中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (06): 413-417.doi: 10.3969/j.issn.1671-4091.2022.06.007

• 临床研究 • 上一篇    下一篇

急性肾损伤患者连续性肾脏替代治疗时长的影响因素分析及预测模型构建#br#

任思芳    柳 莹    王 芸   

  1. 南京医科大学第一附属医院，江苏省人民医院重症监护病房
  • 收稿日期:2021-09-27 修回日期:2022-03-11 出版日期:2022-06-12 发布日期:2022-06-12
  • 通讯作者: 柳莹 676670142@qq.com E-mail:676670142@qq.com
  • 基金资助:
    2019年江苏省干部保健科研课题(BJ19018)

The factors affecting the duration of continuous renal replacement therapy in acute kidney injury patients and the construction of a model for prediction of the duration

REN Si-fang,  LIU Ying,  WANG Yun   

  • Received:2021-09-27 Revised:2022-03-11 Online:2022-06-12 Published:2022-06-12
  • Contact: LIU Ying 676670142@qq.com E-mail:676670142@qq.com

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摘要： 分析急性肾损伤(acute kidney injury，AKI)患者连续性肾脏替代治疗(continuous renal replacement therapy，CRRT)治疗时长的影响因素，并构建AKI患者CRRT治疗时长预测模型。 方法 回顾性分析2018年4月～2020年1月江苏省人民医院重症监护病房(intensive care unit，ICU)行CRRT治疗的102例AKI患者临床资料，根据CRRT中位持续时间[6.0(2.3,10.4)d]分为＜6d组和≥6d组。分别采用单因素分析和二元Logistic回归分析筛选AKI患者CRRT治疗时长的独立影响因素；应用R软件建立列线图模型，并对预测模型的预测价值进行评估。 结果 在收集的102例患者中，＜6d组53例，≥6d组49例，单因素分析结果显示，CRRT持续时间＜6d组患者尿α1-微球蛋白(α1-MG)、β2微球蛋白(β2-MG)、血清肌酐(Scr)、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase-associated lipocalin,NGAL)水平低于≥6d组(t=2.009、2.402、2.395、2.030，P=0.047、0.018、0.019、0.045)，平均动脉压和尿量高于≥6d组(t=2.425、2.058，P=0.017、0.042)；二元Logistic回归分析显示，尿量(OR=1.131,95% CI:1.017～1.024)、NGAL(OR=0.987,95% CI:0.982～0.993)、α1-MG(OR=0.860,95%  CI:0.767～0.976)、 β2-MG(OR=0.755, 95% CI: 0.572～0.996)是AKI患者CRRT治疗时长的独立预测因素；列线图模型的C-index为0.894(95% CI: 0.723～0.896)，校正曲线显示其预测可能性平均绝对误差为0.029，具有良好的区分度和准确性。 结论  基于尿量、NGAL、肾小管标志物α1-MG、β2-MG指标建立的预测模型能能够用于肾损伤患者CRRT治疗时长的预测，可为AKI患者CRRT治疗提供一定参考。

关键词: 急性肾损伤, 连续性肾脏替代治疗, 治疗时长, 预测模型, 列线图

Abstract: To analyze the influencing factors for the duration of continuous renal replacement therapy (CRRT) in the treatment of acute kidney injury (AKI) patients, and to establish a model to predict the duration of CRRT in AKI patients.  Methods  A total of 102 AKI patients treated in the Intensive Care Unit (ICU) of Jiangsu Province Hospital from April 2018 to January 2020 were retrospectively analyzed. They were divided into <6 days group and ≥6 days group based on the median duration of CRRT [6.0 (2.3, 10.4) d]. Univariate analysis and binary logistic regression were used to find out the independent influencing factors for CRRT duration. The R software was then used to construct a prediction nomogram model, and the prediction value of this model was evaluated.  Results  Among the 102 AKI patients, 53 cases were in the <6 days group and 49 cases were in the ≥6 days group. Univariate analysis indicated that α1-MG (t=2.009,          P=0.047), β2-MG (t=2.402, P=0.018), Scr (t=2.395, P=0.019) and neutrophil gelatinase-associated lipocalin (NGAL; t=2.030, P=0.045) were lower in the <6 days group than in the ≥6 days, while mean arterial pressure (MAP; t=2.425, P=0.017) and urine volume (t=2.058, P=0.042) were higher in the <6 days group than in the ≥6 days. Binary logistic regression showed that urine volume (OR=1.131, 95% CI: 1.017~1.024), NGAL (OR=0.987, 95% CI: 0.982~0.993), α1-MG (OR=0.860, 95% CI: 0.767~0.976) and β2-MG (OR=0.755, 95% CI: 0.572~0.996) were the independent predictors for CRRT duration in AKI patients (P<0.05). The C-index of the nomogram model was 0.894 (95% CI: 0.723~0.896). The calibration curve showed that the average absolute error of prediction possibility was 0.029, indicating a better discrimination and accuracy of the prediction model.  Conclusion  The nomogram model constructed on the differences of urine volume, NGAL, α1-MG and β2-MG can better predict the duration of CRRT in AKI patients, and provide useful references for CRRT treatment in AKI patients.

Key words: Acute kidney injury, Continuous renal replacement therapy, Treatment duration, Prediction model, Nomogram

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