急性肝衰竭患者发生急性肾损伤的临床特征

肝脏 ›› 2026, Vol. 31 ›› Issue (1): 14-18.

急性肝衰竭患者发生急性肾损伤的临床特征

郭贺冰, 刘景院, 李昂

100015 北京首都医科大学附属北京地坛医院重症医学科

收稿日期:2025-01-23 出版日期:2026-01-31 发布日期:2026-03-30
通讯作者: 李昂,Email:liang＠ ccmu. edu. cn
基金资助:
北京研究型病房卓越临床研究计划(BRWEP2024W102170109);高层次公共卫生技术人才建设项目培养计划(学科带头人-03-19);国家重点专科建设项目(重症医学)

A study on the occurrence and prognosis of acute kidney injury in patients with acute liver failure

GUO He-bing, LIU Jing-yuan, LI Ang

Department of Critical Care Medicine, Beijing Ditan Hospital, Capital Medical University, Beijing 100015, China

Received:2025-01-23 Online:2026-01-31 Published:2026-03-30
Contact: LI Ang, Email: liang@ccmu.edu.cn

摘要/Abstract

摘要： 目的探究急性肝衰竭(ALF)患者发生急性肾损伤(AKI)的临床特征。方法纳入2009 年 6 月 1 日至 2022 年 5 月 31 日首都医科大学附属北京地坛医院诊断的ALF患者180例。观察不同病因的ALF患者AKI的发生情况及不同AKI分期患者的预后情况。结果 180例ALF患者中,病毒性78例,26例发生AKI,住院90 d死亡25例(32.1%);药物相关62例,20例发生AKI,住院90 d死亡24例(38.7%);其他病因40例,15例发生AKI,住院90 d死亡14例(35%)。61例AKI患者中,AKI 1 期20例(11.1%),AKI 2期 6例(3.3%),AKI 3 期35例(19.4%);36例AKI患者90 d内死亡,其中AKI 1期患者9例,AKI 2+3期患者27例。25例患者存活超过90 d,其中21例肾功能完全恢复,4例转为慢性肾功能不全。非AKI患者90 d死亡27例(22.7%)。结论 ALF患者AKI发生率较高,AKI级别越高,患者的死亡风险越高。存活的AKI患者中,多数肾功能可完全恢复。ALF患者的病因类型与AKI及预后无明显相关性。

关键词: 急性肝衰竭, 急性肾损伤, 发生, 预后

Abstract: Objective To explore the occurrence and prognostic impact of acute kidney injury (AKI) in patients with acute liver failure (ALF). Methods This study included patients who were admitted to Beijing Ditan Hospital, Capital Medical University from June 1, 2009, to May 31, 2022, and met the diagnostic criteria for ALF. The occurrence of AKI in these ALF patients with different etiologies and the prognosis of the patients in different AKI stages were investigated. Results A total of 180 patients were included in this study, among whom 104 were male (57.8%), with an average age of 49 (33~60) years old. Regarding the different etiologies of ALF: there were 78 cases of viral etiology, 26 cases developed AKI, and 25 patients (32.1%) died within 90 days of hospitalization; 62 cases were drug related, 20 cases developed AKI, and 24 patients (38.7%) died within 90 days of hospitalization; 40 cases had other etiologies, 15 cases developed AKI, and 14 patients (35%) died within 90 days of hospitalization. Regarding AKI diagnosis and staging: 61 patients (33.9%) were diagnosed with AKI, among which 20 cases were in AKI stage 1 (11.1%), 6 cases were in AKI stage 2 (3.3%), and 35 cases were in AKI stage 3 (19.4%). 36 AKI patients died within 90 days. 25 patients survived for more than 90 days, among which 21 cases had complete renal function recovery and 4 cases developed chronic renal insufficiency. 27 non-AKI patients died within 90 days (22.7%); the 90-day mortality rate of AKI stage 1 patients was 45%, and the 90-day mortality rate of AKI stage 2 + 3 patients was 65%. Conclusion The incidence of AKI in ALF patients is relatively high. The higher the AKI grade, the greater the risk of death for patients. Most of the surviving AKI patients can have completely recovery of renal function. There is no significant correlation between the etiologies of ALF patients and the occurrence of AKI and prognosis.

Key words: Acute liver failure, Acute kidney injury, Occurrence, Prognosis

郭贺冰, 刘景院, 李昂. 急性肝衰竭患者发生急性肾损伤的临床特征[J]. 肝脏, 2026, 31(1): 14-18.

GUO He-bing, LIU Jing-yuan, LI Ang. A study on the occurrence and prognosis of acute kidney injury in patients with acute liver failure[J]. Chinese Hepatolgy, 2026, 31(1): 14-18.

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