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| 不同病因急性肾损伤的临床特点及预后分析 |
| 申嫒文Δ,汤晓静Δ,孙博,杨杨,林鹭,宋东旭,王武涛,郁胜强* |
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(第二军医大学长征医院肾内科, 解放军肾脏病研究所, 上海 200003
△共同第一作者
*通信作者) |
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| 摘要: |
| 目的 探讨不同病因引起的急性肾损伤（AKI）的临床特点及预后情况。方法 通过医院信息管理系统查询第二军医大学长征医院2011年住院患者的肾功能指标，根据KDIGO的AKI诊断标准筛选出AKI患者，复习其病史资料；并根据病因分为肾前性AKI、肾性AKI和肾后性AKI，分析患者的临床特征及其转归。结果 入组的AKI患者共278例，发病率为0.896%。根据病因类别进行分组，肾前性AKI组200例（71.9%）、肾性AKI组63例（22.7%）、肾后性AKI组15例（5.4%）。3组患者的年龄、基础血清肌酐（sCr）、峰值sCr差异有统计学意义（P<0.05）。3组不同病因患者的识别率差异有统计学意义（P<0.01），其中肾性组的AKI识别率最高，占28.6%（18/63）。肾性组需要肾脏替代治疗的患者比例最高，占17.5%（11/63）。肾前性因素引起的AKI以肝移植科最多，肾性因素以肾内科最多，肾后性因素以泌尿外科居多。Logistic回归分析显示AKI分期是肾前性AKI患者死亡及肾功能预后的危险因素，年龄和AKI分期是肾性AKI肾功能恢复的危险因素。结论 肾前性AKI发病率最高，且多发于肝移植科，AKI分期的递增影响其预后；肾性AKI的基础sCr和峰值sCr较高，肾内科多发，药物易引起肾性AKI的发生，年龄和AKI分期的递增影响肾性AKI的肾功能恢复；肾后性AKI预后较好。 |
| 关键词: 急性肾损伤 病因 预后 肌酐 |
| DOI：10.16781/j.0258-879x.2017.03.0306 |
| 投稿时间：2017-01-12修订日期：2017-02-21 |
| 基金项目:"十二五"国家科技支撑计划（2011BAI10B07）. |
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| Clinical characteristics of acute kidney injury by different causes and patients' prognosis |
| SHEN Ai-wenΔ,TANG Xiao-jingΔ,SUN Bo,YANG Yang,LIN Lu,SONG Dong-xu,WANG Wu-tao,YU Sheng-qiang* |
(Department of Nephrology, Kidney Institute of PLA, Changzheng Hospital, Second Military Medical University, Shanghai 200003, China
△Co-first authors.
* Corresponding author) |
| Abstract: |
| Objective To explore the clinical characteristics of acute kidney injury (AKI) by different causes and to evaluate the patients' outcomes. Methods We searched for the renal function indicators of all the inpatients of Changzheng Hospital in 2011 by the hospital information management system, screened AKI patients according to KDIGO criteria, reviewed the medical histories of AKI patients and divided them into pre-renal, intrinsic-renal and post-renal AKI according to different causes, and then we analyzed the clinical features of the AKI patients and evaluated their outcomes. Results A total of 278 AKI patients were involved in this study and the overall incidence of AKI was 0.896%. The cases with pre-renal, intrinsic-renal and post-renal AKI were 200(71.9%), 63(22.7%) and 15(5.4%), respectively. Significant differences were found among the three groups concerning age, basic serum creatinine (sCr) and peak sCr (P<0.05). The detection rates had a significant difference among three groups (P<0.05), with that of intrinsic-renal AKI patients being the highest (28.6%, 18/63). Among the three groups, the renal replacement therapy rate was the highest in the intrinsic-renal group (17.5%, 11/63). The pre-renal AKI occurred most frequently in liver transplantation department, the intrinsic-renal AKI was frequently found in nephrology department, and the post-renal AKI was in neurosurgery department. Logistic regression analysis showed that the AKI stage was a risk factor for death and renal function prognosis in the pre-renal AKI patients, and age and AKI stage were the risk factors for renal function recovery in the patients with the intrinsic-renal AKI. Conclusion The incidence of pre-renal AKI is the highest, and it occurs frequently in liver transplantation department. AKI stage is the risk factor for the prognosis of the patients with pre-renal AKI. The basic sCr and peak sCr are higher in the intrinsic-renal AKI than in pre- and post-renal AKI. The intrinsic-renal AKI occurs frequently in nephrology department and it can be easily caused by drugs. Age and AKI stage are the risk factors for renal function recovery in the pre-renal AKI patients. The outcome of post-renal patients is the best. |
| Key words: acute kidney injuries cause prognosis creatinine |
