摘要
目的探讨CT平扫检查对急性梗阻性肾衰竭患者解除梗阻后肾功能转归的预测价值。方法回顾性分析2012年1月至2017年8月我院收治的76例急性肾衰竭患者的临床资料。男50例，女26例。年龄25-93岁，平均58.5岁。肾积水病因：输尿管结石38例，肾结石4例，肿瘤压迫32例，腹膜后纤维化2例。53例放置双J管，23例行肾穿刺造瘘术。根据患者解除梗阻后3个月内生肌酐清除率（CCr），分为肾功能恢复组（CCr≥50ml/min）和肾功能失代偿组（CCr〈50ml/min）。肾功能恢复组26例，年龄（48.3±9.7）岁，术前肌酐中位值633.0μmol/L（150-1 628 μmol/L），血钾（4.2±0.7）mmol/L，血钠（135.8±5.3）mmol/L，术后3个月肌酐中位值96.0μmol/L（43-139 μmol/L），术后3个月CCr（65.3±12.8）ml/min。肾功能失代偿组50例，年龄（63.8±13.7）岁，术前肌酐中位值583μmol/L（152-1 712 μmol/L），血钾（4.3±0.7）mmol/L，血钠（132.7±20.1）mmol/L，术后3个月肌酐中位值160 μmol/L（87-1 379 μmol/L），术后3个月CCr（28.9±11.9）ml/min。比较两组梗阻性肾衰竭诊断时CT平扫检查测量的肾实质面积，采用单因素和多因素分析肾实质面积与肾功能恢复的相关性，采用受试者工作特征（ROC）曲线评估CT平扫检查的预测效能。结果肾功能恢复组总肾面积为（3 765.5±628.6）mm^2（2 375.3-4 853.6 mm^2）；肾功能失代偿组总肾面积为（2 493.0±830.6）mm^2（476.9-4 225.1 mm^2），两组比较差异有统计学意义（P〈0.001）。肾功能恢复组优势侧肾面积（2 283.5±430.2）mm^2（1 654.6-3 383.3 mm2）；肾功能失代偿组优势侧肾面积（1 655.5±496.2）mm^2（476.94-2 816.0 mm^2），两组比较差异有统计学意义（P〈0.001）。多因素分析结果显示，总肾面积和年龄是解除梗阻后肾功能转归的独立预测因素。总肾面积预测解除梗阻后3个月肾功能转归的ROC曲线下面积为0.89。总肾面积最
ObjectiveTo evaluate the predictive value of CT scan in the outcome of renal function after decompression procedures in patients with acute obstructive renal failure.MethodsRetrospective analysis of clinical information of 76 patients with acute obstructive renal failure between January 2012 and August 2017 was performed. Clinical information included age, cause of obstruction, type of decompression procedures, total renal area and dominant side renal area measured by CT scan, serum creatinine（SCr） level before operation, SCr level in 3 months after decompression. Patients were divided into 2 groups according to creatinine clearance rate （CCr） in 3 months after decompression, including normal renal function group （26 cases, CCr≥50 ml/min） and decompensated renal function group （50 cases, CCr〈50 ml/min）. The CCr of normal renal function group was （65.3±12.8）ml/min, while the decompensated renal function group was （28.9±11.9）ml/min. The average age of normal renal function group was 48.3 years old, the median value of serum creatinine before operation was 633μmol/L, while the average age of decompensated group was 63.8 years old, the median value of preoperative creatinine was 583 μmol/L. Renal area was measured in CT scan image which was performed when acute obstructive renal failure was diagnosed. Univariate analysis and logistic regression multivariate analysis was used to analyze these parameters. Receiver operating characteristic curve （ROC）was used to evaluate the performance of CT scan for renal function prediction.ResultsThere were significant differences in the renal area between the normal renal function and decompensated renal function group, the total renal area were （3 765.5±628.6）mm^2（range 2 375.3-4 853.6 mm^2） and （2 493.0±830.6）mm^2 （range 476.9-4 225.1 mm^2） respectively（P〈0.001）, while the dominant side renal area were （2 283.5±430.2）mm^2 （range 1 654.6-3 383.3 mm^2） and （1 655.5±496.2）mm^2 （range 476.94-2 816.0 mm^2） r
作者
邵晓光
陈奇
董柏君
潘家骅
朱寅杰
薛蔚
Shao Xiaoguang;Chen Qi;Dong Baijun;Pan Jiahua;Zhu Yinjie;Xue Wei(Department of Urology, Renji Hospital ,School of Medicine ,Shanghai Jiaotong University, Shanghai 200127, China)
出处
《中华泌尿外科杂志》
CAS
CSCD
北大核心
2018年第6期451-454,共4页
Chinese Journal of Urology
关键词
肾衰竭
急性
上尿路梗阻
CT平扫
肾功能
Kidney failure
acute
Upper urinary tract obstruction
Tomography
X-ray computed
Renal function
