Santos Paulo Roberto, Lima Neto José Antonio de, Carneiro Raimundo Aragão Aires, Soares Antônio Igor Taumaturgo Dias, Oliveira Wanessa Ribeiro de, Figueiredo Juliana Oliveira, Silva Filho Narcélio Menezes, Silva Thais Oliveira
Universidade Federal do Ceará, Campus de Sobral, Faculdade de Medicina, Sobral - CE, Brazil.
J Bras Nefrol. 2017 Oct-Dec;39(4):406-412. doi: 10.5935/0101-2800.20170073.
Ultrasound is an emerging method for assessing lung congestion but is still seldom used. Lung congestion is an important risk of cardiac events and death in end-stage renal disease (ESRD) patients on hemodialysis (HD).
We investigated possible variables associated with lung congestion among diabetics with ESRD on HD, using chest ultrasound to detect extracellular lung water.
We studied 73 patients with diabetes as the primary cause of ESRD, undergoing regular HD. Lung congestion was assessed by counting the number of B lines detected by chest ultrasound. Hydration status was assessed by bioimpedance analysis and cardiac function by echocardiography. The collapse index of the inferior vena cava (IVC) was measured by ultrasonography. All patients were classified according to NYHA score. Correlations of the number of B lines with continuous variables and comparisons regarding the number of B lines according to categorical variables were performed. Multivariate linear regression was used to test the variables as independent predictors of the number of B lines.
None of the variables related to hydration status and cardiac function were associated with the number of B lines. In the multivariate analysis, only the IVC collapse index (b = 45.038; p < 0.001) and NYHA classes (b = 13.995; p = 0.006) were independent predictors of the number of B lines.
Clinical evaluation based on NYHA score and measurement of the collapsed IVC index were found to be more reliable than bioimpedance analysis to predict lung congestion.
超声是一种新兴的评估肺充血的方法，但仍很少使用。肺充血是终末期肾病（ESRD）血液透析（HD）患者发生心脏事件和死亡的重要风险因素。
我们使用胸部超声检测细胞外肺水，调查了HD治疗的ESRD糖尿病患者中与肺充血相关的可能变量。
我们研究了73例以糖尿病为ESRD主要病因且接受常规HD治疗的患者。通过计数胸部超声检测到的B线数量来评估肺充血情况。通过生物电阻抗分析评估水化状态，通过超声心动图评估心脏功能。通过超声测量下腔静脉（IVC）的塌陷指数。所有患者均根据纽约心脏协会（NYHA）评分进行分类。进行了B线数量与连续变量的相关性分析以及根据分类变量对B线数量的比较。使用多元线性回归测试这些变量作为B线数量的独立预测因子。
与水化状态和心脏功能相关的变量均与B线数量无关。在多变量分析中，只有IVC塌陷指数（b = 45.038；p <０.001）和NYHA分级（b = 13.995；p = 0.006）是B线数量的独立预测因子。
发现基于NYHA评分的临床评估和塌陷IVC指数的测量比生物电阻抗分析更可靠地预测肺充血。
