切换至 "中华医学电子期刊资源库"

中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (01) : 58 -62. doi: 10.3877/cma.j.issn.1674-3253.2023.01.013

临床研究

超声造影对急性肾损伤治疗后肾血流灌注水平的评价
陈杰桓1, 许志荣2, 刘颖培1, 杨帅3, 周芙蓉1, 陈斌2, 谭雷4,()   
  1. 1. 523000 东莞市滨海湾中心医院超声科
    2. 523000 东莞市滨海湾中心医院重症医学科
    3. 518057 深圳,迈瑞生物医疗电子股份有限公司
    4. 510630 广州,中山大学附属第三医院超声科
  • 收稿日期:2022-09-21 出版日期:2023-02-01
  • 通信作者: 谭雷
  • 基金资助:
    东莞市社会科技发展项目(202050715025595); 东莞市滨海湾中心医院院内科科研项目(2021001)

Evaluation of renal perfusion level after continuous renal replacement therapy for septic acute renal injury by contrast-enhanced ultrasound

Jiehuan Chen1, Zhirong Xu2, Yingpei Liu1, Shuai Yang3, Furong Zhou1, Bin Chen2, Lei Tan4,()   

  1. 1. Department of Ultrasound, the Binhaiwan Central Hospital, Dongguan 523000, China
    2. Department of Critical Care Medicine, the Binhaiwan Central Hospital, Dongguan 523000, China
    3. Mindray Bio-Medical Electronics CoL,td, Shenzhen 518057, China
    4. Department of Ultrasound, the Third Affiliated Hospital, Sun Yat-sen University, Guangzhou 510630, China
  • Received:2022-09-21 Published:2023-02-01
  • Corresponding author: Lei Tan
引用本文:

陈杰桓, 许志荣, 刘颖培, 杨帅, 周芙蓉, 陈斌, 谭雷. 超声造影对急性肾损伤治疗后肾血流灌注水平的评价[J/OL]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(01): 58-62.

Jiehuan Chen, Zhirong Xu, Yingpei Liu, Shuai Yang, Furong Zhou, Bin Chen, Lei Tan. Evaluation of renal perfusion level after continuous renal replacement therapy for septic acute renal injury by contrast-enhanced ultrasound[J/OL]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(01): 58-62.

目的

本研究旨在通过超声造影(CEUS)评估脓毒症性急性肾损伤(SAKI)患者连续性肾脏替代治疗(CRRT)前后肾脏微循环灌注量,探讨其在SAKI患者CRRT后肾脏血流灌注水平的诊断价值。

方法

选择2020年3月至2021年3月东莞市滨海湾中心医院重症医学科脓毒症患者77例作为研究对象。研究分为非AKI和SAKI两组,其中非AKI患者35例和SAKI患者42例,而SAKI组中分为CRRT与未行CRRT两组,而根据CRRT后肾功能恢复情况再分肾功能好转组和未好转组。所有研究对象均通过超声造影动态分析获取肾脏造影参数:峰值强度(PI)、达峰时间(TTP)、曲线下面积(AUC)。

结果

SAKI组与非AKI组对比PI减弱、TTP延长、AUC减少(P均<0.05),SKAI组CRRT后对比CRRT前PI增强、TTP缩短、AUC增加(P均<0.05),SKAI组CRRT后肾功能好转组和未好转组比较,PI增强、TTP缩短、AUC增加(P均<0.05)。SAKI组中经CRRT后肾功能好转组和非AKI组比较,PI、TTP、AUC差异均无统计学意义(P>0.05)。

结论

肾脏超声造影定量分析可在一定程度反映SAKI患者CRRT前后肾功能的变化,有望作为床旁评价SAKI患者CRRT后肾血流灌注水平的一种有效手段。

Objective

To evaluate renal microcirculation perfusion before and after continuous renal replacement therapy (CRRT) in patients with septic acute renal injury (SAKI) by contrast ultrasonography (CEUS), and to explore the diagnostic value of CEUS in renal blood perfusion level after CRRT treatment in SAKI patients.

Methods

Seventy-seven patients with sepsis in the Intensive Care Department of Binhaiwan Central Hospital of Dongguan from March 2020 to March 2021 were selected as subjects. The patients were divided into two groups, non-AKI group (35 cases) and SAKI group (42 cases), while the SAKI group was divided into CRRT group and no CRRT group. And renal function recovery after CRRT was divided into two groups: functional improvement group and non-improved group. All subjects obtained renal angiography parameters by dynamic analysis of contrast-enhanced ultrasound: peak intensity (PI), time to peak (TTP), and area under the curve (AUC).

Results

Compared with non-AKI group, SAKI group decreased PI, prolonged TTP, and decreased AUC (all P<0.05), in the SKAI group, PI was enhanced, TTP was shortened, and AUC was increased after CRRT compared with that before CRRT (all P<0.05). In the SKAI group, compared with the non-improved group, PI enhanced, TTP shortened and AUC increased in the functional improvement group (all P<0.05). There was no significant difference in PI, TTP and AUC between the functional improvement group of SAKI patients after CRRT and the non AKI group.

Conclusions

The quantitative analysis of renal contrast-enhanced ultrasound can reflect the changes of renal function before and after CRRT treatment in SAKI patients to a certain extent, which is expected to be an effective means for evaluation of renal blood perfusion level after CRRT in SAKI patients.

图1 患者分组示意图
图3 超声造影定量分析
表1 各组超声造影患者性别与年龄基线资料比较
表2 SAKI组与非AKI组超声造影定量参数结果分析[MQ1Q3)]
表3 SAKI患者CRRT前后超声造影定量参数结果分析
表4 SAKI经CRRT后肾功能好转组和未好转组超声造影定量参数结果分析(±s
[1]
Andrew SL, Matthew TJ. Acute Kidney Injury[J]. Ann Intern Med, 2017, 167(9): ITC66-ITC80.
[2]
Bellomo R, Kellum JA, Ronco C. Acute kidney injury[J]. Lancet, 2012, 380(9843): 756-766.
[3]
Uhle F, Lichtenstern C, Brenner T, et al. Sepsis und Multiorganversagen-Pathophysiologie der Sepsis[J]. Anästhesiol Intensivmed Notfallmed Schmerzther, 2015, 50(2): 114-122
[4]
Napolitano LM. Sepsis 2018: Definitions and Guideline Changes[J]. Surg Infect (Larchmt), 2018, 19(2): 117-125.
[5]
Poston JT, Koyner JL. Sepsis associated acute kidney injury[J]. BMJ, 2019, 364: k4891.
[6]
Romagnoli S, Ricci Z, Ronco C. CRRT for sepsis-induced acute kidney injury[J]. Curr Opin Crit Care, 2018, 24(6): 483-492.
[7]
Romagnoli S, Clark WR, Ricci Z, et al. Renal replacement therapy for AKI: When? How much? When to stop?[J]. Best Pract Res Clin Anaesthesiol, 2017, 31(3): 371-385.
[8]
Alvarez G, Chrusch C, Hulme T, et al. Renal replacement therapy: a practical update[J]. Can J Anaesth, 2019, 66(5): 593-604.
[9]
Selby NM, Duranteau J. New imaging techniques in AKI[J]. Curr Opin Crit Care, 2020, 26(6): 543-548.
[10]
Wang S, Zhao P, Zhang Y, et al. The therapeutic effects of curcumin in early septic acute kidney injury: An experimental study[J]. Drug Des Devel Ther, 2021, 15: 4243-4255.
[11]
Cao W, Cui S, Yang L, et al. Contrast-enhanced ultrasound for assessing renal perfusion impairment and predicting acute kidney injury to chronic kidney disease progression[J]. Antioxid Redox Signal, 2017, 27(17): 1397-1411.
[12]
Wang XY, Pang YP, Jiang T, et al. Value of early diagnosis of sepsis complicated with acute kidney injury by renal contrast-enhanced ultrasound[J]. World J Clin Cases, 2019, 7(23): 3934-3944.
[13]
Peerapornratana S, Manrique-Caballero CL, Gómez H, et al. Acute kidney injury from sepsis: current concepts, epidemiology, pathophysiology, prevention and treatment[J]. Kidney Int, 2019, 96(5): 1083-1099.
[14]
Manrique-Caballero CL, Del Rio-Pertuz G, Gomez H. Sepsis-associated acute kidney injury[J]. Crit Care Clin, 2021, 37(2): 279-301.
[15]
Joannidis M, Metnitz B, Bauer P, et al. Acute kidney injury incritically ill patients classified by AKIN versus RIFLE using the SAP 3 database[J]. Intensive Care Med, 2009, 35(10): 1692-1702.
[16]
Thakar CV, Christianson A, Freyberg R, et al. Incidence and outcomes of acute kidney injury in intensive care units: a Veterans Administration study[J]. Crit Care Med, 2009, 37(9): 2552-2558.
[17]
Stevens PE, Levin A. Kidney Disease: Improving global outcomes chronic kidney disease guideline development work group members. evaluation and management of chronic kidney disease: synopsis of the kidney disease: improving global outcomes 2012 clinical practice guideline[J]. Ann Intern Med, 2013, 158(11): 825-830.
[18]
Ostermann M, Bellomo R, Burdmann EA, et al. Conference Participants. Controversies in acute kidney injury: conclusions from a Kidney Disease: Improving Global Outcomes (KDIGO) Conference[J]. Kidney Int, 2020, 98(2): 294-309.
[19]
Schrezenmeier EV, Barasch J, Budde K, et al. Biomarkers in acute kidney injury - pathophysiological basis and clinical performance[J]. Acta Physiol (Oxf), 2017, 219(3):554-572.
[20]
Wu X, Qiu F, Jin X, et al. ATF3: a novel biomarker for the diagnosis of acute kidney injury after cardiac surgery[J]. Ann Transl Med, 2021, 9(22): 1655.
[21]
王东, 刘晓辉, 荆涛. 糖尿病患者输尿管结石梗阻导致感染性休克三例报告[J/CD]. 中华腔镜泌尿外科杂志(电子版), 2017, 11(6): 426-427.
[22]
马敏, 贾明. 吸附型CRRT滤器治疗心脏术后脓毒症休克合并急性肾损伤1例[J]. 中国血液净化, 2019, 18(3): 211-212.
[23]
Luo Z, Liu Y, Tang Z, et al. Quantitative evaluation of renal cortex perfusion using contrast-enhanced ultrasound imaging parameters in ischemia-reperfusion injury in rabbits[J]. Ultrasound Med Biol, 2021, 47(11): 3253-3262.
[24]
Jeong S, Park SB, et al. Clinical significance of contrast-enhanced ultrasound in chronic kidney disease: a pilot study[J]. J Ultrasound, 2019, 22(4): 453-460.
[1] 王亚红, 蔡胜, 葛志通, 杨筱, 李建初. 颅骨骨膜窦的超声表现一例[J/OL]. 中华医学超声杂志(电子版), 2024, 21(11): 1089-1091.
[2] 汪洪斌, 张红霞, 何文, 杜丽娟, 程令刚, 张雨康, 张萌. 低级别阑尾黏液性肿瘤与阑尾黏液腺癌超声及超声造影特征分析[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 865-871.
[3] 宋勇, 李东炫, 王翔, 李锐. 基于数据挖掘法分析3 种超声造影剂不良反应信号[J/OL]. 中华医学超声杂志(电子版), 2024, 21(09): 890-898.
[4] 王博冉, 乔春梅, 李春歌, 王欣, 王晓磊. 超声造影评估类风湿关节炎亚临床滑膜炎疾病进展的价值[J/OL]. 中华医学超声杂志(电子版), 2024, 21(08): 802-808.
[5] 马晓菊, 梁潇, 段云友, 袁丽君, 赵萍. NBAV脂质纳泡对ApoE -/-小鼠动脉粥样硬化病变的评估和干预[J/OL]. 中华医学超声杂志(电子版), 2024, 21(06): 608-616.
[6] 庄燕, 戴林峰, 张海东, 陈秋华, 聂清芳. 脓毒症患者早期生存影响因素及Cox 风险预测模型构建[J/OL]. 中华危重症医学杂志(电子版), 2024, 17(05): 372-378.
[7] 郑大雯, 王健东. 胆囊癌辅助诊断研究进展[J/OL]. 中华肝脏外科手术学电子杂志, 2024, 13(06): 769-773.
[8] 杜霞, 马梦青, 曹长春. 造影剂诱导的急性肾损伤的发病机制及干预靶点研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 279-282.
[9] 郭俊楠, 林惠, 任艺林, 乔晞. 氨基酸代谢异常在急性肾损伤向慢性肾脏病转变中的作用研究进展[J/OL]. 中华肾病研究电子杂志, 2024, 13(05): 283-287.
[10] 司楠, 孙洪涛. 创伤性脑损伤后肾功能障碍危险因素的研究进展[J/OL]. 中华脑科疾病与康复杂志(电子版), 2024, 14(05): 300-305.
[11] 沈炎, 张俊峰, 唐春芳. 预后营养指数结合血清降钙素原、胱抑素C及视黄醇结合蛋白对急性胰腺炎并发急性肾损伤的预测价值[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(06): 536-540.
[12] 陈惠英, 邱敏珊, 邵汉权. 脓毒症诱发肠黏膜屏障功能损伤的风险因素模型构建与应用效果[J/OL]. 中华消化病与影像杂志(电子版), 2024, 14(05): 448-452.
[13] 颜世锐, 熊辉. 感染性心内膜炎合并急性肾损伤患者的危险因素探索及死亡风险预测[J/OL]. 中华临床医师杂志(电子版), 2024, 18(07): 618-624.
[14] 温绍敏, 王雅晳, 施依璐, 段莎莎, 云书荣, 张小杉. 靶向超声造影技术在动脉粥样硬化治疗中的应用进展[J/OL]. 中华临床医师杂志(电子版), 2024, 18(05): 496-499.
[15] 史宛瑞, 崔立刚. 颈动脉一过性血管周围炎综合征的影像学诊断研究进展[J/OL]. 中华脑血管病杂志(电子版), 2024, 18(05): 516-519.
阅读次数
全文


摘要