本文選題：急性腎損傷　切入點(diǎn)：尿液指標(biāo)　出處：《北京協(xié)和醫(yī)學(xué)院》2015年博士論文

【摘要】：研究目的：評(píng)價(jià)尿液指標(biāo)鑒別危重病患者腎前性和腎性急性腎損傷(acute kidney injury, AKI)的作用。研究設(shè)計(jì)：前瞻性隊(duì)列研究。地點(diǎn)：北京協(xié)和醫(yī)院內(nèi)科重癥監(jiān)護(hù)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,年齡≥18歲,在入住ICU時(shí)或ICU住院期間出現(xiàn)AKI,排除腎后性AKI、因慢性腎功能不全接受腎臟替代治療以及無法收集尿液的患者。方法：我們根據(jù)組織灌注情況定義腎前性和腎性AKI,評(píng)價(jià)尿液指標(biāo)的鑒別作用。其中,腎前性AKI定義為有組織低灌注表現(xiàn),且組織灌注恢復(fù)后腎功能也迅速恢復(fù)；腎性AKI定義為無組織低灌注表現(xiàn),或組織灌注恢復(fù)后腎功能未能迅速恢復(fù)；混合性AKI定義為有組織低灌注表現(xiàn),但組織灌注和腎功能均未恢復(fù)。同時(shí),我們采用腎功能恢復(fù)時(shí)間(72小時(shí)內(nèi)腎功能是否恢復(fù))和腎血流(由經(jīng)食道超聲測定)作為判斷標(biāo)準(zhǔn),以驗(yàn)證尿液指標(biāo)的鑒別作用。結(jié)果：共入選了49名AKI患者。根據(jù)組織灌注情況作為判斷標(biāo)準(zhǔn),11人為腎前性AKI,19人為腎性AKI,19人為混合性AKI。部分尿液指標(biāo)(尿比重[SG]、尿滲透壓[Uosm]、尿血清肌酐比值[U/P Cr]、尿血清尿素比值[U/P Urea]和尿鈉排泄分?jǐn)?shù)[FeNa])具有一定的鑒別作用,受試者工作特征曲線下面積0.692-0.845,其中U/PUrea在鑒別腎前性因素方面達(dá)到了較高的敏感性(73%]和特異性(89%]。根據(jù)腎功能恢復(fù)時(shí)間或腎血流作為判斷標(biāo)準(zhǔn),或在不同亞組(未使用利尿劑、無全身性感染及無慢性腎功能不全)中,上述尿液指標(biāo)多數(shù)仍具有鑒別作用,其中U/P Urea的準(zhǔn)確性較高。結(jié)論：SG. Uosm、U/P Cr、U/P Urea和FeNa能夠在危重病患者中鑒別腎前性和腎性因素,其中U/P Urea的準(zhǔn)確性較高,且受利尿劑、全身性感染和慢性腎功能不全的影響較小。
[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.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2015
【分類號(hào)】：R692;R446.12

【共引文獻(xiàn)】

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