中华肾脏病杂志
中華腎髒病雜誌
중화신장병잡지
2012年
3期
194-200
,共7页
陆任华%方燕%高嘉元%蔡宏%朱铭力%张敏芳%戴慧莉%张伟明%倪兆慧%钱家麒%严玉澄
陸任華%方燕%高嘉元%蔡宏%硃銘力%張敏芳%戴慧莉%張偉明%倪兆慧%錢傢麒%嚴玉澄
륙임화%방연%고가원%채굉%주명력%장민방%대혜리%장위명%예조혜%전가기%엄옥징
肾功能不全,急性%住院病人%预后%危险因素%病因
腎功能不全,急性%住院病人%預後%危險因素%病因
신공능불전,급성%주원병인%예후%위험인소%병인
Renal insufficiency,acute%Inpatients%Prognosis%Risk factors%Etiology
目的 探讨住院患者急性肾损伤( AKI)的发病及预后情况,寻找与预后相关的危险因素,为临床更好地认识和预防AKI,改善预后提供依据.方法 应用医院实验室网络系统筛选2009年1月至12月上海市一家三级甲等综合性医院所有住院患者,应用急性肾损伤网( AKIN)推荐的AKI定义选择病史完整的AKI患者组成研究队列,回顾性分析AKI住院患者的发病率、病因及分布特点、患者及肾脏预后情况.Logistic回归分析影响住院AKI患者预后和肾脏预后的危险因素.结果 符合入选标准的住院AKI患者共934例,住院患者的AKI发病率为2.41％( 934/38 734).患者男女比例为1.88∶1,平均年龄(60.82±16.94)岁,AKI发病率随着年龄的增加逐渐增高,其中63.4％为外科患者,35.4％为内科患者,1.2％为妇产科患者.病因中肾前性AKI占51.7％,急性肾小管坏死(ATN)占37.7％,急性肾小球和肾小血管病变( AGV)占3.8％,急性小管间质性肾炎(AIN)占3.5％,肾后性AKI占3.3％.患者AKI后28 d存活率为71.8％.AKI后28 d时有65.7％的患者肾功能完全恢复,16.9％的患者部分恢复,17.4％的患者未恢复.AKI Ⅰ、Ⅱ和Ⅲ期患者的病死率分别为24.8％、31.2％和43.7％.多因素Logistic逐步回归模型结果提示,肾损伤药物史(OR=2.313)、前1周低血压史(OR=4.482)、少尿史(OR=5.267)、肾外脏器衰竭数(OR=1.376)和行肾脏替代治疗(RRT)(OR=4.221)是住院AKI患者死亡的独立危险因素；肾外脏器衰竭数(OR=1.529)和行RRT(OR=2.117)是住院AKI患者肾脏丢失的独立危险因素.结论 AKI在住院患者中常见,病死率较高,AKI后可以造成患者的肾脏丢失.预后与肾损害的严重程度密切相关.肾损伤药物史、1周内低血压史、少尿史、肾外脏器衰竭数和需要行RRT是AKI患者死亡的独立危险因素.肾外脏器衰竭数和需要行RRT是肾脏丢失的独立危险因素.
目的 探討住院患者急性腎損傷( AKI)的髮病及預後情況,尋找與預後相關的危險因素,為臨床更好地認識和預防AKI,改善預後提供依據.方法 應用醫院實驗室網絡繫統篩選2009年1月至12月上海市一傢三級甲等綜閤性醫院所有住院患者,應用急性腎損傷網( AKIN)推薦的AKI定義選擇病史完整的AKI患者組成研究隊列,迴顧性分析AKI住院患者的髮病率、病因及分佈特點、患者及腎髒預後情況.Logistic迴歸分析影響住院AKI患者預後和腎髒預後的危險因素.結果 符閤入選標準的住院AKI患者共934例,住院患者的AKI髮病率為2.41％( 934/38 734).患者男女比例為1.88∶1,平均年齡(60.82±16.94)歲,AKI髮病率隨著年齡的增加逐漸增高,其中63.4％為外科患者,35.4％為內科患者,1.2％為婦產科患者.病因中腎前性AKI佔51.7％,急性腎小管壞死(ATN)佔37.7％,急性腎小毬和腎小血管病變( AGV)佔3.8％,急性小管間質性腎炎(AIN)佔3.5％,腎後性AKI佔3.3％.患者AKI後28 d存活率為71.8％.AKI後28 d時有65.7％的患者腎功能完全恢複,16.9％的患者部分恢複,17.4％的患者未恢複.AKI Ⅰ、Ⅱ和Ⅲ期患者的病死率分彆為24.8％、31.2％和43.7％.多因素Logistic逐步迴歸模型結果提示,腎損傷藥物史(OR=2.313)、前1週低血壓史(OR=4.482)、少尿史(OR=5.267)、腎外髒器衰竭數(OR=1.376)和行腎髒替代治療(RRT)(OR=4.221)是住院AKI患者死亡的獨立危險因素；腎外髒器衰竭數(OR=1.529)和行RRT(OR=2.117)是住院AKI患者腎髒丟失的獨立危險因素.結論 AKI在住院患者中常見,病死率較高,AKI後可以造成患者的腎髒丟失.預後與腎損害的嚴重程度密切相關.腎損傷藥物史、1週內低血壓史、少尿史、腎外髒器衰竭數和需要行RRT是AKI患者死亡的獨立危險因素.腎外髒器衰竭數和需要行RRT是腎髒丟失的獨立危險因素.
목적 탐토주원환자급성신손상( AKI)적발병급예후정황,심조여예후상관적위험인소,위림상경호지인식화예방AKI,개선예후제공의거.방법 응용의원실험실망락계통사선2009년1월지12월상해시일가삼급갑등종합성의원소유주원환자,응용급성신손상망( AKIN)추천적AKI정의선택병사완정적AKI환자조성연구대렬,회고성분석AKI주원환자적발병솔、병인급분포특점、환자급신장예후정황.Logistic회귀분석영향주원AKI환자예후화신장예후적위험인소.결과 부합입선표준적주원AKI환자공934례,주원환자적AKI발병솔위2.41％( 934/38 734).환자남녀비례위1.88∶1,평균년령(60.82±16.94)세,AKI발병솔수착년령적증가축점증고,기중63.4％위외과환자,35.4％위내과환자,1.2％위부산과환자.병인중신전성AKI점51.7％,급성신소관배사(ATN)점37.7％,급성신소구화신소혈관병변( AGV)점3.8％,급성소관간질성신염(AIN)점3.5％,신후성AKI점3.3％.환자AKI후28 d존활솔위71.8％.AKI후28 d시유65.7％적환자신공능완전회복,16.9％적환자부분회복,17.4％적환자미회복.AKI Ⅰ、Ⅱ화Ⅲ기환자적병사솔분별위24.8％、31.2％화43.7％.다인소Logistic축보회귀모형결과제시,신손상약물사(OR=2.313)、전1주저혈압사(OR=4.482)、소뇨사(OR=5.267)、신외장기쇠갈수(OR=1.376)화행신장체대치료(RRT)(OR=4.221)시주원AKI환자사망적독립위험인소；신외장기쇠갈수(OR=1.529)화행RRT(OR=2.117)시주원AKI환자신장주실적독립위험인소.결론 AKI재주원환자중상견,병사솔교고,AKI후가이조성환자적신장주실.예후여신손해적엄중정도밀절상관.신손상약물사、1주내저혈압사、소뇨사、신외장기쇠갈수화수요행RRT시AKI환자사망적독립위험인소.신외장기쇠갈수화수요행RRT시신장주실적독립위험인소.
Objective To investigate the incidence and the prognosis of acute kidney injury (AKI) and to find out the risk factors associated with the outcome for better understanding and preventing AKI among inpatients. Methods All the hospitalized patients were screened by Lab Administration Network of Renji Hospital,Shanghai Jiaotong University School of Medicine from Jan.to Dec.2009.Study cohort was comprised of all the patients with AKI defined by Acute Kidney Injury Network (AKIN) and with complete clinical data recorded.The incidence,etiology and distribution characteristics, prognosis of AKI in hospitalized patients were retrospectively analyzed.Logistic regression analysis was used to investigate the risk factors of patients and renal outcome. Results A total of 934 patients with AKI were enrolled.The incidence of AKI in hospitalized patients was 2.41％ (934/38 734).The ratio of male to female was 1.88∶1.Age was (60.82±16.94) years old.Increasing incidence could be seen with age rising.There was 63.4％ AKI found in surgical department,35.4％ in internal medicine department and 1.2％ in obstetric and gynecologic department.Pre-AKI,acute tubular necrosis (ATN),acute glomerular and renal vascular injury (AGV),acute interstitial nephritis (AIN) and post-AKI were accounted for 51.7％,37.7％,3.8％,3.5％ and 3.3％ of the causes of AKI,respectively.On day 28,the survival rate was 71.8％,complete renal recovery rate was 65.7％,partial renal recovery rate was 16.9％ and renal loss rate was 17.4％ among all the patients with AKI.The mortality of AKI with stage Ⅰ,Ⅱ and Ⅲ among inpatients was 24.8％,31.2％ and 43.7％ respectively.Multivariate Logistic regression analysis showed that renal injury drugs [odds ratio (OR)=2.313],hypotension (OR=4.482),oliguria (OR =5.267),the number of failure organs except kidney (OR =1.376) and requiring renal replacement therapy (RRT)(OR=4.221) were independent risk factors for death among AKI patients.The number of failure organs except kidney (OR=1.529) and RRT (OR=2.117) were independent risk factors for kidney loss. Conclusions AKI is one of the most common complications in hospitalized patients.The mortality is high and renal outcome is poor after AKI.The prognosis is closely associated with the severity of AKI.Renal injury drugs,hypotension,oliguria,the number of failure organs except kidney and requiring RRT are independent risk factors for death among AKI patients,while the number of failure organs except kidney and requiring RRT are independent risk.factors for renal loss.
