摘要
目的分析药物致急性肾损伤(AKI)的病因、临床和病理特点及治疗经验,为临床合理用药提供参考。方法回顾性分析1997年7月—2007年9月上海交通大学医学院附属瑞金医院、上海市公惠医院和上海市卢湾区中心医院189例药物致AKI的住院患者的病因、临床病理特点及疗效。结果药物所致AKI患者共189例,占同期AKI患者总数的19.9%,男116例,女73例,平均年龄为(49.7±18.6)岁,其中≥65岁(老年组)51例(27.0%)。引起AKI的药物中,以2种或2种以上药物联合应用最多见,占28.0%;其次为氨基糖苷类抗生素和中草(成)药,均占11.1%;造影剂和化疗药物分别占9.0%和6.9%。临床表现多样,轻重不一。根据RIFLE评分标准,衰竭(failure)患者最多,占61.4%,危险(risk)和损伤(injury)患者分别占16.4%和17.4%。43例患者行肾脏活组织检查,主要病理表现为肾小管间质病变,部分合并肾小球病变。131例(69.3%)采用单纯对症治疗方案,34例应用激素治疗,另有3例应用激素+免疫抑制剂治疗,34例患者需行血液净化治疗。总治愈率为81.5%,病死率为6.4%。老年组的病死率显著高于青年组(P=0.008)。青年组和中年组的痊愈率均显著高于老年组(P值分别=0.016、0.004)。衰竭患者中需要长期透析或死亡的构成比显著高于危险患者(P=0.024)。结论药物所致AKI临床较为常见,病因和临床表现多样,病理改变以肾小管间质病变为主,内科综合治疗结合血液净化的疗效较好。年龄、合并基础疾病、肾损伤严重程度和原发病等是判断预后的重要因素。
Objective To analyze the etiology, clinical manifestations, pathological features and treatment experience of drug-induced acute kidney injury （AKI）, so as to provide evidence for clinical drug usage. Methods A total of 189 patients with drug-induced AKI in three hospitals in Shanghai were collected from Jul. 1997 to Sept. 2007. They were divided into 3 groups according to theirs ages. The etiology, clinical manifestations, pathological changes, prognosis and prognostic risk factors were analyzed. Results Among all the 949 AKI patients admitted during the indicated period, 189 （ 19.9% ） had drug-induced AKI. The mean age was （49.7±18.6） years old, with 116 males and 73 females. Two or more drugs prescribed simultaneously ranked the first cause of drug-induced AKI （28.0%）, followed by aminoglycoside antibiotics and traditional Chinese drugs followed （each accounting for 11.1% ）. Contrast medium and chemo agent accounted for 9.0% and 6.9%, respectively. According to RIFLE criteria, 61.4 % patients had failure grade, 17.4% and 16.4% patients had injury and risk grade, respectively. Forty-three patients underwent renal biopsy. All renal specimens showed tubular-interstitial lesions while some were combined with glomerular lesions. A total of 131 （69.3%） patients had treatment targeting the symptoms. Thirty-four received steroid treatment, and three received steroid plus immunosuppressant. There were 18.0% patients who needed blood purification. Total cure rate and mortality of drug-induced AKI were 81.5% and 6.4%, respectively. The mortality of elder patients was higher than that of the young ones （P = 0. 008）. The cure rate was significantly lower in the elder group than in the young group （P = 0.016） and the middle-aged group （P = 0. 004）. The poor prognosis ratio was significantly higher in renal failure group than risk group （P = 0. 024）. Conclusion Drug-induced AKI is clinically common, with various etiologies and clinical manifestations. Tubular-interstitial lesion is th
出处
《上海医学》
CAS
CSCD
北大核心
2009年第3期214-217,共4页
Shanghai Medical Journal
基金
上海市重点学科(T0201)
上海市卫生局重点学科(05Ⅲ001)
上海市科学技术委员会重点项目(08D21900502)资助项目
关键词
急性肾损伤
药物
临床病理
综合治疗
Acute kidney injury
Drug
Pathologic change
Comprehensive treatment
