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中华妇幼临床医学杂志(电子版) ›› 2023, Vol. 19 ›› Issue (02) : 219 -226. doi: 10.3877/cma.j.issn.1673-5250.2023.02.014

论著

肾脏彩色多普勒超声结果对儿童重症医学科急性肾损伤患儿的辅助诊断价值
陈川, 杨太珠†(), 何泽凤   
  1. 1四川大学华西第二医院超声科、出生缺陷与相关妇儿疾病教育部重点实验室，成都　610041
    2四川锦欣妇女儿童医院超声科，成都　610000
  • 收稿日期:2022-12-12 修回日期:2023-03-02 出版日期:2023-04-01
  • 通信作者: 杨太珠

Predictive value of renal color Doppler ultrasound parameters in children with acute renal injury in Pediatric Intensive Care Unit

Chuan Chen, Taizhu Yang†(), Zefeng He   

  1. 1Department of Ultrasound, Key Laboratory of Birth Defects and Related Diseases of Women and Children (Sichuan University), Ministry of Education, West China Second University Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
    2Department of Ultrasound, Sichuan Jinxin Women and Children′s Hospital, Chengdu 610000, Sichuan Province, China
  • Received:2022-12-12 Revised:2023-03-02 Published:2023-04-01
  • Corresponding author: Taizhu Yang
  • Supported by:
    Science and Technology Plan Project of Science & Technology Department of Sichuan Province(22ZDYF0380)
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引用本文：

陈川, 杨太珠, 何泽凤. 肾脏彩色多普勒超声结果对儿童重症医学科急性肾损伤患儿的辅助诊断价值[J]. 中华妇幼临床医学杂志(电子版), 2023, 19(02): 219-226.

Chuan Chen, Taizhu Yang, Zefeng He. Predictive value of renal color Doppler ultrasound parameters in children with acute renal injury in Pediatric Intensive Care Unit[J]. Chinese Journal of Obstetrics & Gynecology and Pediatrics(Electronic Edition), 2023, 19(02): 219-226.

目的

探讨肾脏彩色多普勒超声结果对儿童重症医学科(PICU)急性肾损伤(AKI)患儿的辅助诊断价值。

方法

选择2022年1至12月四川大学华西第二医院PICU收治的74例患儿为研究对象。采取回顾性分析法，按照患儿于PICU治疗过程中是否发生AKI，将其分别纳入观察组(n＝34，发生AKI的患儿)和对照组(n＝40，未发生AKI的患儿)。对2组患儿均进行肾脏彩色多普勒超声检查。对2组患儿的临床病例资料、肾脏彩色多普勒超声结果进行统计学分析。采用成组t检验、χ2检验分别比较2组患儿一般临床资料及双肾实质回声强度、彩色多普勒血流(CDFI)评分，肾动脉阻力指数(RRI)、搏动指数(PI)等指标，并采用多因素非条件logistic回归分析方法，分析PICU患儿发生AKI的独立影响因素。采用受试者工作特征(ROC)曲线，分析肾脏彩色多普勒超声指标，对PICU患儿发生AKI的辅助诊断价值。本研究遵循的程序符合2013年修订的《世界医学协会赫尔辛基宣言》要求，与患儿家属均签署临床研究知情同意书。

结果

①2组患儿性别构成比、年龄、人体质量指数(BMI)等一般临床资料比较，差异均无统计学意义(P>0.05)。②观察组患儿双肾实质回声增强率、肾动脉RRI和PI值，均显著高于对照组[67.6%(23/34) vs 5.0%(2/40)，(0.76±0.04) vs (0.56±0.04)，(1.56±0.05) vs (1.27±0.05)]，2组比较，差异均有统计学意义(χ2＝32.24，t＝20.51，t＝23.04；P<0.001)。③观察组AKI患儿的CDFI评分，显著低于对照组[0(0，1) vs 2(0，3)]，并且差异有统计学意义(Z＝8.08，P＝0.001)。④多因素非条件logistic回归分析结果显示，双肾实质回声增强(OR＝7.320，95%CI：5.478~11.845，P<0.001)，CDFI评分减低(OR＝0.447，95%CI：0.359~0.837，P<0.001)，肾动脉RRI值增高(OR＝5.117，95%CI：3.622~10.451，P<0.001)，肾动脉PI值增高(OR＝4.727，95%CI：1.855~20.862，P<0.001)，均是导致PICU患儿发生AKI的独立影响因素。⑤对ROC曲线分析结果显示，双肾实质回声强度、CDFI评分、肾动脉RRI值、肾动脉PI值，预测PICU患儿发生AKI的曲线下面积(AUC)，分别为0.667(95%CI：0.541~0.792 P<0.001)，0.766(95%CI：0.643~0.860，P<0.001)，0.840(95%CI：0.750~0.934，P<0.001)和0.783(95%CI：0.658~0.884，P<0.001)。

结论

双肾实质回声强度、CDFI评分、肾动脉RRI和PI值，对PICU患儿发生AKI的辅助诊断，具有较好临床价值。

关键词: 急性肾损伤, 重症监护病房，儿科, 超声检查，多普勒，彩色, 肾动脉, Logistic模型, ROC曲线, 影响因素分析, 儿童
Objective

To explore the predictive value of renal color Doppler ultrasound parameters in children with acute renal injury (AKI) in Pediatric Intensive Care Unit (PICU).

Methods

Seventy-four children admitted to the PICU of West China Second University Hospital from January to December, 2022 were selected in this study. According to combined AKI or not, they were divided into observation group (n=34, children admitted to PICU with combined AKI) and control group (n=40, children admitted to PICU without combined AKI). Renal color Doppler ultrasound was performed in both groups. The clinical data and renal color Doppler ultrasound parameters of two groups were statistically analyzed by retrospective analysis. The general clinical data, renal parenchymal echo intensity, color Doppler flow (CDFI) score, renal artery resistance index (RRI), pulsation index (PI) and other renal color Doppler ultrasound parameters of two groups were compared, and the influencing factors of AKI in PICU children were analyzed by multivariate unconditional logistic regression analysis. The predictive value of renal color Doppler ultrasound parameters in predicting AKI in PICU children was analyzed by using receiver operator characteristic (ROC) curve. The study was conducted in accordance with World Medical Association Declaration of Helsinki revised in 2013. Informed consent was obtained from each participate.

Results

① There were no significant differences between two groups in general clinical data such as gender constituent ratio, age, body mass index (BMI) (P>0.05). ②Compared with the control group, the echo enhancement rate, renal artery RRI and renal artery PI of both renal parenchyma in the observation group were significantly higher (P<0.05), and the CDFI score was significantly lower (P>0.05). The echo intensity of bilateral renal parenchyma, renal artery RRI, and renal artery PI in observation group were significantly higher than those in control group [67.6%(23/34) vs 5.0%(2/40), (0.76±0.04) vs (0.56±0.04), (1.56±0.05) vs (1.27±0.05)], and the differences were statistically significant (χ2=32.24, t=20.51, t=23.04; P<0.001). ③The CDFI score of children in observation group was significantly lower than that in control group [0 (0, 1) vs 2 (0, 3)], and the difference was statistically significant (Z=8.08, P=0.001). ④ Multivariate logistic regression analysis showed that echo intensity of bilateral renal parenchyma (OR=7.320, 95%CI: 5.478-11.845, P<0.001), CDFI score (OR=0.447, 95%CI: 0.359-0.837, P<0.001), renal artery RRI (OR=5.117, 95%CI: 3.622-10.451, P<0.001), renal artery PI (OR=4.727, 95%CI: 1.855-20.862, P<0.001) were independent influencing factors of AKI in PICU children. ⑤The ROC curve analysis results showed that the area under the curve (AUC) of echo intensity of bilateral renal parenchyma, CDFI score, renal artery RRI and renal artery PI predicting the occurrence of AKI in PICU children were 0.667 (95%CI: 0.541-0.792, P<0.001), 0.766 (95%CI: 0.643-0.860, P<0.001), 0.840(95%CI: 0.750-0.934, P<0.001), 0.783(95%CI: 0.658-0.884, P<0.001), respectively.

Conclusions

Renal color Doppler ultrasound parameters, such as echo intensity of bilateral renal parenchyma, CDFI score, renal artery RRI and renal artery PI can provide good guidance for the clinical diagnosis of AKI in PICU children.

Key words: Acute kidney injury, Intensive care units, pediatric, Ultrasonography, Doppler, color, Renal artery, Logistic models, Root cause analysis, Child
表1 2组PICU患儿一般临床资料比较
组别 例数 性别[例数(%)] 年龄(岁，±s) BMI(kg/m2，±s)
男 女
观察组 34 20(58.8) 14(41.2) 6.8±0.5 21.7±0.9
对照组 40 24(60.0) 16(40.0) 6.6±0.4 22.0±1.2
统计量   χ2＝0.10 t＝0.31 t＝0.25
P值   0.917 0.752 0.843
图3 观察组1例AKI患儿(7岁，女性)左肾彩色多普勒超声声像图(仅见肾门处少量血流信号，CDFI评分为1分)
表2 2组PICU患儿双肾实质回声强度比较[例数(%)]
组别 例数 增强 正常
观察组 34 23(67.6) 11(32.4)
对照组 40 2(5.0) 38(95.0)
χ2值   32.24
P值   0.001
图4 观察组1例AKI患儿(10岁，女性)左肾彩色多普勒超声声像图(肾动脉RRI升高，为0.78)注：AKI为急性肾损伤，RRI为阻力指数
表3 2组PICU患儿肾动脉RRI、PI比较(±s)
组别 例数 肾动脉RRI 肾动脉PI
观察组 34 0.76±0.04 1.56±0.05
对照组 40 0.56±0.04 1.27±0.05
t值   20.51 23.04
P值   0.001 0.001
表4 PICU患儿并发AKI影响因素的多因素非条件logistic回归分析
影响因素 B SE Wald值 P值 OR值 OR值95%CI
双肾实质回声增强(vs回声正常) 0.844 0.260 10.410 <0.001 7.320 5.478~11.845
CDFI评分 －11.412 2.514 5.556 <0.001 0.447 0.359~0.837
肾动脉RRI 1.631 0.678 3.340 <0.001 5.117 3.622~10.451
肾动脉PI 0.646 0.344 7.705 <0.001 4.727 1.855~20.862
图5 双肾实质回声强度、CDFI评分、肾动脉RRI值和肾动脉PI值预测PICU患儿并发AKI的ROC曲线注：CDFI为彩色多普勒血流显像，RRI为血流阻力指数，PI为搏动指数，PICU为儿童重症监护病房，AKI为急性肾损伤，ROC曲线为受试者工作特征曲线
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