| 摘要: |
| 目的 探讨超声、超声造影参数及临床相关资料等多因素在移植肾功能延迟恢复中的应用价值，建立移植肾功能延迟恢复的诊断模型，从而为临床早期诊断提供重要依据。方法 回顾分析佛山市第一人民医院泌尿外科收治的同种异体肾移植术后患者共212例，其中移植肾肾功能正常恢复(NGF)组157例和肾功能延迟恢复(DGF)组55例。收集获取两组患者临床资料、超声及超声造影(CEUS)检查的各项指标并进行单因素分析，然后以是否为DGF为因变量，以P＜0.05的变量为自变量做Logistic回归分析，得出有统计学意义的指标，建立诊断模型，绘制ROC曲线并做出诊断评价。结果 DGF组的身高、体重、血尿素氮（BUN）高于NGF组（均P＜0.05），血红蛋白指标DGF组低于NGF组（P=0.004）；DGF组CUES检查结果显示，起始强度（AI）、达峰强度（PI）、回声增强强度（A）、曲线下面积（AUC）低于NGF组（均P＜0.05）；超声检查测及叶间动脉收缩期峰值流速（PSV）及阻力指数（RI）、段动脉PSV及RI、肾门动脉RI、吻合口动脉RI，两组间比较差异有统计学差异（均P＜0.05）；上述多项指标纳入Logistic回归分析，显示BUN、叶间动脉RI、AUC差异有统计学意义（均P＜0.05），建立诊断模型Logistic（P）=-3.363+0.169×BUN+0.794×叶间动脉RI-0.001×AUC，该模型诊断界值为0.332，预测DGF的敏感性为78.2%，特异性为89.8%，约登指数为68.0%，阳性预测值为72.9%，阴性预测值为92.1%。结论 CEUS参数中的AUC和超声参数中的叶间动脉RI联合BUN指标，建立诊断模型对早期预测DGF有较高的敏感性和特异性，对临床有较高的诊断价值。 |
| 关键词: 超声造影 移植肾 延迟恢复 时间强度曲线 Logistic回归分析 |
| DOI： |
| 投稿时间：2022-09-19修订日期：2022-10-10 |
| 基金项目:佛山市“十四五”医学高水平重点专科建设项目（编号：FSGSP145037）；佛山市卫生健康局医学科研项目立项（编号：20210386） |
|
| Multivariate analysis and establishment of diagnostic model for delayed graft function in kidney transplantationd |
| Zhang Weilan,Li Feng,Hu Qiugen,Huang Weijun. |
| () |
| Abstract: |
| Objective To investigate the application value of multiple factors such as ultrasound,contrast-enhanced ultrasound parameters and clinical related data in delayed graft function recovery,so as to establish a diagnostic model for delayed graft function recovery,and further provide an important basis for clinical diagnosis.Methods Retrospective analysis of 212 patients undergoing allogeneic renal transplantation after urologic surgery at the First Foshan People’s Hospital,including 157 cases in the transplanted kidney normalgraftfunction(NGF) group and 55 cases in the delayedgraftfunction(DGF) group.Clinical data,ultrasonography and contrast-enhanced ultrasonography(CEUS) were collected and analyzed by univariate analysis in both groups.Logistic regression analysis was performed with (whether it was DGF) as the dependent variable and (some variables with P<0.05) as the independent variable, and statistically significant indicators were obtained through the analysis, so as to establish a diagnostic model, draw the ROC curve and make a diagnostic evaluation.Results The height,weight and blood urea nitrogen(BUN) in DGF group of transplanted kidney function were higher than those in NGF group(both P<0.05),and the hemoglobin index in DGF group of transplanted kidney function was lower than that in NGF group(P=0.004).The CEUS in DGF group showed that arrival intensity(AI), peak intensity(PI), echo enhancement intensity(A), and area under the curve(AUC) were lower than those in the NGF group (both P<0.05);There were statistically significant differences in the peak systolic velocity(PSV) of interlobar arteries,resistance index(RI) of interlobar arteries,PSV of segmental arteries,RI of segmental arteries,RI of renal portal arteries and RI of anastomotic arteries between the two groups(both P<0.05).The above indicators were included in Logistic regression,and the differences in BUN,RI of interlobar arteries and AUC were statistically significant(both P<0.005).The diagnostic model was Logistic（P）=-3.363+0.169×BUN+0.794×RI of interlobar arteries-0.001×AUC.The cutoff for diagnosis of the model was 0.332,and the sensitivity of predicting DGF was 78.2%.The specificity,Youden index,positive predictive value and negative predictive value were 89.8%,68.0%,72.9% and 92.1%,respectively.Conclusion The diagnostic model of AUC in CEUS parameters,RI of interlobar arteries in ultrasonography parameters combined with BUN index has high sensitivity and specificity for early prediction of DGF of transplanted kidney,and has high clinical diagnostic value. |
| Key words: Contrast-enhanced ultrasonography Transplanted kidney Delayedgraftfunction Time-intensity curve Logistic regression analysis |
