肾周脂肪厚度与闭合性肾损伤严重程度的相关性分析

Correlation analysis between perirenal fat thickness and severity of closed renal trauma

摘要

目的 分析肾周脂肪厚度（PFT）与闭合性肾损伤严重程度的关系，为预测闭合性肾损伤程度及治疗选择提供参考。方法 回顾性分析2012年1月-2022年12月于首都医科大学附属北京积水潭医院泌尿外科就诊的73例因车祸伤导致的单侧闭合性肾损伤患者的临床资料。根据美国创伤外科学会（AAST）肾损伤程度分级，将患者分为低级别组（AAST Ⅰ～Ⅲ级）组和高级别组（AAST Ⅳ～Ⅴ级），使用PACS软件在计算机断层扫描（CT）图像上测量患者受伤时健侧肾脏的PFT，使用logistic回归分析PFT与闭合性肾损伤程度的相关性。使用单因素方差分析比较不同治疗方式的患者PFT的差异。结果 73例患者平均年龄（44.7±17.1）岁，高级别组16例（21.9%）、低级别组57例（78.1%），平均PFT为（5.5±1.9）mm。高级别组较低级别组的PFT更小[（4.4±1.4）mm vs.（5.8±2.0）mm，P=0.003]。校正年龄、性别、身体质量指数、糖尿病、保护装置、合并脏器损伤后的多因素logistic回归分析结果显示，PFT的增加与高级别闭合性肾损伤风险的降低密切相关（OR=0.628，95%CI：0.430～0.918，P=0.016）。单因素方差分析显示PFT在选择保守、介入及手术治疗的患者中差异有统计学意义[（5.8±2.0）mm vs.（4.4±1.5）mm vs.（4.5±1.1）mm，P=0.034]。结论 PFT与闭合性肾损伤的严重程度密切相关，是预测闭合性肾损伤程度及指导治疗方式选择的相对客观指标。

Abstract

Objective To analyze the relationship between perirenal fat thickness (PFT) and the severity of closed renal trauma, so as to provide reference for treatment selection and prediction of the severity of injury. Methods The clinical data of 73 patients with unilateral closed renal trauma due to traffic accidents treated in our hospital during Jan. 2012 and Dec. 2022 were reviewed. According to American Association for the Surgery of Trauma (AAST), the patients were classified into mild group (AAST Ⅰ-Ⅲ) and severe group (AAST Ⅳ-Ⅴ). The PFT of the healthy kidneys during injury was measured on the PACS software CT images, and the correlation between PFT and severity of injury was analyzed using logistic regression. The difference in PFT between patients across treatment modalities using one-way ANOVA. Results The mean age of patients was (44.7±17.1) years. There were 16 patients (21.9%) in the severe group and 57 (78.1%) in the mild group, the mean PFT being (5.5±1.9) mm. The severe group had significantly lower PFT than the mild group [(4.4±1.4) mm vs. (5.8±2.0) mm, P=0.003]. After age, gender, body mass index, diabetes, protective devices and complicated organ injuries were adjusted, multivariable logistic analysis indicated that increased PFT was associated with lower risk of severe injury (OR=0.628, 95%CI: 0.430-0.918, P=0.016). One-way ANOVA analysis showed statistically significant differences in PFT among patients with conservative, interventional and surgical treatment options [(5.8±2.0) mm vs. (4.4±1.5) mm vs. (4.5±1.1) mm, P=0.034]. Conclusion PFT, which is closely related to the severity of closed renal trauma, is a reliable indicator to predict the severity of injury and the choice of treatments.

关键词

肾周脂肪厚度 / 闭合性肾损伤 / 损伤程度 / 美国创伤外科学会

Key words

perirenal fat thickness / closed renal trauma / severity of injury / American Association for the Surgery of Trauma

参考文献

[1] ERLICH T, KITREY ND. Renal trauma: the current best practice[J]. Ther Adv Urol, 2018, 10(10): 295-303.

[2] SANTUCCI RA, MCANINCH JM. Grade Ⅳ renal injuries: evaluation, treatment, and outcome[J]. World J Surg, 2001, 25(12): 1565-1572.

[3] DVORAK JE, LESTER ELW, MALUSO PJ, et al. The obesity paradox in the trauma patient: normal may not be better[J]. World J Surg, 2020, 44(6): 1817-1823.

[4] HAKAM N, NABAVIZADEH B, SADIGHIAN MJ, et al. The impact of obesity on renal trauma outcome: an analysis of the National Trauma Data Bank from 2013 to 2016[J]. World J Surg, 2021, 45(12): 3633-3642.

[5] WANG SC, BEDNARSKI B, PATEL S, et al. Increased depth of subcutaneous fat is protective against abdominal injuries in motor vehicle collisions[J]. Annu Proc Assoc Adv Automot Med, 2003, 47: 545-559.

[6] 杜柘彬, 张进, 孔文, 等. 肾周脂肪厚度对预测腹腔镜肾部分切除术手术相关因素价值的研究[J]. 现代泌尿生殖肿瘤志, 2016, 8(6): 341-344.

[7] HAKAM N, LUI JL, SHAW NM, et al. Cushioning the blow: role of perirenal fat in renal trauma injury severity[J]. BJU Int, 2023, 31(2): 208-212.

[8] KEIHANI S, XU Y, PRESSON AP, et al. Contemporary management of high-grade renal trauma: results from the American Association for the Surgery of Trauma Genitourinary Trauma study[J]. J Trauma Acute Care Surg, 2018, 84(3): 418-425.

[9] JAVANMARD B, FALLAH-KARKAN M, RAZZAGHI M, et al. Characteristics of traumatic urogenital injuries in emergency department: a 10-year cross-sectional study[J]. Arch Acad Emerg Med, 2019, 7(1): e63.

[10] TEE YS, CHENG CT, HSIEH CH, et al. Does a "cushion effect" really exist? A morphomic analysis of vulnerable road users with serious blunt abdominal injury[J]. Healthcare (Basel), 2021, 9(8): 1006.

[11] PETRONE P, PEREZ-CALVO J, BRATHWAITE CEM, et al. Traumatic kidney injuries: a systematic review and meta-analysis[J]. Int J Surg, 2020, 74(2020): 13-21.

[12] 程伟, 占鹏程, 虞学助, 等. 肾损伤患者151例临床分析[J]. 浙江医学, 2019, 41(7): 688-690.

[13] KELLY CE, BOWERS KE, HOLTON AE, et al. Non-operatively managed blunt and penetrating renal trauma: does early follow up CT scan change management? A systematic review[J]. Injury, 2022, 53(1): 69-75.

[14] LINDNER AK, LUGER AK, FRITZ J, et al. Do we need repeated CT imaging in uncomplicated blunt renal injuries? Experiences of a high-volume urological trauma centre[J]. World J Emerg Surg, 2022, 17(1): 38.

[15] STRENG KW, VOORS AA, HILLEGE HL, et al. Waist-to-hip ratio and mortality in heart failure[J]. Eur J Heart Fail, 2018, 20(9): 1269-1277.

[16] FU CY, BAJANI F, BUTLER C, et al. Morbid obesity's silver lining: an armor for hollow viscus in blunt abdominal trauma[J]. World J Surg, 2019, 43(4): 1007-1013.

[17] KURTZ MP, ESWARA JR, VETTER JM, et al. Blunt abdominal trauma from motor vehicle collisions from 2007 to 2011: renal injury probability and severity in children versus adults[J]. J Urol, 2017, 197(3 Pt 2): 906-910.

[18] MOREY AF, BROGHAMMER JA, HOLLOWELL CMP, et al. Urotrauma guideline 2020: AUA guideline[J]. J Urol, 2021, 205(1): 30-35.

[19] GLYKAS I, FRAGKOULIS C, PAIZIS T, et al. Conservative management of grade 4 and 5 renal injuries: a high-volume trauma center experience[J]. Urologia, 2021, 88(4): 287-291.

[20] ZEMP P, MANN U, ROURKE KF. Perinephric hematoma size is independently associated with the need for urological intervention in multisystem blunt renal trauma[J]. J Urol, 2018, 199(5): 1283-1288.