尿液指标鉴别危重病患者肾前性与肾性急性肾损伤的作用

发布时间：2018-04-02 18:23

本文选题：急性肾损伤　切入点：尿液指标　出处：《北京协和医学院》2015年博士论文

【摘要】：研究目的：评价尿液指标鉴别危重病患者肾前性和肾性急性肾损伤(acute kidney injury, AKI)的作用。研究设计：前瞻性队列研究。地点：北京协和医院内科重症监护病房(intensive care unit, ICU)。研究人群：2015年1月至2015年4月收治的危重病患者,年龄≥18岁,在入住ICU时或ICU住院期间出现AKI,排除肾后性AKI、因慢性肾功能不全接受肾脏替代治疗以及无法收集尿液的患者。方法：我们根据组织灌注情况定义肾前性和肾性AKI,评价尿液指标的鉴别作用。其中,肾前性AKI定义为有组织低灌注表现,且组织灌注恢复后肾功能也迅速恢复；肾性AKI定义为无组织低灌注表现,或组织灌注恢复后肾功能未能迅速恢复；混合性AKI定义为有组织低灌注表现,但组织灌注和肾功能均未恢复。同时,我们采用肾功能恢复时间(72小时内肾功能是否恢复)和肾血流(由经食道超声测定)作为判断标准,以验证尿液指标的鉴别作用。结果：共入选了49名AKI患者。根据组织灌注情况作为判断标准,11人为肾前性AKI,19人为肾性AKI,19人为混合性AKI。部分尿液指标(尿比重[SG]、尿渗透压[Uosm]、尿血清肌酐比值[U/P Cr]、尿血清尿素比值[U/P Urea]和尿钠排泄分数[FeNa])具有一定的鉴别作用,受试者工作特征曲线下面积0.692-0.845,其中U/PUrea在鉴别肾前性因素方面达到了较高的敏感性(73%]和特异性(89%]。根据肾功能恢复时间或肾血流作为判断标准,或在不同亚组(未使用利尿剂、无全身性感染及无慢性肾功能不全)中,上述尿液指标多数仍具有鉴别作用,其中U/P Urea的准确性较高。结论：SG. Uosm、U/P Cr、U/P Urea和FeNa能够在危重病患者中鉴别肾前性和肾性因素,其中U/P Urea的准确性较高,且受利尿剂、全身性感染和慢性肾功能不全的影响较小。
[Abstract]:Objective: to evaluate the role of urine markers in differential diagnosis of acute kidney injuryand acute renal injury in critically ill patients.Research Design: prospective cohort study.Setting: intensive care unit, ICUU.Study population: critically ill patients, aged more than 18 years, who were admitted from January 2015 to April 2015, had AKI at the time of admission to ICU or during the hospitalization of ICU, excluded patients with retrorenal AKI, received renal replacement therapy due to chronic renal insufficiency and were unable to collect urine.Methods: we define prerenal AKI and renal AKI according to tissue perfusion and evaluate the differential effect of urine markers.Among them, prerenal AKI was defined as tissue hypoperfusion, and renal function recovered rapidly after tissue perfusion, renal AKI was defined as non-tissue hypoperfusion, or renal function did not recover rapidly after tissue perfusion.Mixed AKI was defined as tissue hypoperfusion, but neither tissue perfusion nor renal function recovered.At the same time, we used renal function recovery time and renal blood flow (measured by transesophageal ultrasound) as the criteria to verify the differential effect of urine indicators.Results: a total of 49 patients with AKI were enrolled.According to the tissue perfusion condition, 11 were prerenal AKI, 19 were renal AKI and 19 were mixed AKI.Some urine indexes (specific gravity of urine [SG], urine osmotic pressure [Uosm], serum creatinine ratio [U / P Cr], urea ratio of urine serum [up P Urea] and urinary sodium excretion fraction [FeNa]) have some differential effects.The area under the operating characteristic curve was 0.692-0.845, in which U/PUrea reached a high sensitivity of 73% and a specificity of 89% in distinguishing prerenal factors.According to the time of recovery of renal function or renal blood flow, or in different subgroups (no diuretic, no systemic infection and no chronic renal insufficiency), most of the above urine markers still had differential effect.Conclusion: SG.Uosmosis / P / P Urea and FeNa were able to identify prerenal and renal factors in critically ill patients. The accuracy of U / P Urea was higher, and the effect of diuretics, systemic infection and chronic renal insufficiency was less.
【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2015
【分类号】：R692;R446.12

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