肾阻力指数及生物标志物在脓毒症相关急性肾损伤患者中的研究进展

Research Progress on Renal Resistance Index and Biomarkers in Patients with Sepsis-Related Acute Kidney Injury

摘要: 脓毒症(Sepsis)是导致重症患者发生急性肾损伤(Acute Kidney Injury, AKI)的最重要病因，其所致AKI患者病死率明显增高，但临床对其病理生理机制认识不足，在早期诊断和治疗方面缺乏有效手段。肾血管收缩被认为是AKI的早期表现之一，超声测量的肾阻力指数(Renal Resistance Index, RRI)可对肾脏微循环的改变进行评价，反映人体外周及肾脏灌注情况；尽管近年来许多生物标志物用于发现早期脓毒症急性肾损伤，但由于各种生物标志物的局限性，其在临床实践中的价值不高。单个或多个生物标志物联合来预测脓毒症患者的AKI仍是亟待探索的领域。故本文归纳整理了脓毒症相关急性肾损伤患者生物标志物的诊断效能，评价这些标志物在预测AKI发生时的准确性与局限性及探讨超声联合生物标志物对预测脓毒症AKI的价值，以期尽早识别脓毒症急性肾损伤，改善患者预后。

Abstract: Sepsis is the most important cause of acute kidney injury (AKI) in critically ill patients, leading to a significantly increased mortality rate in AKI patients. However, there is insufficient understanding of its pathophysiological mechanisms in clinical practice, and effective means for early diagnosis and treatment are lacking. Renal vasoconstriction is considered an early manifestation of AKI, and the renal resistance index (RRI) measured by ultrasound can evaluate changes in renal microcirculation, reflecting peripheral and renal perfusion. Although many biomarkers have been used to detect early sepsis-induced AKI in recent years, their value in clinical practice is limited due to various constraints. The combination of single or multiple biomarkers to predict AKI in septic patients remains an area that urgently needs exploration. Therefore, this review summarizes the diagnostic efficacy of biomarkers for sepsis-related AKI and evaluates the accuracy and limitations of these markers in predicting AKI occurrence. It also discusses the value of ultrasound combined with biomarkers for predicting sepsis-induced AKI, aiming to identify sepsis-induced AKI as early as possible and improve patient prognosis.