尿ACR预测重症患者急性肾损伤及预后的临床价值

发布时间：2018-05-29 15:00

  本文选题：尿微量白蛋白与尿肌酐比值 + 重症患者　； 参考：《南方医科大学》2017年硕士论文

【摘要】：目的探讨尿微量白蛋白与尿肌酐比值(urinary albumin/creatinine ratio,uACR)在预测重症患者急性肾损伤(acute kidney injury,AKI)诊断及预后的临床价值。研究对象和方法前瞻性收集2014年10月至2015年5月入住广东省3家三级甲等医院重症监护病房(intensive care unit,ICU)的所有重症患者。排除标准:入住ICU前有透析史、慢性透析治疗期间、近一年内接受器官移植、怀孕、年龄18岁、入住ICU时间24h、资料不全、未获得知情同意者。按排除标准筛选,共527例重症患者入选,所有入选重症患者进入ICU后至少每天检测一次血清肌酐(serumcreatinine,sCr)并记录每小时尿量。采用2012年改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)发布的《KDIGO急性肾损伤临床实践指南》对于AKI的诊断标准,即48h内sCr水平升高≥0.3mg/dl(≥26.5μmol/L)或超过基础值的1.5倍及以上,且明确或经推断上述情况发生在7d之内;或持续6h尿量0.5ml/kg/h。以sCr基线值为指标,采用肾脏病改良饮食(modification of diet in renal disease,MDRD)简化公式计算患者的肾小球滤过率估计值(estimated glomerular filtration rate,eGFR)。将患者分为AKI组和非AKI组,其中AKI组又分为轻症AKI(KDIGO标准1期)及重症AKI(KDIGO标准2、3期),分别检测并比较各组uACR指标水平,使用受试者工作特征(receiver operating characteristic,ROC)曲线及其曲线下面积(area under curve,AUC)评价uACR在AKI诊断、进展及预后的临床价值,以P0.05为差异具有统计学意义。结果(1)527例重症患者中有148例发生AKI,AKI发生率为28.1%。AKI组患者年龄高于非AKI组患者(P0.001),入选的所有重症患者中,合并糖尿病、高血压病、冠心病的患者AKI发生率比非AKI组患者明显升高(P0.001)。急诊手术及内科治疗患者AKI发生率明显高于择期手术患者(P0.001)。AKI组患者入ICU时急性生理与慢性健康评分Ⅱ(Acute Physiology and Chronic Health Evaluation Ⅱ,APACHE Ⅱ)、ICU 肾脏替代治疗需求、ICU 病死率、住院病死率明显高于非AKI组(P均0.001)。AKI组ICU停留时间、住院时间明显长于非AKI组(P均0.001)。(2)148例AKI患者中有54例患者发展成重症AKI(10.2%)。AKI组患者uACR水平明显高于非AKI组患者(P0.05)。轻症AKI组sCr、uACR水平高于非AKI组,eGFR低于非AKI组(P均0.05);重症AKI组sCr、uACR水平显著高于非AKI组及轻症AKI组,eGFR水平明显低于非AKI组及轻症AKI组(sCr、eGFR均P0.001,uACR为P0.05)。(3)uACR 预测 AKI 及重症 AKI 的 AUC 分别为 0.706,0.748,均具有中度以上预测能力。(4)uACR预测入ICU时AKI的AUC为0.702,具有中度以上预测能力。uACR预测ICU肾脏替代治疗、ICU病死率、住院病死率的AUC分别为0.851,0.781,0.748,预测ICU肾脏替代治疗的能力uACR优于APACHE Ⅱ评分。结论uACR可预测重症患者AKI及其预后,是AKI早期诊断及预后评估的生物标志物。
[Abstract]:Objective to investigate the clinical value of urinary Microalbumin / urinary creatinine ratio (albumin/creatinine) in the diagnosis and prognosis of acute kidney injury-AKI in patients with severe renal injury. Subjects and methods all severe patients admitted to intensive care unit in 3 Grade 3A hospitals in Guangdong Province from October 2014 to May 2015 were collected prospectively. Exclusion criteria: dialysis history before admission to ICU, organ transplantation within one year during chronic dialysis treatment, pregnancy, age of 18 years, admission to ICU for 24 hours, incomplete data, and no informed consent. A total of 527 severe patients were selected according to the exclusion criteria. The serum creatinine (Cr) was detected at least once a day after entering ICU and the urine volume per hour was recorded. Using the guidelines for Clinical practice of KDIGO Acute Renal injury, published by Kidney Disease:Improving Global Outcomes-KDIGO in 2012, the diagnostic criteria for AKI were used, that is, the level of sCr increased more than 0.3 mg / dl (鈮，

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