中国血液净化

中国血液净化 ›› 2021, Vol. 20 ›› Issue (02): 95-98.doi: 10.3969/j.issn.1671-4091.2021.02.006

• 临床研究 • 上一篇    下一篇

RIFLE、AKIN 和KDIGO 急性肾损伤诊断标准在肺移植术后的应用比较

杜雯雯1,王晓星1,陈文倩1,张丹1,张相林1,李朋梅1   

  1. 1北京中日友好医院药学部
  • 收稿日期:2020-09-01 修回日期:2020-11-30 出版日期:2021-02-12 发布日期:2021-02-23
  • 通讯作者: 李朋梅 lipengmei@yeah.net E-mail:lipengmei@yeah.net
  • 基金资助:
    北京医卫健康公益基金会医学科学研究基金(YWJKJJHKYJJ-B19046HN)

Post-operative acute kidney injury in lung transplant patients: comparing the diagnostic criteria of RIFLE,AKIN and KDIGO 

  1.  1Department of Pharmacy, China-Japan Friendship Hospital, Beijing 100029, China
  • Received:2020-09-01 Revised:2020-11-30 Online:2021-02-12 Published:2021-02-23

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摘要： 【摘要】目的比较风险、损伤、衰竭、失功能、终末期肾病(risk,injury,failure,loss,end stage renal disease，RIFLE)、急性肾损伤网络(acute kidney injury network，AKIN)和改善全球肾脏病预后组织(kidney disease: improving global outcomes，KDIGO)3 种急性肾损伤(acute kidney injury，AKI)诊断标准在肺移植术后AKI 评估方面的差异性。方法回顾性分析2017 年4 月～2019 年4 月在中日友好医院接受肺移植术的101 例患者，对上述患者进行AKI 诊断和分期，比较各分期患者在ICU 住院天数、机械通气天数、体外膜肺氧合(extracorporeal membrane oxygenation，ECMO)支持天数和总住院天数的差异，应用受试者工作特征曲线(receiver operating characteristic curve，ROC)比较3 种诊断标准对术后1 年死亡率的预测能力。结果根据RIFLE、AKIN 和KDIGO 标准，肺移植术后AKI 的发生率分别为73.2%、71.6%和75.3%。3 种标准下AKI 各分期在ICU 住院天数(H 值分别为1.933，3.337，1.814；P 值分别为0.586，0.343，0.612)、机械通气天数(H 值分别为3.226,4.102，2.032; P 值分别为0.358，0.251，0.566)、ECMO 支持天数(H 值分别为2.646，0.638，1.847；P 值分别为0.450，0.888，0.605)和总住院天数(H 值分别为0.678，0.576，1.151；P 值分别为0.878，0.902，0.765)上没有差异性。RIFLE、AKIN 和KDIGO标准预测肺移植术后1 年死亡率的ROC 曲线下面积(area under the curve, AUC)分别为0.744、0.710和0.765，其中AKIN 与KDIGO 比较，差异有统计学意义(Z=2.009，P=0.044)。结论肺移植患者术后AKI
的发生率因采用诊断标准不同而异。KDIGO 标准可以诊断更多的AKI 患者，对术后1 年死亡率预测能力更强。

关键词: 急性肾损伤, RIFLE, AKIN, KDIGO, 肺移植

Abstract: 【Abstract】Objective The aim of this study was to compare the differences of three diagnostic criteria, RIFLE (risk, injury, failure, loss, end stage renal disease), AKIN (acute kidney injury network), and KDIGO(kidney disease: improving global outcomes), in the assessment of post- operative acute renal kidney injury(AKI) in lung transplant recipients. Methods A total of 101 lung transplant patients treated in China-Japan Friendship Hospital from April 2017 to April 2019 were retrospectively analyzed. Their diagnosis and stage of AKI were conducted using RIFLE, AKIN and KDIGO criteria. The differences in ICU stay days, mechanical ventilation days, extracorporeal membrane oxygenation (ECMO) support days and hospitalization days were compared among the patients with different AKI stages. Receiver operating characteristic curve (ROC) curve was used to compare the accuracy of the 3 criteria in the prediction of one-year mortality. Results The incidence rates of post-operative AKI based on RIFLE, AKIN and KDIGO criteria were 73.2%, 71.6% and 75.3% respectively. There were no statistical differences in ICU stay days (P=0.586, 0.343 and 0.612, respectively), mechanical ventilation days (P=0.358, 0.251 and 0.566, respectively), ECMO support days (P=0.450, 0.888 and 0.605, respectively), and hospitalization days (P=0.878, 0.902 and 0.765, respectively) among the patients with different stages classified by the three AKI diagnostic criteria. The area under the curves (AUCs) of ROC for RIFLE, AKIN and KDIGO to predict one-year mortality after lung transplant were 0.744, 0.710 and 0.765 respectively, in which the AUCs of ROC for AKIN and KDIGO were statistically different (Z=2.009, P=0.044). Conclusions The incidence of AKI after lung transplant varies using the three diagnostic criteria. This study found that KDIGO criterion identified more AKI patients, and had better ability to predict postoperative one-year mortality.

Key words: Acute kidney injury, RIFLE, AKIN, KDIGO, Lung transplant

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