Care Unit(PICU).Methods Seventy-four children admitted to the PICU of West China Second University Hospital from January to December,2022 were selected in this study.According to combined AKI or not,they were divided into observation group(n=34,children admitted to PICU with combined AKI)and control group(n=40,children admitted to PICU without combined AKI).Renal color Doppler ultrasound was performed in both groups.The clinical data and renal color Doppler ultrasound parameters of two groups were statistically analyzed by retrospective analysis.The general clinical data,renal parenchymal echo intensity,color Doppler flow(CDFI)score,renal artery resistance index(RRI),pulsation index(PI)and other renal color Doppler ultrasound parameters of two groups were compared,and the influencing factors of AKI in PICU children were analyzed by multivariate unconditional logistic regression analysis.The predictive value of renal color Doppler ultrasound parameters in predicting AKI in PICU children was analyzed by using receiver operator characteristic(ROC)curve.The study was conducted in accordance with World Medical Association Declaration of Helsinki revised in 2013.Informed consent was obtained from each participate.Results ①There were no significant differences between two groups in general clinical data such as gender constituent ratio,age,body mass index(BMI)(P>0.05).②Compared with the control group,the echo enhancement rate,renal artery RRI and renal artery PI of both renal parenchyma in the observation group were significantly higher(P<0.05),and the CDFI score was significantly lower(P>0.05).The echo intensity of bilateral renal parenchyma,renal artery RRI,and renal artery PI in observation group were significantly higher than those in control group[67.6%(23/34)us 5.0%(2/40),(0.76±0.04)vs(0.56±0.04),(1.56±0.05)vs(1.27±0.05),and the differences were statistically significant(x?=32.24,t=20.51,t=23.04;P<0.001).③The CDFI score of children in observation group was significantly lower than that in control group[0(0,1)us 2(0,3)J,and the difference was statistically significant(Z=8.08,P=0.001).Multivariate logistic regression analysis showed that echo intensity of bilateral renal parenchyma(OR=7.320,95%CI:5.478-11.845,P<0.001),CDFI score(OR=0.447,95%CI:0.359-0.837,P<0.001),renal artery RRI(OR=5.117,95%CI:3.622-10.451,P<0.001),renal arteryPI(OR=4.727,95%CI:1.855-20.862,P<0.001)were independent influencing factors of AKI in PICU children.@The ROC curve analysis results showed that the area under the curve(AUC)of echo intensity of bilateral renal parenchyma,CDFI score,renal artery RRI and renal artery PI predicting the occurrence of AKI in PICU children were O.667(95%CI:0.541-0.792,P<0.001),0.766(95%CI:0.643-0.860,P<0.001),0.840(95%CI:0.750-0.934,P<0.001),0.783(95%CI:0.658-0.884,P<0.001),respectively.Conclusions Renal color Doppler ultrasound parameters,such as echo intensity of bilateral renal parenchyma,CDFI score,renal artery RRI and renal artery PI can provide good guidance for the clinical diagnosis of AKI in PICU children.