摘要
目的从宏观循环和微观循环灌注的角度, 分析脓毒性急性肾损伤(AKI)患者彩色多普勒及超声造影(CEUS)血流参数的变化, 以探讨超声在该病中的临床应用价值。方法选择苏州大学附属第二医院2021年1月至2022年5月确诊为脓毒性AKI的ICU住院患者53例, 根据2012 KDIGO AKI诊断标准, 将脓毒性AKI患者分为1~3期, 1期为轻度组(17例), 2、3期为重度组(21例), 同期未发生AKI的脓毒性患者为对照组(15例)。测量宏观循环肾动脉相对血流量(RBF)、时间平均速度(TAV)等超声参数以及心排出量、心脏指数等心功能参数, 并通过CEUS分析软件分析时间-强度曲线计算微观循环中肾皮质叶间动脉达峰时间(TTP)、上升时间(RT)、降半时间(FHT)和平均渡越时间(MTT)等造影参数, 比较各组之间超声多普勒及CEUS参数的差异。使用ROC曲线分析各参数在重度AKI中的诊断效能。结果①宏观循环方面, 随着疾病的进展, 脓毒性AKI患者RBF和TAV逐渐减少(P=0.004, P<0.001)。而三组的心输出量和心脏指数差异无统计学意义(P=0.17, 0.12)。②微观循环方面, 脓毒性AKI患者肾叶间动脉超声多普勒参数搏动指数(PI)、阻力指数(RI)、收缩期/舒张期血流比值(S/D)逐渐升高(均P<0.05), CEUS时间参数TTP、RT、FHT和MTT均延长(P<0.001, P=0.003, P=0.004, P=0.009)。③RI联合TTP有利于重度脓毒性AKI患者的诊断[曲线下面积(AUC)=0.93(0.85~1.00)]。结论多普勒超声联合CEUS能够发现脓毒性AKI患者的肾脏宏观及微观循环减少, 尤其是重度组AKI患者, 且与心排出量或心脏指数的变化无关。
Objective To analyse the changes in color Doppler and contrast-enhanced ultrasound(CEUS)blood flow parameters in patients with septic acute kidney injury(AKI)from the perspective of macroscopic circulation and microscopic circulation perfusion,in order to explore the value of clinical application of ultrasound in this disease.Methods A total of 53 ICU-admitted patients diagnosed with septic AKI at the Second Affiliated Hospital of Soochow University from January 2021 to May 2022 were selected.Patients with septic AKI were classified into stages 1-3 according to the 2012 Kidney Disease:Improving Global Outcomes(KDIGO)AKI diagnostic criteria,with stage 1 being the mild group(17 cases),stages 2 and 3 being the severe group(21 cases),and septic patients without AKI in the same period being the control group(15 cases).The ultrasound parameters such as the relative blood flow(RBF)and time-averaged velocity(TAV)of the renal artery as well as the cardiac output(CO)and cardiac index(CI)in the macroscopic circulation were measured,and the time-intensity curve was analysed by the CEUS analysis software to calculate the microscopic parameters such as time to peak(TTP),rise time(RT),fall half time(FHT)and mean transit time(MTT),and the cardiac output and cardiac index were also measured.The differences in ultrasound Doppler and CEUS parameters among the various groups were compared.The diagnostic effectiveness of each parameter for severe AKI was assessed using ROC curve analysis.Results①In macrocirculation,the renal blood flow(RBF)and time-averaged velocity(TAV)gradually decreased(P=0.004,P<0.001)as the disease progressed in AKI patients.But the difference of CO and CI among the three groups were not statistically significant in each group(P=0.17,0.12).②In microcirculation,the renal interlobar artery Doppler parameters pulsatility index(PI),resistance index(RI),and systolic/diastolic flow ratio(S/D)gradually increase in patients with septic AKI(P<0.05)and the CEUS parameters TTP,RT,FHT and MTT were prolonged(P<0.001,P=0.
作者
刘培青
张迎春
丁常伟
刘励军
李叶骋
Liu Peiqing;Zhang Yingchun;Ding Changwei;Liu Lijun;Li Yecheng(Department of Ultrasound,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of Critical Medicine,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China;Department of General Surgery,the Second Affiliated Hospital of Soochow University,Suzhou 215004,China)
出处
《中华超声影像学杂志》
CSCD
北大核心
2023年第10期871-879,共9页
Chinese Journal of Ultrasonography
基金
国家自然科学基金项目(82102826)
苏州大学附属第二医院科研预研基金项目(SDFEYJC2239)
江苏省卫健委老年医学临床技术应用研究项目(LD2021031)
苏州大学附属第二医院建设托举工程(XKTJ-TD202007)
苏州大学附属第二医院神经疾病研究中心研究课题(ND2023B01)。
关键词
超声造影
超声心动描记术
急性肾损伤
宏观循环
微观循环
Contrast-enhanced ultrasound
Echocadiography
Acute kidney injury
Macrocirculation
Microcirculation
