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目的探讨肝硬化合并腹水患者随机尿Na/K比值的分布及能否正确反映24小时尿钠排量,并确定评价利尿剂反应的随机尿Na/K比值。方法以40例肝硬化合并腹水患者为研究对象,每个患者在早8点给利尿剂,采集24小时尿量、用利尿剂后2-4小时和7-9小时随机尿5ml,并检测24小时尿钠排量、随机尿Na/K比值以及分析随机尿Na/K比的ROC曲线。结果选择40名尿肌酐排量大于15m Eq/Kg的患者进行分析,24小时平均排尿量1722.5±915.3ml(500~3500ml),24小时尿排钠量均值为107.9±91.2(3~366)mmol/L,上午及下午随机尿Na/K比值分别为3.44±3.64、3.97±4.60,对24小时尿排钠量大于78 mmol/L患者进行上午及下午随机尿Na/K比ROC曲线分析,上午随机尿Na/K比值ROC曲线下面积为0.861,下午随机尿Na/K比值ROC曲线下面积为0.929。分析上午及下午随机尿Na/K比值一致性,上午随机尿Na/K比值ROC曲线下面积与下午随机尿Na/K比值ROC曲线下面积之差为0.0682(95%CI=-0.161~0.153,P=0.113),统计学无差异。另外,随机尿Na/K比值在1.25~1.45以上时,可以反映24小时尿排钠量大于78 mmol/L。结论随机尿Na/K比值大于1.25时,可以正确反映24小时尿钠排量大于78mmol/L,随机尿Na/K比值检测是判断利尿剂效果的方便、灵敏而特异的指标。
Objective To investigate the distribution of Na / K ratio in random urine of cirrhotic patients with ascites and whether it can correctly reflect the 24-hour urinary sodium excretion, and to determine the ratio of Na / K in random urine for the evaluation of diuretic response. Methods Forty patients with cirrhosis and ascites were enrolled in this study. Each patient received diuretic as early as 8 o’clock, urine volume was measured 24 hours, diarrhea 2-4 hours and 7-9 hours random urine 5ml, and 24 Hour urinary sodium excretion, Na / K ratio of random urine, and ROC curve for analyzing Na / K ratio of random urine. Results 40 patients with urinary creatinine> 15m Eq / kg were selected for analysis. The mean urinary output was 1722.5 ± 915.3ml (500 ~ 3500ml) in 24 hours and 107.9 ± 91.2 (3 ~ 366) mmol / L, morning and afternoon random urine Na / K ratio were 3.44 ± 3.64,3.97 ± 4.60, 24 hours urinary sodium excretion greater than 78 mmol / L for morning and afternoon random urine Na / K ROC curve analysis, morning The area under the ROC curve of random urine Na / K ratio was 0.861, and the area under the ROC curve of random urine Na / K ratio was 0.929 in the afternoon. The morning and afternoon random urine Na / K ratio consistency, morning random Na urine K / R ratio area under the ROC curve and afternoon random urine Na / K ROC area under the difference of 0.0682 (95% CI = -0.161 ~ 0.153, P = 0.113), no statistical difference. In addition, random urine Na / K ratio of 1.25 to 1.45 or more, can reflect 24 hours urinary sodium excretion greater than 78 mmol / L. Conclusion The random urine Na / K ratio greater than 1.25, can correctly reflect the 24-hour urinary sodium excretion greater than 78mmol / L, random urine Na / K ratio is to determine the diuretic effect of convenient, sensitive and specific indicators.