中国实用医刊
中國實用醫刊
중국실용의간
CENTRAL PLAINS MEDICAL JOURNAL
2011年
16期
28-30
,共3页
张翠翠%杜跃亮%唐琳%郭青%周雅丽
張翠翠%杜躍亮%唐琳%郭青%週雅麗
장취취%두약량%당림%곽청%주아려
急性间质性肾炎%药物相关急性间质性肾炎%肾活检%激素治疗
急性間質性腎炎%藥物相關急性間質性腎炎%腎活檢%激素治療
급성간질성신염%약물상관급성간질성신염%신활검%격소치료
Acute interstitial nephritis%Drug associated acute interstitial nephritis%Renal biopsy%Hormone therapy
目的 分析急性间质性肾炎(AIN)的病因、临床特点、肾脏病理改变、治疗及转归.方法 回顾性分析2007年1月至2010年10月郑州大学第一附属医院经肾活检确诊为AIN患者的病因、临床特点、肾脏病理结果、治疗措施及转归.结果 ①确诊为AIN患者共34例,其中药物相关性急性间质性肾炎(DAIN) 27例,占79.4％,抗生素导致的AIN占DAIN的70.4％,最常见的抗生素依次为β-内酰胺类、氨基糖甙类、喹诺酮类、磺胺类.②临床表现有急性肾功能衰竭(ARF)( 100％)、发热(64.7％)、蛋白尿(55.9％)、少尿或无尿(52.9％)、镜下血尿(41.2％)、白细胞尿(38.2％)、皮疹(32.4％)、尿糖(26.5％)及关节痛(14.7％).③病理显示肾小管损伤轻重不等,肾小球及肾血管无明显病变.④18例(52.9％)口服强的松治疗,7例(20.6％)应用甲强龙冲击,7例(20.6％)行血液透析治疗,2例仅给予对症支持治疗；6周后,除2例患者未脱离透析,其他患者均明显好转.入院时患者平均血清尿素氮(BUN)为(19.9±7.3) mmol/L,肌酐(Scr)为(532±237) μmol/L,尿酸(UA)为(415±141) μmol/L;治疗6周后,肾功能的各项指标均有明显降低,平均BUN为(7.4±2.7)mmol/L,Scr为(133±85) μmol/L,UA为(309±94)μmol/L,与治疗前相比差异有统计学意义(P均＜0.01),疗效显著.结论 AIN的常见致病因素为药物.临床表现呈多样性,无特异性,发热为其最常见的临床表现.临床及病理改变决定治疗措施,激素及血液透析是治疗AIN的有效方法,及时把握时机,并选取恰当的治疗方法是改善预后的关键.
目的 分析急性間質性腎炎(AIN)的病因、臨床特點、腎髒病理改變、治療及轉歸.方法 迴顧性分析2007年1月至2010年10月鄭州大學第一附屬醫院經腎活檢確診為AIN患者的病因、臨床特點、腎髒病理結果、治療措施及轉歸.結果 ①確診為AIN患者共34例,其中藥物相關性急性間質性腎炎(DAIN) 27例,佔79.4％,抗生素導緻的AIN佔DAIN的70.4％,最常見的抗生素依次為β-內酰胺類、氨基糖甙類、喹諾酮類、磺胺類.②臨床錶現有急性腎功能衰竭(ARF)( 100％)、髮熱(64.7％)、蛋白尿(55.9％)、少尿或無尿(52.9％)、鏡下血尿(41.2％)、白細胞尿(38.2％)、皮疹(32.4％)、尿糖(26.5％)及關節痛(14.7％).③病理顯示腎小管損傷輕重不等,腎小毬及腎血管無明顯病變.④18例(52.9％)口服彊的鬆治療,7例(20.6％)應用甲彊龍遲擊,7例(20.6％)行血液透析治療,2例僅給予對癥支持治療；6週後,除2例患者未脫離透析,其他患者均明顯好轉.入院時患者平均血清尿素氮(BUN)為(19.9±7.3) mmol/L,肌酐(Scr)為(532±237) μmol/L,尿痠(UA)為(415±141) μmol/L;治療6週後,腎功能的各項指標均有明顯降低,平均BUN為(7.4±2.7)mmol/L,Scr為(133±85) μmol/L,UA為(309±94)μmol/L,與治療前相比差異有統計學意義(P均＜0.01),療效顯著.結論 AIN的常見緻病因素為藥物.臨床錶現呈多樣性,無特異性,髮熱為其最常見的臨床錶現.臨床及病理改變決定治療措施,激素及血液透析是治療AIN的有效方法,及時把握時機,併選取恰噹的治療方法是改善預後的關鍵.
목적 분석급성간질성신염(AIN)적병인、림상특점、신장병리개변、치료급전귀.방법 회고성분석2007년1월지2010년10월정주대학제일부속의원경신활검학진위AIN환자적병인、림상특점、신장병리결과、치료조시급전귀.결과 ①학진위AIN환자공34례,기중약물상관성급성간질성신염(DAIN) 27례,점79.4％,항생소도치적AIN점DAIN적70.4％,최상견적항생소의차위β-내선알류、안기당대류、규낙동류、광알류.②림상표현유급성신공능쇠갈(ARF)( 100％)、발열(64.7％)、단백뇨(55.9％)、소뇨혹무뇨(52.9％)、경하혈뇨(41.2％)、백세포뇨(38.2％)、피진(32.4％)、뇨당(26.5％)급관절통(14.7％).③병리현시신소관손상경중불등,신소구급신혈관무명현병변.④18례(52.9％)구복강적송치료,7례(20.6％)응용갑강룡충격,7례(20.6％)행혈액투석치료,2례부급여대증지지치료；6주후,제2례환자미탈리투석,기타환자균명현호전.입원시환자평균혈청뇨소담(BUN)위(19.9±7.3) mmol/L,기항(Scr)위(532±237) μmol/L,뇨산(UA)위(415±141) μmol/L;치료6주후,신공능적각항지표균유명현강저,평균BUN위(7.4±2.7)mmol/L,Scr위(133±85) μmol/L,UA위(309±94)μmol/L,여치료전상비차이유통계학의의(P균＜0.01),료효현저.결론 AIN적상견치병인소위약물.림상표현정다양성,무특이성,발열위기최상견적림상표현.림상급병리개변결정치료조시,격소급혈액투석시치료AIN적유효방법,급시파악시궤,병선취흡당적치료방법시개선예후적관건.
Objective To analyze the cause,clinical features,renal pathology,treatment and prognosis of acute interstitial nephritis (AIN).Methods We performed a retrospective study of etiology,clinical features, pathology, treatment and prognosis for 34 renal biopsy specimen which were collected during the period of Jan.2007 to Oct.2010 in the First Affiliated Hospital of Zhengzhou University.Results ① Drug associated acute interstitial nephritis (DAIN) accounts for 79.4％ of all AIN patients.AIN caused by antibiotics accounted for 70.4％ of DAIN,and the most common antibiotics were β -lactams,aminoglycosides,quinolones,sulfonamides.②The clinical features of AIN included acute renal failure ( 100％ ),fever (64.7％ ),proteinuria (55.9％),oliguria or anuria (52.9％ ),microscopic hematuria (41.2％),leukourine ( 38.2％ ),rash ( 32.4％ ),glucosurine (26.5％ ) and arthralgia ( 14.7％ ).③The pathology showed varying severity of renal tubular injury,but glomerular and renal vascular had no obvious lesions.④Eighteen cases were treated by prednisone,7 cases were given methylprednisolone,7 cases required acute renal replacement therapy.Two patients were given only symptomatic and supportive treatment.After 6 weeks,most patients were significantly improved,but 2 cases still need dialysis. At frist, the patients' average BUN was (19.9 ±7.3) mmol/L,Scr was (532 ±237) μmol/L,UA was (415 ± 141) μmol/L,after the treatment about 6 weeks,patients' renal function indicators were significantly reduced,the average BUN was (7.4 ±2.7) mmol/L,Scr was (133 ± 85) μmol/L,UA was (309 ± 94 ) μmol/L,compared with that before treatment,there were significant differences ( P ＜0.01 ).Conclusions The common causative factors of AIN are drugs.The clinical manifestations has diversity and no speficity.Fever is the most common clinical performance.Treatment relies on pathology.Hormones and blood dialysis is an effective method for treatment of AIN,to grasp the opportunity,and select the appropriate treatment is important to improving the prognosis of AIN.
