实用肝脏病杂志
實用肝髒病雜誌
실용간장병잡지
JOURNAL OF CLINICAL HEPATOLOGY
2014年
4期
360-363
,共4页
肝硬化%急性肾损伤%危险因素%单因素分析%Logistic回归分析
肝硬化%急性腎損傷%危險因素%單因素分析%Logistic迴歸分析
간경화%급성신손상%위험인소%단인소분석%Logistic회귀분석
Liver cirrhosis%Acute kidney injury%Risk factors%Univariate analysis%Logistic regres-sion analysis
探讨失代偿期肝硬化患者发生急性肾损伤的危险因素。方法收集254例失代偿期肝硬化伴有腹水患者的相关临床资料，以血肌酐高于正常参考值上限为标准，将研究对象分为急性肾损伤观察组和无急性肾损伤的对照组，回顾性分析入选病例基础临床资料和相关实验室指标，应用单因素和多因素分析统计学方法，分析失代偿期肝硬化发生急性肾损伤的相关危险因素。结果观察组患者肝性脑病发生率为50.4%，对照组为10.1%（P＜0.01）；观察组自发性细菌性腹膜炎和其他部位感染发生率分别为70.4%和32.6%，显著高于对照组的41.2%和19.3%（P＜0.05）；观察组血钠、血清总胆红素和白细胞计数水平分别为128 mmol/L、391.8μmol/L和9.33×109/L，均显著低于或高于对照组的136.8 mmol/L、51.58μmol/L和3.9×109/L （P＜0.05）；观察组血浆凝血酶原活动度为(34.2±17.3)%，显著低于对照组的（52.1±16.1）%（P＜0.01）；Logistic回归分析结果提示肝性脑病、低血钠、总胆红素水平、血浆凝血酶原活动度、白细胞计数均为失代偿期肝硬化患者发生急性肾损伤的独立危险因素（P＜0.05）。结论失代偿期肝硬化伴有肝性脑病、感染、低血钠、高胆红素血症和严重凝血功能障碍是发生急性肾损伤的高危人群。
探討失代償期肝硬化患者髮生急性腎損傷的危險因素。方法收集254例失代償期肝硬化伴有腹水患者的相關臨床資料，以血肌酐高于正常參攷值上限為標準，將研究對象分為急性腎損傷觀察組和無急性腎損傷的對照組，迴顧性分析入選病例基礎臨床資料和相關實驗室指標，應用單因素和多因素分析統計學方法，分析失代償期肝硬化髮生急性腎損傷的相關危險因素。結果觀察組患者肝性腦病髮生率為50.4%，對照組為10.1%（P＜0.01）；觀察組自髮性細菌性腹膜炎和其他部位感染髮生率分彆為70.4%和32.6%，顯著高于對照組的41.2%和19.3%（P＜0.05）；觀察組血鈉、血清總膽紅素和白細胞計數水平分彆為128 mmol/L、391.8μmol/L和9.33×109/L，均顯著低于或高于對照組的136.8 mmol/L、51.58μmol/L和3.9×109/L （P＜0.05）；觀察組血漿凝血酶原活動度為(34.2±17.3)%，顯著低于對照組的（52.1±16.1）%（P＜0.01）；Logistic迴歸分析結果提示肝性腦病、低血鈉、總膽紅素水平、血漿凝血酶原活動度、白細胞計數均為失代償期肝硬化患者髮生急性腎損傷的獨立危險因素（P＜0.05）。結論失代償期肝硬化伴有肝性腦病、感染、低血鈉、高膽紅素血癥和嚴重凝血功能障礙是髮生急性腎損傷的高危人群。
탐토실대상기간경화환자발생급성신손상적위험인소。방법수집254례실대상기간경화반유복수환자적상관림상자료，이혈기항고우정상삼고치상한위표준，장연구대상분위급성신손상관찰조화무급성신손상적대조조，회고성분석입선병례기출림상자료화상관실험실지표，응용단인소화다인소분석통계학방법，분석실대상기간경화발생급성신손상적상관위험인소。결과관찰조환자간성뇌병발생솔위50.4%，대조조위10.1%（P＜0.01）；관찰조자발성세균성복막염화기타부위감염발생솔분별위70.4%화32.6%，현저고우대조조적41.2%화19.3%（P＜0.05）；관찰조혈납、혈청총담홍소화백세포계수수평분별위128 mmol/L、391.8μmol/L화9.33×109/L，균현저저우혹고우대조조적136.8 mmol/L、51.58μmol/L화3.9×109/L （P＜0.05）；관찰조혈장응혈매원활동도위(34.2±17.3)%，현저저우대조조적（52.1±16.1）%（P＜0.01）；Logistic회귀분석결과제시간성뇌병、저혈납、총담홍소수평、혈장응혈매원활동도、백세포계수균위실대상기간경화환자발생급성신손상적독립위험인소（P＜0.05）。결론실대상기간경화반유간성뇌병、감염、저혈납、고담홍소혈증화엄중응혈공능장애시발생급성신손상적고위인군。
Objective To study the risk factors for acute kidney injury in patients with decompen-sated liver cirrhosis. Methods Relevant clinical data of 254 patients with decompensated liver cirrhosis and ascites were retrospectively analyzed. The patients were divided into observation group with serum creatinine levels beyond the upper limit of normal(n=135) and control group with normal serum creati-nine (n=119). The risk factors for acute kidney injury were analyzed by univariate and multivariate analysis methods. Results The incidences of hepatic encephalopathy were 50.4% in observation group and 10.1% in control group (P<0.01);the incidences of spontaneous bacteria peritonitis (SBP) and in-fection in other sites were 70.4% and 32.6% in observation group,significantly higher than in patients in control group (41.2% and 19.3%,respectively,P<0.01);the serum sodium,total bilirubin levels and white blood cell counts were 128 mmol/L,391.8 μmol/L and 9.33×109/L,respectively,in observation group,which were significantly different as compared to those in control group (136.8 mmol/L,51.58μmol/L and 3.9×109/L,respectively,P<0.01);the plasma prothrombin time activity(PTA) were (34.2± 17.3)% in observation group and (52.1±16.1)% in control group (P<0.01). logistic regression analysis showed that hepatic encephalopathy,hyponatremia,total bilirubin,PTA,white blood cell counts were all independent risk factors for acute kidney injury in patients with decompensated cirrhosis (P<0.05). Conclusion Patients with decompensated cirrhosis are under high-risk of acute kidney injury when hepatic encephalopathy,infection,hyponatremia,hyper-bilirubinemia or serious coagulopathy occur.
