肺超声特征在连续性肾脏替代治疗患者水负荷评估中的价值

Value of Pulmonary Ultrasound Characteristics in Water Load Assessment of CRRT Patients

目的:探讨肺超声特征在连续性肾脏替代治疗(CRRT)患者水负荷评估中的价值。方法:以2020年3月至2023年12月我院收治的175例CRRT患者为研究对象,根据生物电阻抗人体成分分析(BCM)测定结果,将所有患者分为正常水负荷组(OH<2)和非正常水负荷组(OH≥2)。比较2组患者一般资料、实验室检查结果、超声心动图以及肺超声特征;采用多因素Logistic回归分析影响CRRT患者水负荷的因素,绘制ROC曲线分析肺超声特征对患者水负荷的评估价值。结果:正常水负荷组TNF-α水平低于非正常水负荷组(P<0.05);正常水负荷组LVEF高于非正常水负荷组,IVST、LVPWT、LAD、肺彗星均低于非正常水负荷组(P<0.05);多因素Logistic回归分析结果显示TNF-α(OR=1.888,95%CI 1.517~2.351)、IVST(OR=1.717,95%CI 1.256~2.348)、LVEF(OR=0.717,95%CI 0.601~0.857)、肺彗星(OR=1.186,95%CI 1.056~1.333)是影响水负荷的相关因素(P<0.05);ROC曲线显示TNF-α、IVST、LVEF、肺彗星对患者水负荷均具有较高的诊断价值(AUC均>0.70),当肺彗星的最佳截断值为13.71时其诊断价值最高(P<0.05)。结论:TNF-α、IVST、LVEF、肺彗星是影响水负荷的相关因素,并且肺超声特征对水负荷具有较高的评估价值。

Objective:To explore the value of pulmonary ultrasound characteristics in water load assessment of patients undergoing continuous renal replacement therapy(CRRT).Methods:From March 2020 to December 2023,175 patients with CRRT in our hospital were taken as the research objects.According to the results of bioelectrical impedance body composition analyzer(BCM),all patients were divided into normal water load(OH<2)and abnormal water load group(OH≥2).The general data,laboratory examination results,echocardiography and pulmonary ultrasound characteristics of the two groups were compared.Multivariate Logistic regression was used to analyze the factors affecting water load of CRRT patients,and ROC curve was drawn to analyze the evaluation value of pulmonary ultrasound features on water load of patients.Results:The level of TNF-αin normal water load group was lower than that in abnormal water load group ( P <0.05). LVEF in normal water load group was higher than that in abnormal water load group, while IVST, LVPWT, LAD and lung comet were lower than those in abnormal water load group ( P < 0.05). Multivariate Logistic regression analysis showed that TNF-α (OR=1.888, 95%CI 1.517-2.351), IVST (OR=1.717, 95%CI 1.256-2.348), LVEF (OR=0.717, 95%CI 0.601-0.857). ROC curve showed that TNF-α, IVST, LVEF and lung comet all had high diagnostic value (AUCs were all > 0.70), and the diagnostic value was the highest when the best cutoff value of lung comet was 13.71 ( P <0.05). Conclusion: TNF-α, IVST, LVEF, and pulmonary comet are all related factors affecting water load, and the characteristics of pulmonary ultrasound have high evaluation value for water load.