肝功能基础对肝硬化及肝衰竭并发急性肾损伤转归及预后的影响

摘要/Abstract

摘要： 目的观察肝功能基础对肝硬化及肝衰竭并发急性肾损伤(AKI)转归及预后的影响,并分析相关的影响因素。方法回顾性分析2016年3月至2017年6月在海军军医大学长海医院感染科住院期间发生AKI的肝硬化(失代偿期)及肝衰竭患者157例的临床资料,随访短期预后。根据肝功能基础及AKI分期进行分层分析,明确肝功能基础对治疗、AKI转归和预后的影响。进一步通过Logistic回归分析AKI转归及预后的影响因素。结果 157例患者中,肝硬化(失代偿期)患者73例,肝衰竭患者84例,两组患者在发生AKI时的MELD评分(t=-13.05,P=0.000)、AKI分期(χ²=12.80,P=0.002)、AKI治疗应答情况(χ²=25.06,P=0.000)、AKI转归(χ²=26.01,P=0.000)以及预后(χ²=47.69,P=0.000)均差异有统计学意义。Logistic回归多因素分析显示,AKI分期(OR=0.079,P=0.000)及MELD评分(OR=1.073,P=0.002)是AKI转归的主要影响因素;而AKI转归(OR=22.753,P=0.000)及MELD评分(OR=0.823,P=0.000)是预后的主要影响因素。结论 2015年ICA更新的指南可提高诊断的敏感性,但需重点关注原发疾病和肝功能基础对治疗应答、AKI转归以及预后的影响;对肝衰竭的患者,密切观察下尽早诊断AKI并积极的干预,可能改善AKI转归及预后。

关键词: 急性肾损伤, 肝硬化, 肝衰竭, 转归, 预后, 影响因素

Abstract: Objective To investigate the influence of liver function on the outcomes and prognosis of acute kidney injury (AKI) in liver cirrhosis or liver failure patients and analyze the related factors. Methods Clinical data of 157 AKI patients with decompensated liver cirrhosis or liver failure in the Department of Infectious Diseases in our hospital from March 2016 to June 2017 was retrospectively analyzed. Stratified analysis based on liver function and AKI stage was applied to evaluate the influence of liver function on treatment efficiency, outcomes and prognosis of AKI. Logistic regression analysis was used to analyze factors related to outcomes and prognosis of AKI. Results There were 157 patients with AKI (73 decompensated liver cirrhosis and 84 liver failure patients) during hospitalization, 75.1% of whom met the diagnostic criteria of hepatorenal syndrome (HRS) (2007). Model for end-stage liver disease (MELD) score (t=-13.05, P=0.000), AKI staging (χ²=12.80, P=0.002), AKI treatment response (χ²=25.06, P=0.000), progression of AKI (χ²=26.01, P=0.000) and prognosis (χ²=47.69, P=0.000) were significantly different between liver cirrhosis group and liver failure group. Logistic regression multivariate analysis showed that AKI staging (OR=0.079, P=0.000) and MELD score (OR=1.073, P=0.002) were the main influencing factors for AKI outcomes. Furthermore, AKI outcomes (OR=22.753, P=0.000) and MELD score (OR=0.823, P=0.000) were the main influencing factors for prognosis. Conclusion The 2015 International Club of Ascites (ICA) updated guideline increases diagnostic sensitivity, but intense attention should be paid to the effect of primary liver disease and liver function on treatment efficiency, outcomes and prognosis of AKI, especially in patients with liver failure. Early diagnosis and active intervention under close observation may improve AKI outcomes and prognosis.

Key words: Acute renal injury, Liver cirrhosis, Liver failure, Outcomes, Prognosis, Influencing factors

尹伟, 李成忠, 邹多武. 肝功能基础对肝硬化及肝衰竭并发急性肾损伤转归及预后的影响[J]. 肝脏, 2018, 23(4): 297-301.

YIN Wei, LI Cheng-zhong, ZOU Duo-wu. Influence of liver function on the outcomes and prognosis of acute kidney injury in liver cirrhosis and liver failure patients[J]. Chinese Hepatolgy, 2018, 23(4): 297-301.

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