上海市药物性急性肾衰竭临床现况分析
상해시약물성급성신쇠갈림상현황분석
Analysis of drug-induced acute renal failure in Shanghai
  • 万方数据
    中华医学杂志 중화의학잡지
    National Medical Journal of China
    2009年 11期 744-749 ,共6页

    车妙琳%严玉澄%张芸%顾勇%汪年松%陈楠%毛佩菊%张金元%丁小强%袁伟杰%梅长林%姚建%樊雨良%周毅%张薇%朱汉威%刘梅%金惠敏%钱家麒

    차묘림%엄옥징%장예%고용%왕년송%진남%모패국%장금원%정소강%원위걸%매장림%요건%번우량%주의%장미%주한위%류매%금혜민%전가기

    肾功能衰竭%药物毒性%发病率 腎功能衰竭%藥物毒性%髮病率
    신공능쇠갈%약물독성%발병솔
    Kidney failure%Drug toxicity%Incidence
    目的 了解上海地区综合性医院住院患者药物性急性肾衰竭(ARF)的发病率,肾毒性药物种类、预后,为合理用药、最大程度避免药物性ARF的发生提供依据.方法 患者资料来源于2004年1月1日至2006年12月31日上海17家二级以七综合性医院住院患者的ARF患者登记表,从中将药物性ARF患者挑出并记录其基础疾病、临床特点及转归.结果 在1200例各种原因的ARF患者中,药物性ARF共347例(28.9%).男224例,女123例,年龄(58±20)岁,60岁以上占51.0%.发生于非手术科室的药物性ARF以社区获得性为主(60.2%).在非手术科室中医院获得性的药物性ARF的发生率在肾脏科最低,仅为9.5%,而在血液科、心血管科及神内科较高.发生于手术科室的药物性ARF则以医院获得性为主(55.7%).其中医院获得性的药物性ARF在肝移植科,神外科和心胸外科中发生率较高,而泌尿外科较低.合并的基础疾病以慢性肾脏疾病较常见(69例,占19.9%),之后依次为脑血管疾病59例(17.0%),糖尿病43例(12.4%),高血压41例(11.8%),冠心病20例(5.8%).肾活检病理主要为急性肾小管坏死18例(37.5%),急性间质性肾炎11例(22.9%),急性小管间质性肾炎6例(12.5%).肾毒性药物中抗生素占首位166例(47.8%),主要为氨基糖甙类(17.0%)与头孢菌素类(12.7%);其次为利尿剂77例(22.2%)和造影剂46例(13.3%);两种或两种以上联合用药占22.5%.119例患者(34.3%)行肾脏替代治疗.院内死亡患者100例(28.8%).存活患者中,188例(54.2%)肾脏完全恢复,42例(12.1%)肾脏部分恢复,17例(4.9%)肾脏死亡.结论 药物性ARF的发病率较高,往往与多种致病因素联合作用,多发于存在基础合并症的老年患者.氨基糖甙类、头孢菌素类抗生素,利尿剂,造影剂是主要的肾毒性药物.
    목적 료해상해지구종합성의원주원환자약물성급성신쇠갈(ARF)적발병솔,신독성약물충류、예후,위합리용약、최대정도피면약물성ARF적발생제공의거.방법 환자자료래원우2004년1월1일지2006년12월31일상해17가이급이칠종합성의원주원환자적ARF환자등기표,종중장약물성ARF환자도출병기록기기출질병、림상특점급전귀.결과 재1200례각충원인적ARF환자중,약물성ARF공347례(28.9%).남224례,녀123례,년령(58±20)세,60세이상점51.0%.발생우비수술과실적약물성ARF이사구획득성위주(60.2%).재비수술과실중의원획득성적약물성ARF적발생솔재신장과최저,부위9.5%,이재혈액과、심혈관과급신내과교고.발생우수술과실적약물성ARF칙이의원획득성위주(55.7%).기중의원획득성적약물성ARF재간이식과,신외과화심흉외과중발생솔교고,이비뇨외과교저.합병적기출질병이만성신장질병교상견(69례,점19.9%),지후의차위뇌혈관질병59례(17.0%),당뇨병43례(12.4%),고혈압41례(11.8%),관심병20례(5.8%).신활검병리주요위급성신소관배사18례(37.5%),급성간질성신염11례(22.9%),급성소관간질성신염6례(12.5%).신독성약물중항생소점수위166례(47.8%),주요위안기당대류(17.0%)여두포균소류(12.7%);기차위이뇨제77례(22.2%)화조영제46례(13.3%);량충혹량충이상연합용약점22.5%.119례환자(34.3%)행신장체대치료.원내사망환자100례(28.8%).존활환자중,188례(54.2%)신장완전회복,42례(12.1%)신장부분회복,17례(4.9%)신장사망.결론 약물성ARF적발병솔교고,왕왕여다충치병인소연합작용,다발우존재기출합병증적노년환자.안기당대류、두포균소류항생소,이뇨제,조영제시주요적신독성약물.
    Objective To investigate the incidence and prognosis of drug-induced acute renal failure (ARF) in Shanghai. Methods The registration forms of ARF patients admitted in 17 hospitals of and over the middle class in Shanghai from January 1 2004 to December 31 2006 were screened prospectively. The data, such as epidemiology, survival, mortality, and morbidity were analyzed. Results 347 of the 1200 ARF patients (28.9%), 224 males and 123 females, aged (58±20), suffered from drug-induced ARF. 51.0% of the 347 patients were older than 60. 60.2% of the drug-induced ARF in the non-surgical departments were community-acquired, while 55.7% of the drug-induced ARF in the surgical departments were hospital-acquired. Among the non-surgical departments, the incidence of hospital-acquired drug-induced ARF was the lowest in the department of nephrology (9.5%), while higher in the departments of hematology, cardiology, and neurology, and among the surgical departments, it was the lowest in depart6ment of renal surgery, while higher in the departments of liver transplantation, neurosurgery, and cardiovascular surgery. The most common complication was chronic kidney disease (CKD) (n=69, 19.9%), followed by cerebrovascular disease (n=59, 17.0%), diabetes mellitus (n=43, 12.4%), and hypertension (n=41, 11.8%). Renal biopsy showed acute tubular necrosis (18, 37.5%), acute interstitial nephritis (11, 22.9%), and acute infectious tubulo-interstitial nephritis (6, 12.5%). Antibiotics (47.8%) were the head causes of drug-induced ARF, especially aminoglycoside(17.0%) and cephalosporins (12.7%), followed by diuretics (22.2%) and radiocontrasts (13.3%). 22.5% of the drug-induced ARF patients had used two or more drugs. 119 patients (34.3%) needed renal replacement treatment. 100 of the 347 patients (28.8%) died. 188 of the surviving patients (54.2%) had their renal function recovered completely, the renal function of 42 of them (12.1%) was recovered partially, and 17 of then (4.9%) required dialysis when discharged. Conclusion Drug-induced ARF is common with higher incidence in the patients with complications. Antibiotics, diuretic agents, and contrast medium are the main causes.
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