摘要
目的探讨肾动脉血流阻力指数对肝炎肝硬化患者发生肝肾综合征的预测及严重程度评估价值。方法2017年12月至2019年1月期间于柳州市人民医院确诊的肝炎肝硬化患者65例,根据其后续是否出现肝肾综合征将其分为单纯肝炎肝硬化组41例、肝炎肝硬化合并肝肾综合征的肝肾综合征组24例,同期在本院进行体检的健康志愿者50人作为正常对照组。对比三组研究对象的肾动脉主干(MRA)、肾窦内段动脉(SRA)、叶间动脉(IRA)的阻力指数(RI),炎症因子[超敏C反应蛋白(hs-CRP)、肿瘤坏死因子α(TNF-α)、白介素-6(IL-6)],肝功能指标[谷丙转氨酶(ALT)、谷草转氨酶(AST)、总胆红素(TBIL)],肾功能指标[血肌酐(Scr)、24 h内生肌酐清除率(24 hCcr)、尿素氮(BUN)、24 h尿量]。采用相关性分析判断肝炎肝硬化合并肝肾综合征患者的RI值与病情相关指标的内在联系。结果单纯肝炎肝硬化组、肝肾综合征组的MRA RI、SRA RI、IRA RI高于正常对照组;血清中hsCRP、TNF-α、IL-6水平高于正常对照组;外周血中ALT、AST、TBIL水平高于正常对照组(P<0.05),且肝肾综合征组上述指标水平变化幅度大于单纯肝炎肝硬化组(P<0.05)。肝肾综合征组的Scr、BUN水平高于单纯肝炎肝硬化组、正常对照组,24 h-Ccr、24 h尿量低于单纯肝炎肝硬化组、正常对照组(P<0.05);单纯肝炎肝硬化组、正常对照组间上述肾功能指标水平的差异无统计学意义(P>0.05)。相关性分析发现,肝炎肝硬化合并肝肾综合征患者的MRA RI、SRA RI、IRA RI值与hs-CRP、TNF-α、IL-6水平呈正相关;与ALT、AST、TBIL水平呈正相关;与Scr、BUN水平呈正相关,与24 h-Ccr、24 h尿量呈负相关(P<0.05)。结论肾动脉血流阻力指数在预测是否发生肝肾综合征方面具有一定价值,且可有效反映患者肝肾功能损伤程度。
Objective To evaluate the value of renal artery blood flow resistance index in predicting and evaluating the severity of hepatorenal syndrome with hepatitis cirrhosis.Methods 65 cases of hepatitis hepatocirrhosis patients in Liuzhou People′s Hospital during December 2017 to January 2019 were divided into pure hepatitis cirrhosis group(n=41),hepatorenal syndrome group(n=24)according to whether hepatorenal syndrome occurs subsequently.50 cases of healthy volunteers were chosen as normal control group.Main renal artery(MRA),segmental renal artery(SRA),interlobar renal artery(IRA),resistance index(RI),inflammatory factors[hypersensitive c-reactive protein(hs-CRP),tumor necrosis factorα(TNF-α),interleukin-6(IL-6)],liver function indexes[alanine aminotransferase(ALT),aspertate aminotransferase(AST),total bilirubin(TBIL)],kidney indexes[serum creatinine(Scr),24 h-creatinine clearance(24 hCcr),urea nitrogen(BUN),24 h urine output]were compared between three groups.Correlation analysis was used to determine the internal relationship between RI value and disease-related indicators in patients with hepatitis cirrhosis and hepatorenal syndrome.Results MRA RI,SRA RI and IRA RI were higher in pure hepatitis cirrhosis group and hepatorenal syndrome group than those in normal control group;serum levels of hs-CRP,TNF-alpha and IL-6 were higher than those of normal control group;levels of ALT,AST and TBIL in peripheral blood were higher than those in normal control group(P<0.05),and the above changes in hepatorenal syndrome group were greater than those in pure hepatitis cirrhosis group(P<0.05).Scr and BUN levels in hepatorenal syndrome group were higher than those in pure hepatitis cirrhosis group and normal control group,and 24 h-Ccr,24 h urine volume was lower than those in pure hepatitis cirrhosis group and normal control group(P<0.05).There was no statistically significant difference in renal function between pure hepatitis cirrhosis group and normal control group(P>0.05).Correlation analysis showed that RI value of renal artery blood flow in patients with hepatitis cirrhosis and hepatorenal syndrome was directly correlated with the degree of inflammation,liver and kidney function damage(P<0.05).Conclusion Renal artery blood flow resistance index had certain value in early prediction of hepatorenal syndrome,which could effectively reflect the degree of liver and kidney function damage in patients.
作者
熊敏君
王晓源
吕光宇
XIONG Min-jun;WANG Xiao-yuan;LV Guang-yu(Department of Critical Care Medicine,Liuzhou People's Hospital,Liiizhou,Guangxi 545100,China)
出处
《热带医学杂志》
CAS
2020年第4期534-537,553,共5页
Journal of Tropical Medicine
基金
广西壮族自治区卫生健康委员会自筹经费科研课题(Z20190322)。
关键词
肝炎肝硬化
肝肾综合征
肾动脉血流阻力指数
Hepatitis hepatocirrhosis
Hepatorenal syndrome
Renal artery blood flow resistance index
作者简介
熊敏君(1984-),女,本科,主治医师,研究方向:重症超声及血流动力学,E-mail:jiuhei722384@163.com。
