肾阻力指数对急性Stanford A型主动脉夹层患者术后急性肾损伤诊断的可靠性研究

摘要

目的 探讨肾阻力指数对急性Stanford A型主动脉夹层患者术后急性肾损伤(AKI)诊断的可靠性.方法 选取2016年3-8月在首都医科大学附属北京安贞医院接受手术治疗的急性Stanford A型主动脉夹层患者61例进行前瞻性观察研究.通过超声检查测量肾阻力指数(RRI).以AKI工作组标准(AKIN)为参考标准诊断AKI,涉及血肌酐和尿量指标,术后AKI依据严重程度分为3级.RRI测量结果与之做比较,用受试者工作特征曲线评价RRI诊断AKI的敏感度、特异度、阳性预测值、阴性预测值、漏诊率、误诊率及诊断符合率.用Pearson分析探究RRI与AKI严重程度的相关性.结果 与AKIN比较,RRI诊断急性主动脉夹层术后AKI敏感度为79.5％,特异度为81.8％,阳性预测值为88.6％,阴性预测值为69.2％,漏诊率为20.5％,误诊率为18.2％,诊断符合率为80.0％.RRI随着AKI严重程度增高而增大,二者呈正相关(r=0.674,P＜0.05).结论 RRI在急性Stanford A型主动脉夹层术后AKI诊断中与AKIN诊断结果具有较好的一致性,诊断符合率较高,且RRI的升高与AKI严重程度相关.%Objective To analyze the reliability of renal resistance index (RRI) in diagnosis of acute kidney injury (AKI) after acute Stanford type A aortic dissection surgery.Methods A prospective study was conducted in 61 patients with acute Stanford type A aortic dissection who had surgical operation from March to August 2016 in Beijing Anzhen Hospital,Capital Medical University.RRI was measured by ultrasonic examination.AKI was diagnosed according to the diagnostic criteria of the Acute Renal Injury Working Network Group(AKIN) and severity of the disease was divided into stage 1,2,3 based on serum creatinine and urine volume.Sensitivity,specificity,positive predictive value,negative predictive value,missed diagnosis rate,misdiagnosis rate and diagnostic coincidence rate of RRI in diagnosis of AKI were analyzed by the receiver operating characteristic curve.Correlation between RRI and severity of AKI was analyzed by Pearson test.Results Sensitivity,specificity,positive predictive value,negative predictive value,missed diagnosis rate,misdiagnosis rate and diagnostic coincidence rate of RRI in diagnosis of AKI were 79.5％,81.8％,88.6％,69.2％,20.5％,18.2％ and 80.0％,respectively.RRI increased with AKI severity and there was a positive correlation between them(r =0.674,P ＜0.05).Conclusions RRI shows high consistency and coincidence compared with AKIN criteria in diagnosis of AKI.RRI is positive correlated with severity of AKI.