超声血流动力学参数联合肾功能指标对肾移植术后急性肾损伤的预测价值OA
Predictive value of ultrasonic hemodynamic parameters combined with renal function indicators for acute kidney injury after renal transplantation
目的 基于超声血流动力学参数和肾功能指标探讨肾移植术后急性肾损伤(AKI)的影响因素及其早期预测价值.方法 回顾性分析接受肾移植术治疗的166例慢性肾功能不全尿毒症期患者的临床资料.根据术后3个月内是否发生AKI,将患者分为AKI组(61例)和非AKI组(105例).比较2组患者的临床资料,通过多因素Logistic回归分析筛选肾移植术后AKI的影响因素,绘制受试者工作特征(ROC)曲线评估预测效能.结果 AKI组术后第1天肾动脉和叶间动脉的收缩期峰值流速(PSV)、舒张末期流速(EDV)、阻力指数(RI)、搏动指数(PI),肾段动脉的EDV、RI和PI,以及肾功能指标中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胱抑素C(Cys-C)、血清肌酐(SCr)、尿素氮(BUN)、β2-微球蛋白(β2-MG)水平与非AKI组比较,差异均有统计学意义(P＜0.05).多因素Logistic回归分析显示,肾动脉PI(OR=2.249,95％CI:1.346～3.757)、叶间动脉 RI(OR=1.898,95％CI:1.131～3.187)、NGAL(OR=3.519,95％CI:1.905～6.500)、Cys-C(OR=2.130,95％CI:1.229～3.690)和SCr(OR=2.576,95％CI:1.498～4.429)是肾移植术后AKI的独立影响因素(P＜0.05).ROC曲线显示,肾动脉PI、叶间动脉RI、NGAL、Cys-C和SCr的曲线下面积(AUC)分别为0.722、0.696、0.746、0.711和0.761,截断值分别为1.42、0.74、677.63 ng/mL、3.40 mg/L和697.38 μmol/L;以上指标联合预测的AUC为0.905,敏感度为93.5％,特异度为90.2％,预测效能优于各指标单独预测.结论 肾动脉PI、叶间动脉RI、NGAL、Cys-C和SCr是肾移植术后AKI发生的独立影响因素,据此构建的联合预测模型对肾移植术后AKI具有良好的预测效能.
Objective To explore the influencing factors and early predictive value of acute kid-ney injury(AKI)after renal transplantation based on ultrasonic hemodynamic parameters and renal function indicators.Methods The clinical data of 166 patients with chronic renal insufficiency at the uremic stage who underwent renal transplantation were retrospectively analyzed.According to whether AKI occurred within 3 months after the operation,the patients were divided into AKI group(61 cases)and non-AKI group(105 cases).The clinical data of the two groups were compared.Multivariate Logis-tic regression analysis was used to screen the influencing factors of AKI after renal transplantation,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive efficacy.Results On the first day after the operation,the peak systolic velocity(PSV),end-diastolicvelocity(EDV),resistance index(RI),and pulsatility index(PI)of the renal artery and interlobar artery,the EDV,RI,and PI of the renal segmental artery,and the levels of renal function indicators such as neutrophil gelatinase-associated lipocalin(NGAL),cystatin C(Cys-C),serum creatinine(SCr),blood urea nitrogen(BUN),and β2-microglobulin(β2-MG)in the AKI group showed significant difference from those in the non-AKI group(P＜0.05).Multivariate Logistic regression analysis showed that the renal artery PI(OR=2.249,95％CI,1.346 to 3.757),interlobar artery RI(OR=1.898,95％CI,1.131 to 3.187),NGAL(OR=3.519,95％CI,1.905 to 6.500),Cys-C(OR=2.130,95％CI,1.229 to 3.690),and SCr(OR=2.576,95％CI,1.498 to 4.429)were independent influencing factors for AKI after renal transplantation(P＜0.05).The ROC curve showed that the areas under the curve(AUCs)of the renal artery PI,interlobar artery RI,NGAL,Cys-C,and SCr were 0.722,0.696,0.746,0.711,and 0.761,respectively,with cutoff values of 1.42,0.74,677.63 ng/mL,3.40 mg/L,and 697.38 μmol/L,respectively.The AUC of the combined prediction of the above indicators was 0.905,with a sensitivity of 93.5％and a specificity of 90.2％.The predictive effi-cacy was better than that of each indicator alone.Conclusion The renal artery PI,interlobar artery RI,NGAL,Cys-C,and SCr are independent influencing factors for the occurrence of AKI after re-nal transplantation.The combined prediction model constructed based on these factors has good pre-dictive efficacy for AKI after renal transplantation.
李鑫;刘致中;李雪
内蒙古医科大学第三临床医学院,内蒙古包头,014000||内蒙古包钢医院泌尿外科,内蒙古,包头,014000内蒙古医科大学第三临床医学院,内蒙古包头,014000||内蒙古包钢医院泌尿外科,内蒙古,包头,014000内蒙古包钢医院泌尿外科,内蒙古,包头,014000
医药卫生
肾移植急性肾损伤超声检查血流动力学参数胱抑素C肌酐中性粒细胞明胶酶相关脂质运载蛋白移植物功能延迟恢复
renal transplantationacute kidney injuryultrasonographyhemodynamic parame-terscystatin Ccreatinineneutrophil gelatinase-associated lipocalindelayed graft function
《实用临床医药杂志》 2026 (8)
74-78,84,6
2024年度中国金属学会冶金安全与健康分会健康卫生科研项目(jkws202417)
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