超声测量下腔静脉直径评估血液透析患者容量负荷的价值

doi:10.3969/j.issn.1006-298X.2025.01.005

肾脏病与透析肾移植杂志 ›› 2025, Vol. 34 ›› Issue (1): 27-31.DOI: 10.3969/j.issn.1006-298X.2025.01.005

超声测量下腔静脉直径评估血液透析患者容量负荷的价值

出版日期:2025-02-28 发布日期:2025-03-15

Assessing degree of volume load in hemodialysis patients by measuring the diameter of inferior vena cava with ultrasound

Online:2025-02-28 Published:2025-03-15

摘要/Abstract

摘要： 目的:评估维持性血液透析患者透析后下腔静脉直径指数（VCD）[ 即下腔静脉直径（IVCD）/ 体表面积（ BSA）] 与理想水分比率（ ECW/ TBW）的相关性，探讨超声测量下腔静脉在评价血液透析患者容量负荷程度中的价值｡方法:选取东南大学附属中大医院血液净化中心 232 例患者，于透析后 0.5 ~ 1 h 内使用 InBody720 人体成分分析仪测量患者ECW/TBW，完成测量后立即使用超声测量患者的IVCD､呼吸变异率（ΔIVCD），同时收集患者身高､体重数据计算 BSA 和 VCD｡分析不同 ΔIVCD 组 ECW/TBW 的差异性，分析 VCD 和 ECW/TBW 相关性，绘制 VCD 诊断理想 ECW/TBW（数值范围:0.380~ 0.385）受试者特征曲线（ROC），分析其检测效能｡结果:最终收集了 210 例患者完整资料｡ 71 例（33.8%）患者透析后 ECW/TBW 超过理想范围｡ 30 例患者 ΔIVCD≤50%，180 例患者 ΔIVCD>50%，ΔIVCD≤50%组ECW/TBW 显著高于ΔIVCD>50%组（0.388±0.011 vs 0.383±0.011，P = 0.023）;两组 VCD 也有显著差异（9.083±2.168 vs 6.336± 2.131，P< 0.001）;VCD 和 ECW/TBW 有显著相关性（r = 0.321，P< 0.001），其中 ΔIVCD≤50% 组相关系数高于 ΔIVCD>50% 组（r = 0.455 vs r = 0.278）;VCD 检测理想 ECW/TBW 为 0.380 时的最佳临界值为 6.48 mm/m2 ，曲线下面积为 0.805，敏感度和特异度分别为 65.6% 和 86.7%（P<0.001）; VCD 检测理想 ECW/TBW 为 0.385 时的最佳临界值为 7.12 mm/m2 ，曲线下面积为 0.790，敏感度和特异度分别为66.3%和 78.7%（P<0.001）｡结论:血液透析患者透析后 VCD 与 ECW/TBW 相关，在评估容量负荷程度上具有一定的临床价值｡

关键词: 超声 , 维持性血液透析, 下腔静脉直径指数, 水分比率, 容量负荷

Abstract: Objective:To evaluate the correlation between inferior vena cava diameter index （VCD）， defined as the ratio of the inferior vena cava diameter （IVCD） to body surface area （BSA）， and ideal water ratio （ECW/TBW） after dialysis in maintenance hemodialysis patients， and to explore the value of ultrasonic measurement of inferior vena cava in evaluating the volume load degree of hemodialysis patients. Methodology: A total of 232 patients from the Blood Purifcation Center of Zhongda Hospital Afiliated to Southeast University were enrolled and their ECW/TBW was measured within 0.5-1 h after dialysis using InBody720 body composition analysis instrument. After the measurement， the inferior vena cava diameter （IVCD）and respiratory variation rate （ΔIVCD）were measured by ultrasound immediately. Meanwhile， the height and weight data of patients were collected to calculate the body surface area （BSA）. The diameter index of inferior vena cava was calculated. The differences of ECW/TBW in different ΔIVCD groups was analyzed. The correlation between VCD and ECW/TBW was analyzed， the receiver characteristic curve （ROC） of ideal ECW/TBW （value range: 0.380 ~ 0.385） for VCD diagnosis was drawn， and the detection efficiency was analyzed. Results:In the 232 patients， 22 cases of inferior vena cava were not clear on ultrasound. Finally， complete data of 210 patients were collected. Among the patients， 71 cases had an ECW/TBW ratio exceeding the ideal range after dialysis， accounting for 33.8%. There were 30 patients with ΔIVCD≤50% and 180 patients with>50%. ECW/TBW in ΔIVCD≤50% group was significantly higher than that in ΔIVCD> 50% group （0.388 ± 0.011 vs 0.383 ± 0.011， P = 0.023）. There were significant differences in VCD between the two groups （9.083± 2.168 vs 6.336± 2.131， P< 0.001）. VCD was significantly correlated with ECW/TBW
（r = 0.321， P<0.001）， and the correlation coefficient of ΔIVCD≤50% group was higher than that of ΔIVCD>50% group
（r = 0.455 vs r = 0.278）.The optimal cut-off value of VCD for ideal ECW/TBW of 0.380 was 6.48 mm/m2 ， with an area under the curve was 0.805， and the sensitivity and specificity were 65.6% and 86.7%， respectively （P < 0.001）. The optimal cut-off value of VCD for the ideal ECW/TBW of 0.385 was 7.12 mm/m2 ， with an area under the curve of 0.790， and the sensitivity and specificity were 66.3% and 78.7% respectively （P < 0.001） . Conclusion: VCD is related to ECW/TBW After dialysis， which has certain clinical value in evaluating the degree of volume load.

Key words: ultrasound, , , maintenance hemodialysis , , inferior vena cava diameter index, , , water ratio, , , volume load

王越, 谢庆磊, 刘宏, 张留平, 张思琳, 秦波. 超声测量下腔静脉直径评估血液透析患者容量负荷的价值[J]. 肾脏病与透析肾移植杂志, 2025, 34(1): 27-31.

WANG Yue, XIE Qinglei, LIU Hong, ZHANG Liuping, ZHANG Silin, QIN Bo. Assessing degree of volume load in hemodialysis patients by measuring the diameter of inferior vena cava with ultrasound[J]. Chinese Journal of Nephrology, Dialysis & Transplantation, 2025, 34(1): 27-31.

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ISSN 1006-298X CN 32-1425/R

超声测量下腔静脉直径评估血液透析患者容量负荷的价值

Assessing degree of volume load in hemodialysis patients by measuring the diameter of inferior vena cava with ultrasound

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