CAJ | 학술논문

目的：应用风险期、损伤期、衰竭期、丧失期、终末期肾病(risk，injury，failure，loss，end stage kidney disease，RIFLE)和急性肾损伤网络(acute kidney injury network，AKIN)两种标准评价住院急性肾损伤(acute kidney injury， AKI)患者的病死率及其相关危险因素。方法：分析2006年2月至2011年1月中南大学湘雅二医院各临床科室收治的AKI患者的临床资料，分别采用RIFLE和AKIN标准对已诊断为AKI的病例重新确认AKI诊断并分级，比较两种标准诊断的住院AKI各期患者临床特征、院内病死率及其相关危险因素；应用logistic回归分析筛选出影响AKI院内病死率的相关危险因素。结果：采用RIFLE标准诊断出1020例、AKIN标准诊断出1027例AKI患者。RIFLE和AKIN标准的所有AKI患者及其相对应各期患者的院内病死率、住院天数、完全恢复率两两比较，差异均未见统计学意义(P>0.05)。单因素方差分析显示，死亡组AKI患者的年龄、肾前性疾病、院内AKI、机械通气、低血压、多器官功能衰竭数目、急性肾小管坏死个体严重程度指数(ATN-ISS评分)、血清钾离子浓度与存活组患者比较均差异有统计学意义(P<0.05)。多因素logistic回归分析筛选出年龄≥65岁、院内AKI、低血压、多器官功能衰竭数目、ATN-ISS评分、血清钾离子浓度为影响AKI患者院内病死率的独立危险因素。结论：RIFLE和AKIN标准对住院AKI患者近期预后的评价具有相同科学价值，且AKI分级与住院AKI患者的预后有关。
목적：응용풍험기、손상기、쇠갈기、상실기、종말기신병(risk，injury，failure，loss，end stage kidney disease，RIFLE)화급성신손상망락(acute kidney injury network，AKIN)량충표준평개주원급성신손상(acute kidney injury， AKI)환자적병사솔급기상관위험인소。방법：분석2006년2월지2011년1월중남대학상아이의원각림상과실수치적AKI환자적림상자료，분별채용RIFLE화AKIN표준대이진단위AKI적병례중신학인AKI진단병분급，비교량충표준진단적주원AKI각기환자림상특정、원내병사솔급기상관위험인소；응용logistic회귀분석사선출영향AKI원내병사솔적상관위험인소。결과：채용RIFLE표준진단출1020례、AKIN표준진단출1027례AKI환자。RIFLE화AKIN표준적소유AKI환자급기상대응각기환자적원내병사솔、주원천수、완전회복솔량량비교，차이균미견통계학의의(P>0.05)。단인소방차분석현시，사망조AKI환자적년령、신전성질병、원내AKI、궤계통기、저혈압、다기관공능쇠갈수목、급성신소관배사개체엄중정도지수(ATN-ISS평분)、혈청갑리자농도여존활조환자비교균차이유통계학의의(P<0.05)。다인소logistic회귀분석사선출년령≥65세、원내AKI、저혈압、다기관공능쇠갈수목、ATN-ISS평분、혈청갑리자농도위영향AKI환자원내병사솔적독립위험인소。결론：RIFLE화AKIN표준대주원AKI환자근기예후적평개구유상동과학개치，차AKI분급여주원AKI환자적예후유관。
Objective:To evaluate the mortality and risk factors for acute kidney injury (AKI) in hospitalized patients by the risk, injury, failure, loss, end stage kidney disease (RIFLE) and acute kidney injury network (AKIN). <br> Methods:We constructed a retrospective study of all AKI patients in the Second Xiangya Hospital of Central South University between February 2006 and January 2011. The diagnosis and classiifcation of AKI were reconifrmed and categorized by RIFLE and AKIN criteria. To compare the clinical characteristics, mortality and associated risk factors in AKI patients by the RIFLE and AKIN stage, univariate analysis and multivariate logistic regression analysis were performed. Results:The patients were diagnosed as AKI by AKIN (n=1027) or by RIFLE criteria (n=1020). There was no signiifcant difference in the hospital mortality, hospital length stay (days), or the proportion of complete recovery in each stage of AKI patients by RIFLE and AKIN (P>0.05). In the univariate analysis, age, pre-renal causes, proportion of hospital acquired AKI, mechanical ventilation, hypotension, the number of failed organs, acute tubular necrosis-index severity score (ATN-ISS), and the peak of serum potassium ion concentration were signiifcantly higher in the non-survivors than in the survivors (P<0.05). Logistic regression analysis revealed that age older than 65, hospital acquired AKI, hypotension, number of failed organs, ATN-ISS scores, and the peak of serum potassium ion concentration were independent risk factors for hospital mortality. Conclusion:Both RIFLE and AKIN criteria have similar scientiifc value in assessing hospital mortality. AKI stage is associated with the recent prognosis of AKI patients.