急性肾损伤对失代偿期乙型肝炎肝硬化患者临床预后的影响

摘要/Abstract

摘要： 目的分析失代偿期乙型肝炎肝硬化患者急性肾损伤(AKI)的临床预后。方法 2017年1月至2020年12月宁德市医院诊治失代偿期乙型肝炎肝硬化患者176例。根据患者是否合并AKI分为AKI组、非AKI组,比较两组患者的临床资料。统计学处理采用t检验或卡方检验,生存率比较采用Log-Rank检验。结果 AKI组、非AKI组分别为55例、121例。非AKI组、AKI组年龄(47.2±8.2)岁、(49.8±9.2)岁,差异有统计学意义(t=7.163,P<0.05)。非AKI组、AKI组食管静脉曲张78例(64.4%)、47例(85.4%),差异有统计学意义(χ²=8.096,P<0.05)。非AKI组中性粒细胞百分比、INR、TBil、Scr、BUN、血清钠、血清钾分别为(68.5±8.6)%、(1.3±0.2)、(39.2±12.8)μmol/L、(68.9±21.8)μmol/L、(9.3±2.1)mmol/L、(138.4±8.0)mmol/L及(4.0±0.8)mmol/L,AKI组分别为(78.4±9.6)%、(1.5±0.2)、(70.5±19.2)μmol/L、(170.7±66.8)μmol/L、(13.7±2.5)mmol/L、(129.0±7.6)mmol/L及(4.7±1.0)mmol/L,差异均有统计学意义(均P<0.05)。非AKI组、AKI组MELD评分(15.5±3.6)分、(24.7±5.7)分,差异有统计学意义(P<0.05)。非AKI组、AKI组感染39例(32.2%)、31例(56.4%),差异有统计学意义(P<0.05)。随访3个月。非AKI组、AKI组患者28 d生存率为87.6%(106/121)、65.4%(36/55),差异有统计学意义(P<0.05),90 d生存率为75.2%(91/121)、43.6%(24/55),差异有统计学意义(P<0.05)。结论失代偿期乙型肝炎肝硬化并发AKI患者临床预后较差,随着AKI分期增加,血生化指标异常更为显著,值得临床重视。

关键词: 乙型肝炎病毒, 失代偿期肝硬化, 急性肾损伤, 血清肌酐

Abstract: Objective To investigate the effect of acute kidney injury (AKI) on the clinical prognosis of patients with hepatitis B virus related decompensated liver cirrhosis (HBV-DLC).Methods A total of 176 patients with HBV-DLC (111 males and 65 females) admitted to our hospital from January 2017 to December 2020 were enrolled, with an age of (48.0±8.4) years. Patients were divided into AKI group and non-AKI group according to whether combined with AKI. According to the type of data, t-test or chi-square test was used for comparison, and Log-Rank test was used for survival rate comparison.Results There were 65 cases in AKI group and 111 cases in non-AKI group. The ages of non-AKI group and AKI group were (47.2±8.2) years and (49.8±9.2) years, the difference was statistically significant (P<0.05). There were 78 cases (64.4%) and 47 cases (85.4%) with esophageal varices in non-AKI group and AKI group, the difference was statistically significant (P<0.05). The percentage of neutrophils, international normalized ratio (INR), total bilirubin (TBil), serum creatinine (Scr), blood urea nitrogen (BUN), serum sodium and serum potassium [(68.5±8.6)%, (1.3±0.2), (39.2±12.8) μmol/l, (68.9±21.8) μmol/L, (9.3±2.1) mmol/L, (138.4±8.0) mmol/L and (4.0±0.8) mmol/L] in the non-AKI group were significantly lower than those in the AKI group, [(78.4±9.6) %, (1.5±0.2), (70.5±19.2) μmol/l, (170.7±66.8) μmol/l, (13.7±2.5) mmol/l, (129.0±7.6) mmol/l and (4.7±1.0)mmol/l]m, (P<0.05). Model for end stage liver disease (MELD) scores of non-AKI group and AKI group were (15.5±3.6) points and (24.7±5.7) points, the difference between the 2 group was statistically significant (P<0.05). There were 39 cases (32.2%) and 31 cases (56.4%) combined with infection in non-AKI group and AKI group, the difference between the 2 group was statistically significant (P<0.05). All patients were followed up effectively for 3 months, and the end point of follow-up was death related to HBV-DLC. The 28-day survival rates of non-AKI group and AKI group were 87.6% (106/121) and 65.4% (36/55), and the difference was statistically significant (P<0.05). The 90-day survival rates of non-AKI group and AKI group were 75.2% (91/121) and 43.6% (24/55), with statistically significant (P<0.05).Conclusion The clinical prognosis of patients with HBV-DLC is poor while complicated with AKI. Many blood biochemical indexes increase obviously with the stage of AKI increasing, which deserves clinical attention.

Key words: Hepatitis B virus, Decompensated liver cirrhosis, Acute kidney injury, Serum creatinine

谢巧华, 王巍, 唐龙, 陈佳霖, 苏妙芳, 蔡奇志. 急性肾损伤对失代偿期乙型肝炎肝硬化患者临床预后的影响[J]. 肝脏, 2022, 27(8): 868-870.

XIE Qiao-hua, WANG Wei, TANG Long, CHEN Jia-lin, SU Miao-fang, CAI Qi-zhi. Effect of acute kidney injury on clinical prognosis of patients with hepatitis B virus related decompensated liver cirrhosis[J]. Chinese Hepatolgy, 2022, 27(8): 868-870.

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