血气分析%肾功能不全,急性%预后
血氣分析%腎功能不全,急性%預後
혈기분석%신공능불전,급성%예후
Blood gas analysis%Kidney insufficiency,acute%Prognosis
目的 随访急性肾损伤(AKI)患者肾功能的变化,评价血HCO3-浓度预测肾脏长期预后的价值.方法 入选169例AKI患者,随访12个月,测定患者发生AKI时、3个月、6个月、12个月时血HCO3-浓度值变化,根据肾功能恢复情况分成恢复组和未恢复组,分析比较血HCO3-浓度,评估血HCO3-浓度在AKI患者肾脏长期预后判断中的应用价值.结果 发生AKI时血HCO3-浓度(r=-0.302,P＜0.001)、AKI后3个月时血HCO3-浓度(r=-0.363,P＜0.05)、AKI后6个月时血HCO3-浓度(r=-0.591,P＜0.001)均与Scr均呈负相关.肾功能未恢复组血HCO3-浓度在发生AKI时(21.92 mmol/L比24.58 mmol/L)、AKI后3个月(22.58 mmol/L比25.54 mmol/L)、6个月(21.89 mmol/L比25.42 mmol/L)、12个月(19.85 mmol/L比24.07 mmol/L)时均显著低于恢复组(均P＜ 0.05).发生AKI时Scr、血HCO3-浓度,以及血Scr与血HCO3-浓度联合值预测肾脏预后的受试者工作特征(ROC)曲线下面积分别为0.840、0.667、0.837,敏感度分别为68.6％、51％、80.4％,特异性分别为88.9％、80.9％、73.6％.AKI后3个月时Scr、血HCO3-浓度,以及Scr与血HCO3-浓度联合值的ROC曲线下面积分别为0.838、0.732、0.848,敏感度分别为83.3％,69.2％、91.7％,特异性分别为79.5％、70.8％、74.4％.AKI后6个月时Scr、血HCO3-浓度,以及Scr与血HCO3-浓度联合值的ROC曲线下面积分别为0.948、0.798、0.952,敏感度分别为100％、80％,100％,特异性分别为84％、80％、88％.联合AKI时、AKI后3个月、AKI后6个月三个时间点血HCO3-浓度ROC曲线下面积0.850,敏感度85.7％,特异性84.2％;联合AKI时、AKI后3个月、AKI后6个月三个时间点Scr值ROC曲线下面积0.940,敏感性100％,特异性84.2％;进一步对AKI时、AKI后3个月、AKI后6个月血Scr与HCO3浓度联合值进行联合分析,ROC曲线下面积0.962,敏感度100％,特异性94.7％.影响AKI患者肾功能的多因素COX回归分析显示,年龄＞ 50.1岁、AKI时Scr＞ 195 mmol/L、AKI后3个月时血HCO3＜24.3 mmol/L与肾脏不良预后相关.K-M生存曲线分析结果提示,当发生AKI时血HCO3-浓度＜21.65mmol/L、AKI后3个月时血HCO3-浓度＜24.3 mmol/L、AKI后6个月时血HCO3-浓度＜23.5 mmol/L时其肾脏生存率显著降低,预后较差.结论 发生AKI时、AKI后3个月、6个月时血HCO3-浓度水平对AKI后患者肾脏长期预后的评估有较好价值,联合血HCO3-和Scr水平能进一步提高预测肾脏长期预后的敏感度和特异性.
目的 隨訪急性腎損傷(AKI)患者腎功能的變化,評價血HCO3-濃度預測腎髒長期預後的價值.方法 入選169例AKI患者,隨訪12箇月,測定患者髮生AKI時、3箇月、6箇月、12箇月時血HCO3-濃度值變化,根據腎功能恢複情況分成恢複組和未恢複組,分析比較血HCO3-濃度,評估血HCO3-濃度在AKI患者腎髒長期預後判斷中的應用價值.結果 髮生AKI時血HCO3-濃度(r=-0.302,P＜0.001)、AKI後3箇月時血HCO3-濃度(r=-0.363,P＜0.05)、AKI後6箇月時血HCO3-濃度(r=-0.591,P＜0.001)均與Scr均呈負相關.腎功能未恢複組血HCO3-濃度在髮生AKI時(21.92 mmol/L比24.58 mmol/L)、AKI後3箇月(22.58 mmol/L比25.54 mmol/L)、6箇月(21.89 mmol/L比25.42 mmol/L)、12箇月(19.85 mmol/L比24.07 mmol/L)時均顯著低于恢複組(均P＜ 0.05).髮生AKI時Scr、血HCO3-濃度,以及血Scr與血HCO3-濃度聯閤值預測腎髒預後的受試者工作特徵(ROC)麯線下麵積分彆為0.840、0.667、0.837,敏感度分彆為68.6％、51％、80.4％,特異性分彆為88.9％、80.9％、73.6％.AKI後3箇月時Scr、血HCO3-濃度,以及Scr與血HCO3-濃度聯閤值的ROC麯線下麵積分彆為0.838、0.732、0.848,敏感度分彆為83.3％,69.2％、91.7％,特異性分彆為79.5％、70.8％、74.4％.AKI後6箇月時Scr、血HCO3-濃度,以及Scr與血HCO3-濃度聯閤值的ROC麯線下麵積分彆為0.948、0.798、0.952,敏感度分彆為100％、80％,100％,特異性分彆為84％、80％、88％.聯閤AKI時、AKI後3箇月、AKI後6箇月三箇時間點血HCO3-濃度ROC麯線下麵積0.850,敏感度85.7％,特異性84.2％;聯閤AKI時、AKI後3箇月、AKI後6箇月三箇時間點Scr值ROC麯線下麵積0.940,敏感性100％,特異性84.2％;進一步對AKI時、AKI後3箇月、AKI後6箇月血Scr與HCO3濃度聯閤值進行聯閤分析,ROC麯線下麵積0.962,敏感度100％,特異性94.7％.影響AKI患者腎功能的多因素COX迴歸分析顯示,年齡＞ 50.1歲、AKI時Scr＞ 195 mmol/L、AKI後3箇月時血HCO3＜24.3 mmol/L與腎髒不良預後相關.K-M生存麯線分析結果提示,噹髮生AKI時血HCO3-濃度＜21.65mmol/L、AKI後3箇月時血HCO3-濃度＜24.3 mmol/L、AKI後6箇月時血HCO3-濃度＜23.5 mmol/L時其腎髒生存率顯著降低,預後較差.結論 髮生AKI時、AKI後3箇月、6箇月時血HCO3-濃度水平對AKI後患者腎髒長期預後的評估有較好價值,聯閤血HCO3-和Scr水平能進一步提高預測腎髒長期預後的敏感度和特異性.
목적 수방급성신손상(AKI)환자신공능적변화,평개혈HCO3-농도예측신장장기예후적개치.방법 입선169례AKI환자,수방12개월,측정환자발생AKI시、3개월、6개월、12개월시혈HCO3-농도치변화,근거신공능회복정황분성회복조화미회복조,분석비교혈HCO3-농도,평고혈HCO3-농도재AKI환자신장장기예후판단중적응용개치.결과 발생AKI시혈HCO3-농도(r=-0.302,P＜0.001)、AKI후3개월시혈HCO3-농도(r=-0.363,P＜0.05)、AKI후6개월시혈HCO3-농도(r=-0.591,P＜0.001)균여Scr균정부상관.신공능미회복조혈HCO3-농도재발생AKI시(21.92 mmol/L비24.58 mmol/L)、AKI후3개월(22.58 mmol/L비25.54 mmol/L)、6개월(21.89 mmol/L비25.42 mmol/L)、12개월(19.85 mmol/L비24.07 mmol/L)시균현저저우회복조(균P＜ 0.05).발생AKI시Scr、혈HCO3-농도,이급혈Scr여혈HCO3-농도연합치예측신장예후적수시자공작특정(ROC)곡선하면적분별위0.840、0.667、0.837,민감도분별위68.6％、51％、80.4％,특이성분별위88.9％、80.9％、73.6％.AKI후3개월시Scr、혈HCO3-농도,이급Scr여혈HCO3-농도연합치적ROC곡선하면적분별위0.838、0.732、0.848,민감도분별위83.3％,69.2％、91.7％,특이성분별위79.5％、70.8％、74.4％.AKI후6개월시Scr、혈HCO3-농도,이급Scr여혈HCO3-농도연합치적ROC곡선하면적분별위0.948、0.798、0.952,민감도분별위100％、80％,100％,특이성분별위84％、80％、88％.연합AKI시、AKI후3개월、AKI후6개월삼개시간점혈HCO3-농도ROC곡선하면적0.850,민감도85.7％,특이성84.2％;연합AKI시、AKI후3개월、AKI후6개월삼개시간점Scr치ROC곡선하면적0.940,민감성100％,특이성84.2％;진일보대AKI시、AKI후3개월、AKI후6개월혈Scr여HCO3농도연합치진행연합분석,ROC곡선하면적0.962,민감도100％,특이성94.7％.영향AKI환자신공능적다인소COX회귀분석현시,년령＞ 50.1세、AKI시Scr＞ 195 mmol/L、AKI후3개월시혈HCO3＜24.3 mmol/L여신장불량예후상관.K-M생존곡선분석결과제시,당발생AKI시혈HCO3-농도＜21.65mmol/L、AKI후3개월시혈HCO3-농도＜24.3 mmol/L、AKI후6개월시혈HCO3-농도＜23.5 mmol/L시기신장생존솔현저강저,예후교차.결론 발생AKI시、AKI후3개월、6개월시혈HCO3-농도수평대AKI후환자신장장기예후적평고유교호개치,연합혈HCO3-화Scr수평능진일보제고예측신장장기예후적민감도화특이성.
Objective To evaluate the value of serum bicarbonate concentration as a prognostic indicator of renal function by following up the renal function in the acute kidney injury (AKI) patients.Methods 169 cases of AKI patients were enrolled in the study.Clinical data were collected prospectively.Risk factors of the renal outcome were evaluated.The patients were followed up for average 19 months.Results The serum bicarbonate concentration on AKI (r=-0.302,P ＜ 0.001),3 months after AKI (r=-0.363,P ＜ 0.363),and 6 months after AKI (r=-0.591,P ＜ 0.001) were all negatively correlated with serum creatinine.Compared with renal function recovered group,the serum bicarbonate concentration of renal function unrecovered group on AKI (21.92 mol/L vs 24.58 mol/L),3 months after AKI (22.58 mol/L vs 25.54 mol/L),6 months after AKI (21.89 mol/L vs 25.42 mol/L),12 months after AKI (19.85 mol/L vs 24.07 mol/L) were all significantly decreased (all P ＜ 0.05).When AKI occurred,the Scr,serum bicarbonate concentration,the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney,area under the receiver-operating characteristic (ROC) curves were 0.840,0.667,0.837,sensitivity were 68.6％,51％,80.4％,specificity were 88.9％,80.9％ and 73.6％,respectively.3 months AKI after,the Scr,serum bicarbonate concentration,the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney,area under the ROC curves were 0.838,0.732,0.848,sensitivity was 83.3％、69.2％、91.7％,specificity were 79.5％,70.8％ and 74.4％,respectively.6 months the after AKI,Scr,serum bicarbonate concentration,the combined value of Scr and serum bicarbonate concentration to predict prognosis of kidney,area under the ROC curves were 0.948,0.798,0.952,sensitivity were 100％,80％,100％,specificity were 84％,80％ and 88％,respectively.Combined 3 time points of serum bicarbonate concentration when AKI occurred,3 month and 6 months after AKI,the area under the ROC curve was 0.850,sensitivity was 85.7％,specificity was 84.2％.When combined 3 time points of the Scr levels of AKI occurred,3 months and 6 months after AKI,area under the ROC curve was 0.940,sensitivity was 100％,specificity was 84.2％.When combined 3 time points of combined value of Scr levels and serum bicarbonate concentrations of AKI occurred,3 months and 6 months after AKI,the area under the ROC curve was 0.962,sensitivity was 100％ and specificity was 94.7％.The Kaplan-Meier survival curve analysis showed that the serum bicarbonate concentration on AKI ＜ 21.65 mmol/L,serum bicarbonate concentration 3 months after AKI ＜ 24.3 mmol/L or serum bicarbonate concentration 6 months after AKI ＜ 23.5 mmo]/L were all significantly correlated with poor renal prognosis.Condusion Serum bicarbonate concentration is helpful to predict the renal ont come after AKI.Combination of serum bicarbonate concentrations and serum creatinine levels increased the accuracy of prediction.
