摘要
目的探讨失代偿性肝硬化患者发生急性肾损伤(AKI)后进展为慢性肾脏病(CKD)的临床特征及其对预后的影响。方法回顾性分析2015年1月至2019年7月天津市第二人民医院收治的346例失代偿性肝硬化住院患者的一般资料和实验室检查结果。随访12个月。采用单因素分析和多因素logistic回归分析筛选AKI和CKD的危险因素。通过Kaplan-Meier方法进行生存分析。统计学方法采用独立样本t检验、Mann-Whitney U检验和卡方检验。结果共128例失代偿性肝硬化患者发生AKI,其中25例进展为CKD。单因素分析显示,年龄、高血压、肝硬化并发症感染、腹水、肝性脑病、慢加急性肝衰竭、肝功能Child-Turcotte-Pugh评分、基线血肌酐、入院后血肌酐、血清钠、白细胞计数、总胆固醇、甘油三酯、高密度脂蛋白、总胆红素、白蛋白、国际标准化比值(INR)和凝血酶原活动度均是失代偿性肝硬化患者发生AKI的危险因素(t=3.822,χ^(2)=12.534、26.761、5.035、3.894、26.101,U=7004.500、9132.500、5925.000、10144.000、10717.500、10827.000、10912.000、5741.500、10017.000、10187.500、11680.500、11321.500,P均<0.05);失代偿性肝硬化发生AKI后进展为CKD的危险因素包括肝硬化病因、高血压、基线血肌酐、诊断AKI时血肌酐、总胆固醇、INR、AKI病因和AKI分级(χ^(2)=13.153、9.144,U=353.000、337.000、576.500、481.000,χ^(2)=9.501、17.801,P均<0.05)。多因素logistic回归分析显示,失代偿性肝硬化发生AKI后进展为CKD的独立危险因素包括基线血肌酐(比值比=1.066,95%可信区间1.020~1.114,P=0.005)和AKI分级(比值比=6.086,95%可信区间1.828~20.260,P=0.003)。Kaplan-Meier生存分析显示,随访12个月后,失代偿性肝硬化AKI进展为CKD患者的生存率低于未进展为CKD的患者[52.0%(13/25)比86.4%(51/59)],差异有统计学意义(χ^(2)=11.482,P=0.001)。结论失代偿性肝硬化AKI患者进展为CKD较常见,会影响临床预后,降低�
Objective To explore the clinical features of decompensated liver cirrhosis patients with acute kidney injury(AKI)progressing to chronic kidney disease(CKD)and its impact on prognosis.Methods From January 2015 to July 2019,at Tianjin Second People′s Hospital,the general data and laboratory test results of 346 hospitalized patients with decompensated liver cirrhosis were retrospectively analyzed.The patients were followed up for 12 months.Univariate analysis and multivariate logistic regression analysis were used to analyze the risk factors of AKI and CKD.Kaplan-Meier method was used for survival analysis.The independent sample t test,Mann-Whitney U test and chi-square test were used for statistical analysis.Results A total of 128 patients with decompensated liver cirrhosis developed AKI,and 25 of them developed into CKD.Univariate analysis showed that age,hypertension,complications of liver cirrhosis infection,ascites and hepatic encephalopathy,acute-on-chronic liver failure,Child-Turcotte-Pugh score of liver function,baseline serum creatinine,post-admission serum creatinine,serum sodium,white blood cell count,total cholesterol,triglyceride,high-density lipoprotein,total bilirubin,albumin,international normalized ratio(INR)and prothrombin time activity were risk factors of AKI in patients with decompensated liver cirrhosis(t=3.822,χ^(2)=12.534,26.761,5.035,3.894 and 26.101,U=7004.500,9132.500,5925.000,10144.000,10717.500,10827.000,10912.000,5741.500,10017.000,10187.500,11680.500 and 11321.500,all P<0.05).The risk factors of AKI progressing to CKD in decompensated liver cirrhosis included the etiology of liver cirrhosis,hypertension,baseline serum creatinine,serum creatinine at the time of diagnosis of AKI,total cholesterol,INR,AKI etiology and AKI classification(χ^(2)=13.153 and 9.144,U=353.000,337.000,576.500 and 481.000,χ^(2)=9.501 and 17.801,all P<0.05).The results of multivariate logistic regression analysis showed that the independent risk factors of AKI progressing to CKD in decompensated liver cirrhos
作者
冯婧
张鹏
吴雪
楚伟可
张依恋
李萍
Jing Feng;Peng Zhang;Xue Wu;Weike Chu;Yilian Zhang;Ping Li(School of Graduate,Tianjin Medical University,Tianjin 300070,China;Department of Hepatology,Tianjin Second People′s Hospital,Tianjin 300192,China)
出处
《中华消化杂志》
CAS
CSCD
北大核心
2021年第12期823-828,共6页
Chinese Journal of Digestion
关键词
肝硬化
急性肾损伤
慢性肾脏病
血肌酐
Liver cirrhosis
Acute kidney injury
Chronic kidney disease
Serum creatinine
