慢性肝病住院患者急性肾损伤的发病及预后相关因素分析

摘要/Abstract

摘要： 目的探讨慢性肝病住院患者急性肾损伤(AKI)的发病情况、病因、预后及死亡危险因素,为AKI的防治提供依据。方法筛选出2014年10月至12月感染科住院的慢性肝病患者,应用KDIGO标准对慢性肝病患者进行AKI诊断和分期。选择病史完整的AKI患者,收集其临床资料,进行横断面调查。分析慢性肝病住院患者AKI的发病率、病因、分布特点、肾脏预后情况及病死率。结果感染科住院的慢性肝病患者AKI发病率为13.98％(45／322),男女比例为2.2∶1,平均年龄(55.2±16.0)岁,其中肝硬化占57.77%、慢性重型肝炎占24.44%、 HCC占11.11%、其他慢性肝炎患者占6.66%。AKI分期Ⅰ、Ⅱ和Ⅲ期的发生率分别为57.77％、24.44%和17.77%,在肝硬化组分别为39.99%、11.11%、6.66%;慢性重型肝炎组为4.44%、11.11%、8.89%;HCC组为6.67%、2.22%、2.22%;其他慢性肝炎患者6.67%、0%、0%。AKI后7 d有15.55%的患者肾功能完全恢复,24.44%患者部分恢复,60.00%的患者未恢复。AKI患者28 d病死率33.33%,其中AKI Ⅰ、Ⅱ和Ⅲ期患者的病死率分别为15.38%、54.54%和62.50%。死亡组基础血清肌酐(Scr)值、最高血清肌酐(Scr)值、血清Cys-C、终末期肝病模型评分(MELD评分)、血清CRP均明显高于存活组,差异均有统计学意义(P<0.05),但血清钠离子浓度明显低于存活组,差异有统计学意义(P<0.05)。结论 AKI在感染科住院的慢性肝病患者中常见,预后与肾损害的严重程度、高MELD评分、低钠血症及合并感染有关,病死率较高。

关键词: 急性肾损伤, 慢性肝病, 住院患者, 病因, 预后

Abstract: Objective To investigate the incidence, etiology and prognosis of acute kidney injury (AKI) in hospitalized patients with chronic liver disease, and to provide a basis for its prevention and treatment. Methods Chronic liver disease patients hospitalized in the department of infectious diseases from October to December in 2014 were enrolled. Among those patients, AKI diagnosis and staging were carried out according to kidney disease improving global outcomes(KDIGO) standard. The cross-sectional survey was conducted for analysis of the incidence, etiology, distribution characteristics, prognosis of AKI. Results A total of 322 patients with chronic liver diseases were enrolled, with the AKI incidence as 13.97% (45/322). Among the AKI patients, the ratio of male to female was 2.2∶1, with the average age of 55.22±16.04-year old. The incidence of liver cirrhosis, chronic severe hepatitis, hepatocellular carcinoma (HCC) and other chronic hepatitis were 57.77%, 24.44%, 11.11% and 6.66%, respectively. KDIGO Ⅰ,Ⅱ, Ⅲ accounted for 57.77%, 24.44%, 17.77% in all the AKI patients, 39.99%, 11.11%, 6.66% in cirrhosis, 4.44%,11.11%, 8.89% in chronic severe hepatitis, 6.67%,2.22%, 2.22% in HCC, and 6.67%, 0.0%, 0.0% in other chronic hepatitis, respectively. Additionally, on day 7 after AKI, complete renal recovery rate was 15.55%, partial renal recovery rate was 24.44% and renal loss rate was 60.00%. The mortality was 33.33% on day 28, which was 15.38 %, 54.54% and 62.50% in AKI stage Ⅰ, Ⅱ and Ⅲ, respectively. Levels of baseline serum creatinine, highest serum creatinine, model for end-stage liver disease (MELD) score, cystatin c (Cys-C) and C-reactive protein (CRP) in death group were significantly higher than those in survival group (P<0.05). Otherwise, the level of serum sodium in death group was obviously lower than that in survival group (P<0.05). Conclusion AKI is one of the most common complications in hospitalized patients with chronic liver diseases, which causes unacceptably high mortality. The poor prognosis is closely correlated with the advanced AKI stage, higher MELD score, higher CRP level and lower serum sodium concentration.

Key words: Acute kidney injury, Inpatients, Chronic liver disease, Etiology, Prognosis

史冬梅,项晓刚,王晓琳,谢青. 慢性肝病住院患者急性肾损伤的发病及预后相关因素分析[J]. 肝脏, 2017, 22(3): 200-204.

SHI Dong-mei, XIANG Xiao-gang, WANG Xiao-lin, XIE Qing. Risk factors for incidence and prognosis of acute kidney injury in hospitalized patients with chronic liver diseases[J]. Chinese Hepatolgy, 2017, 22(3): 200-204.

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