CAJ | 학술논문

目的分析脓毒症并发急性肾损伤(AKI)的相关危险因素,以寻找早期诊断的预警方程.方法回顾性分析2011年4月至2013年4月滨州医学院附属医院重症监护病房(ICU)90例脓毒症并发AKI患者的临床资料,同期选择58例脓毒症未发生AKI患者作为对照.统计分析两组患者的年龄、平均动脉压(MAP)评分、序贯器官衰竭评分(SOFA)、急性生理学与慢性健康状况评分系统Ⅱ(APACHEⅡ)评分、24 h尿量、24 h液体净入量评分、血肌酐(SCr)评分、血尿素氮(BUN)、氧合指数、动脉血乳酸评分、血浆白蛋白共11项脓毒症合并AKI的可能发病危险因素,采用多因素logistic回归分析确定危险因素并得出回归方程.结果将单因素分析中有统计学意义的9个影响脓毒症患者发生AKI的因素,包括MAP评分、SOFA评分、APACHEⅡ评分、24 h尿量、24 h液体净入量评分、SCr评分、血BUN、氧合指数、动脉血乳酸评分作为协变量进入logistic回归模型,筛选变量后,最终SCr评分、MAP评分、24 h液体净入量评分、动脉血乳酸评分4个变量进入回归模型,回归方程:Y=0.237X1+0.139X2+ 0.057X3+ 0.051X4(X1、X2、X3、X4分别代表SCr评分、MAP评分、动脉血乳酸评分、24 h液体净入量评分),检验方程F=125.897,P=0.000；临界数值为0.778.预警方程的敏感度为80％,特异度为100％,约登指数为0.8,阳性预测值为100％,阴性预测值为74％.结论 SCr评分、MAP评分、血乳酸评分及24 h液体净入量评分为脓毒症并发AKI的独立危险因素.回归方程Y=0.237X1+ 0.139X2+ 0.057X3+ 0.051X4的数值大于0.778应考虑脓毒症有并发AKI的危险性,该方程有助于临床医生早期诊断脓毒症并发AKI,但仍需进一步研究以验证其临床价值.
목적 분석농독증병발급성신손상(AKI)적상관위험인소,이심조조기진단적예경방정.방법 회고성분석2011년4월지2013년4월빈주의학원부속의원중증감호병방(ICU)90례농독증병발AKI환자적림상자료,동기선택58례농독증미발생AKI환자작위대조.통계분석량조환자적년령、평균동맥압(MAP)평분、서관기관쇠갈평분(SOFA)、급성생이학여만성건강상황평분계통Ⅱ(APACHEⅡ)평분、24 h뇨량、24 h액체정입량평분、혈기항(SCr)평분、혈뇨소담(BUN)、양합지수、동맥혈유산평분、혈장백단백공11항농독증합병AKI적가능발병위험인소,채용다인소logistic회귀분석학정위험인소병득출회귀방정.결과 장단인소분석중유통계학의의적9개영향농독증환자발생AKI적인소,포괄MAP평분、SOFA평분、APACHEⅡ평분、24 h뇨량、24 h액체정입량평분、SCr평분、혈BUN、양합지수、동맥혈유산평분작위협변량진입logistic회귀모형,사선변량후,최종SCr평분、MAP평분、24 h액체정입량평분、동맥혈유산평분4개변량진입회귀모형,회귀방정:Y=0.237X1+0.139X2+ 0.057X3+ 0.051X4(X1、X2、X3、X4분별대표SCr평분、MAP평분、동맥혈유산평분、24 h액체정입량평분),검험방정F=125.897,P=0.000；림계수치위0.778.예경방정적민감도위80％,특이도위100％,약등지수위0.8,양성예측치위100％,음성예측치위74％.결론 SCr평분、MAP평분、혈유산평분급24 h액체정입량평분위농독증병발AKI적독립위험인소.회귀방정Y=0.237X1+ 0.139X2+ 0.057X3+ 0.051X4적수치대우0.778응고필농독증유병발AKI적위험성,해방정유조우림상의생조기진단농독증병발AKI,단잉수진일보연구이험증기림상개치.
Objective To analyze related risk factors of sepsis complicated acute kidney injury (AKI),and to explore the precaution equation for early clinical diagnosis.Methods A retrospective review of patients with sepsis complicating AKI admitted to intensive care unit (ICU) of Affiliated Hospital of Binzhou Medical University from April 2011 to April 2013 were enrolled.Fifty-eight sepsis patients without AKI were enrolled as control.Eleven indexes including age,mean arterial pressure (MAP) score,sequential organ failure assessment (SOFA) score,acute physiology and chronic health evaluation Ⅱ (APACHE Ⅱ) score,24-hour urine volume,24-hour net liquid intake score,serum creatinine (SCr) score,blood urea nitrogen (BUN),oxygenation index,blood lactic acid score and plasma albumin were collected as possible risk factors for AKI in sepsis patients.The risk factors and calculation of the critical value were analyzed by multiple factor logistic regression analysis.Results Nine factors with statistical significance for AKI in sepsis patients analyzed with univariate analysis were substituted in logistic regression model including MAP score,SOFA score,APACHE Ⅱ score,24-hour urine volume,24-hour net liquid intake score,SCr score,BUN,oxygenation index,blood lactic acid score.After variable screening SCr score,MAP score,24-hour net liquid intake score and blood lactic acid score were substituted in regression equation:Y=0.237X1 + 0.139X2 +0.057X3 + 0.051X4 (X1,X2,X3,X4 typified SCr score,MAP score,blood lactic acid score and 24-hour net liquid intake score),F=125.897,P=0.000.The diagnostic cutoff appeared as 0.778.The sensitivity,the specificity,the Youden index,positive predictive value and negative predictive value were 80％,100％,0.8,100％ and 74％,respectively.Conclusions SCr score,MAP score,blood lactic acid score and 24-hour net liquid intake score were risk factors of sepsis complicating AKI.When the value higher than 0.778 from regression equation Y=0.237X1 + 0.139X2 +0.057X3 + 0.051X4,it hinted there was risk related to AKI in sepsis patients.The equation can help the clinicians diagnose sepsis and AKI earlier.