肾病患儿下腔静脉/主动脉（IVC/Ao）比值与血清乳酸水平的相关性
Correlation Between the Inferior Vena Cava/Aorta (Ivc/Ao) Ratio and Serum Lactate Levels in Children With Renal Disorder.
作者信息
Hakim Dzulfikar Djalil Lukmanul, Widiasta Ahmedz, Rachmadi Dedi, Rahayunigsih Sri Endah, Apandi Putria Rayani, Adrizain Riyadi, Martiano Muhamad Rinaldhi Akbar
机构信息
Division of Emergency and Intensive Care, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin, Bandung, Indonesia.
Division of Nephrology, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran Dr. Hasan Sadikin, Bandung, Indonesia.
出版信息
Int J Nephrol Renovasc Dis. 2025 Jan 22;18:43-51. doi: 10.2147/IJNRD.S488639. eCollection 2025.
BACKGROUND
Acute kidney injury (AKI) is common in critically ill children in the PICU, with incidence rates from 2.5% to 58%, impacting mortality and hospital duration. Early AKI detection is vital, but conventional hemodynamic monitoring often lacks specificity. This study investigates the relationship between the inferior vena cava/aortic (IVC/Ao) ratio and serum lactate levels as non-invasive indicators of renal hemodynamics and tissue perfusion in children. Understanding these parameters could improve early diagnosis, aid clinical decisions, and enhance outcomes for pediatric AKI patients, offering an accessible monitoring method for clinicians.
METHODS
This cross-sectional study involved 48 pediatric patients aged 5-18 years showing Pediatric Early Warning Score (PEWS) ≥3 and diagnosed with renal disorders. Patients were admitted to the emergency department, high care unit, PICU, and pediatric ward at Dr. Hasan Sadikin Hospital, Bandung, between May and August 2023. AKI was diagnosed using pRIFLE or KDIGO criteria. The IVC/Ao ratio was assessed via transabdominal USG, and serum lactate levels were measured. Spearman correlation analysis was conducted to assess their relationship.
RESULTS
The median (IQR) IVC/Ao ratio was 0.91 (0.70-1.10), and serum lactate levels were 1.5 (1.1-2.4) mmol/L. Spearman correlation analysis revealed a negative correlation between the IVC/Ao ratio and serum lactate (rho = -0.65, p < 0.001).
CONCLUSION
A decrease in the IVC/Ao ratio correlates with an increase in serum lactate levels in children with AKI.
背景
急性肾损伤（AKI）在儿科重症监护病房（PICU）的危重症儿童中很常见，发病率在2.5%至58%之间，影响死亡率和住院时间。早期检测AKI至关重要，但传统的血流动力学监测往往缺乏特异性。本研究调查了下腔静脉/主动脉（IVC/Ao）比值与血清乳酸水平之间的关系，将其作为儿童肾血流动力学和组织灌注的非侵入性指标。了解这些参数可以改善早期诊断，辅助临床决策，并提高儿科AKI患者的治疗效果，为临床医生提供一种易于使用的监测方法。
方法
这项横断面研究纳入了48例年龄在5至18岁之间、儿科早期预警评分（PEWS）≥3且被诊断为肾脏疾病的儿科患者。2023年5月至8月期间，这些患者被收治于万隆哈桑·萨迪金博士医院的急诊科、重症监护病房、PICU和儿科病房。使用pRIFLE或KDIGO标准诊断AKI。通过经腹超声评估IVC/Ao比值，并测量血清乳酸水平。进行Spearman相关性分析以评估它们之间的关系。
结果
IVC/Ao比值的中位数（IQR）为0.91（0.70 - 1.10），血清乳酸水平为1.5（1.1 - 2.4）mmol/L。Spearman相关性分析显示IVC/Ao比值与血清乳酸之间呈负相关（rho = -0.65，p < 0.001）。
结论
AKI患儿的IVC/Ao比值降低与血清乳酸水平升高相关。
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