CAJ | 학술논문

目的探讨多项指标在预测急性肾损伤伴心肾综合征(cardiorenal syndrome,CRS)患者行肾脏替代治疗(RRT)时机的价值.方法选取75例心肾综合征住院患者为对象,所有患者给予保守治疗3d,心功能好转者为对照组(n=39),心功能无好转者进入RRT组(n=36).记录患者入院第1天的一般情况,血白蛋白、血红蛋白、血肌酐-Ⅰ、尿素氮-Ⅰ、B型钠尿肽-Ⅰ (BNP-Ⅰ)、24 h尿量-Ⅰ、呋塞米用量(呋塞米-Ⅰ),治疗第4天的呋塞米用量(呋塞米-Ⅱ)、24 h尿量-Ⅱ、肌酐-Ⅱ、尿素氮-Ⅱ、BNP-Ⅱ等指标,计算治疗前后部分指标的比值:24h尿量Ⅱ/Ⅰ、肌酐Ⅱ/Ⅰ、尿素氮Ⅱ/Ⅰ、BNPⅡ/Ⅰ(第1天指标以“Ⅰ”标记,治疗第4天指标以“Ⅱ”标记,指标的动态变化以第4天指标与第1天指标的比值表示,以“Ⅱ/Ⅰ”标记).运用受试者工作特征曲线(ROC)下面积评价上述各指标预测患者行RRT治疗的敏感性与特异性.结果对照组与RRT组在24h尿量-Ⅰ、24 h尿量-Ⅱ、肌酐Ⅱ/Ⅰ、BNP-Ⅱ、BNPⅡ/Ⅰ方面的差异有统计学意义(均P＜ 0.01).计算各指标ROC曲线下面积,其中24h尿量-Ⅰ(AUC=0.736)、24h尿量-Ⅱ(AUC=0.875)、肌酐Ⅱ/Ⅰ(AUC=0.747)、BNP-Ⅱ(AUC=0.779)、BNPⅡ/Ⅰ(AUC=0.894)在预测患者行RRT治疗方面均有较高价值.对上述阳性指标,当分别选取截点值为:24h尿量-Ⅰ =905ml(敏感度75.0％,特异度94.9％)、24h尿量-Ⅱ=1450 ml(敏感度75.0％,特异度100％)、BNP-Ⅱ=3360 ng/L(敏感度72.2％,特异度100％)、BNPⅡ/Ⅰ=1.37(敏感度75.0％,特异度100％)、肌酐Ⅱ/Ⅰ=1.25(敏感度72.2％,特异度94.4％)时,对于是否行RRT治疗有较高的预测价值.结论 24 h尿量、治疗后的BNP数值及BNP与肌酐的动态变化,可以较好地预测伴CRS的急性肾损伤患者是否要行RRT治疗.
목적 탐토다항지표재예측급성신손상반심신종합정(cardiorenal syndrome,CRS)환자행신장체대치료(RRT)시궤적개치.방법 선취75례심신종합정주원환자위대상,소유환자급여보수치료3d,심공능호전자위대조조(n=39),심공능무호전자진입RRT조(n=36).기록환자입원제1천적일반정황,혈백단백、혈홍단백、혈기항-Ⅰ、뇨소담-Ⅰ、B형납뇨태-Ⅰ (BNP-Ⅰ)、24 h뇨량-Ⅰ、부새미용량(부새미-Ⅰ),치료제4천적부새미용량(부새미-Ⅱ)、24 h뇨량-Ⅱ、기항-Ⅱ、뇨소담-Ⅱ、BNP-Ⅱ등지표,계산치료전후부분지표적비치:24h뇨량Ⅱ/Ⅰ、기항Ⅱ/Ⅰ、뇨소담Ⅱ/Ⅰ、BNPⅡ/Ⅰ(제1천지표이“Ⅰ”표기,치료제4천지표이“Ⅱ”표기,지표적동태변화이제4천지표여제1천지표적비치표시,이“Ⅱ/Ⅰ”표기).운용수시자공작특정곡선(ROC)하면적평개상술각지표예측환자행RRT치료적민감성여특이성.결과 대조조여RRT조재24h뇨량-Ⅰ、24 h뇨량-Ⅱ、기항Ⅱ/Ⅰ、BNP-Ⅱ、BNPⅡ/Ⅰ방면적차이유통계학의의(균P＜ 0.01).계산각지표ROC곡선하면적,기중24h뇨량-Ⅰ(AUC=0.736)、24h뇨량-Ⅱ(AUC=0.875)、기항Ⅱ/Ⅰ(AUC=0.747)、BNP-Ⅱ(AUC=0.779)、BNPⅡ/Ⅰ(AUC=0.894)재예측환자행RRT치료방면균유교고개치.대상술양성지표,당분별선취절점치위:24h뇨량-Ⅰ =905ml(민감도75.0％,특이도94.9％)、24h뇨량-Ⅱ=1450 ml(민감도75.0％,특이도100％)、BNP-Ⅱ=3360 ng/L(민감도72.2％,특이도100％)、BNPⅡ/Ⅰ=1.37(민감도75.0％,특이도100％)、기항Ⅱ/Ⅰ=1.25(민감도72.2％,특이도94.4％)시,대우시부행RRT치료유교고적예측개치.결론 24 h뇨량、치료후적BNP수치급BNP여기항적동태변화,가이교호지예측반CRS적급성신손상환자시부요행RRT치료.
Objective To investigate the value of clinical parameters in predicting the initiation of renal replacement therapy(RRT) in acute kidney injury (AKI) patients with cardiorenal syndrome (CRS).Methods A total of 75 AKI patients hospitalized with CRS were enrolled.All patients received pharmacologic therapy on the beginning 3 days.The patients whose heart function improved were divided into control group (n=39),and the patients whose heart function worsened were divided into RRT group (n=36).Clinical and laboratory data on the first day and the fourth day were collected and analyzed.The factors on the first day were labeled as " Ⅰ ",and those on the fourth day were labeled as " Ⅱ." The ratio of some parameters calculated were labeled as " Ⅱ/Ⅰ ".Area under curve (AUC) of receiver operating characteristic curve (ROC) of these factors was used to evaluate the sensitivity and specificity in predicting the initiation of RRT.Results The patients in RRT group had significantly higher levels of BNP-Ⅱ,BNP Ⅱ / Ⅰ and creatinine Ⅱ / Ⅰ (P ＜ 0.01),and lower levels of 24 hours urine volume-Ⅰ and 24 hours urine volume-Ⅱ (P ＜ 0.01).From ROC curve analysis,the AUC of 24 hours urine volume-Ⅰ,24 hours urine volume-Ⅱ,creatinine Ⅱ / Ⅰ,BNP-Ⅱ levels and BNP Ⅱ/Ⅰ to predict RRT were 0.736,0.875,0.747,0.779 and 0.894 respectively.When the cutoff values of 24 hours urine volume-Ⅰ,24 hours urine volume-Ⅱ,BNP-Ⅱ levels,BNP Ⅱ / Ⅰ and creatinine Ⅱ / Ⅰ were 905 ml (sensitivity 75％,specificity 94.9％),1450 ml (sensitivity 75％,specificity 100％),3360 ng/L (sensitivity 72.2％,specificity 100％),1.37 (sensitivity 75％,specificity 100％) and 1.25 (sensitivity 72.2％,specificity 94.4％) respectively,the value of the parameters to predict RRT was high.Conclusions The 24 hours urine volume,BNP levels after treatment and the dynamic changes of BNP levels and creatinine levels can be used as predictors of the initiation of RRT in the AKI patients with CRS.