發(fā)布時間：2018-05-29 15:00

  本文選題：尿微量白蛋白與尿肌酐比值 + 重癥患者�。� 參考：《南方醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討尿微量白蛋白與尿肌酐比值(urinary albumin/creatinine ratio,uACR)在預(yù)測重癥患者急性腎損傷(acute kidney injury,AKI)診斷及預(yù)后的臨床價值。研究對象和方法前瞻性收集2014年10月至2015年5月入住廣東省3家三級甲等醫(yī)院重癥監(jiān)護(hù)病房(intensive care unit,ICU)的所有重癥患者。排除標(biāo)準(zhǔn):入住ICU前有透析史、慢性透析治療期間、近一年內(nèi)接受器官移植、懷孕、年齡18歲、入住ICU時間24h、資料不全、未獲得知情同意者。按排除標(biāo)準(zhǔn)篩選,共527例重癥患者入選,所有入選重癥患者進(jìn)入ICU后至少每天檢測一次血清肌酐(serumcreatinine,sCr)并記錄每小時尿量。采用2012年改善全球腎臟病預(yù)后組織(Kidney Disease:Improving Global Outcomes,KDIGO)發(fā)布的《KDIGO急性腎損傷臨床實踐指南》對于AKI的診斷標(biāo)準(zhǔn),即48h內(nèi)sCr水平升高≥0.3mg/dl(≥26.5μmol/L)或超過基礎(chǔ)值的1.5倍及以上,且明確或經(jīng)推斷上述情況發(fā)生在7d之內(nèi);或持續(xù)6h尿量0.5ml/kg/h。以sCr基線值為指標(biāo),采用腎臟病改良飲食(modification of diet in renal disease,MDRD)簡化公式計算患者的腎小球濾過率估計值(estimated glomerular filtration rate,eGFR)。將患者分為AKI組和非AKI組,其中AKI組又分為輕癥AKI(KDIGO標(biāo)準(zhǔn)1期)及重癥AKI(KDIGO標(biāo)準(zhǔn)2、3期),分別檢測并比較各組uACR指標(biāo)水平,使用受試者工作特征(receiver operating characteristic,ROC)曲線及其曲線下面積(area under curve,AUC)評價uACR在AKI診斷、進(jìn)展及預(yù)后的臨床價值,以P0.05為差異具有統(tǒng)計學(xué)意義。結(jié)果(1)527例重癥患者中有148例發(fā)生AKI,AKI發(fā)生率為28.1%。AKI組患者年齡高于非AKI組患者(P0.001),入選的所有重癥患者中,合并糖尿病、高血壓病、冠心病的患者AKI發(fā)生率比非AKI組患者明顯升高(P0.001)。急診手術(shù)及內(nèi)科治療患者AKI發(fā)生率明顯高于擇期手術(shù)患者(P0.001)。AKI組患者入ICU時急性生理與慢性健康評分Ⅱ(Acute Physiology and Chronic Health Evaluation Ⅱ,APACHE Ⅱ)、ICU 腎臟替代治療需求、ICU 病死率、住院病死率明顯高于非AKI組(P均0.001)。AKI組ICU停留時間、住院時間明顯長于非AKI組(P均0.001)。(2)148例AKI患者中有54例患者發(fā)展成重癥AKI(10.2%)。AKI組患者uACR水平明顯高于非AKI組患者(P0.05)。輕癥AKI組sCr、uACR水平高于非AKI組,eGFR低于非AKI組(P均0.05);重癥AKI組sCr、uACR水平顯著高于非AKI組及輕癥AKI組,eGFR水平明顯低于非AKI組及輕癥AKI組(sCr、eGFR均P0.001,uACR為P0.05)。(3)uACR 預(yù)測 AKI 及重癥 AKI 的 AUC 分別為 0.706,0.748,均具有中度以上預(yù)測能力。(4)uACR預(yù)測入ICU時AKI的AUC為0.702,具有中度以上預(yù)測能力。uACR預(yù)測ICU腎臟替代治療、ICU病死率、住院病死率的AUC分別為0.851,0.781,0.748,預(yù)測ICU腎臟替代治療的能力uACR優(yōu)于APACHE Ⅱ評分。結(jié)論uACR可預(yù)測重癥患者AKI及其預(yù)后,是AKI早期診斷及預(yù)后評估的生物標(biāo)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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