住院患者急性肾损伤发病情况及危险因素分析  

Analysis of incidence and risk factor in hospitalized patients with acute kidney injury

作　　者：陆任华[1] 方燕[1] 高嘉元[1] 蔡宏[1] 朱铭力[1] 张敏芳[1] 戴慧莉[1] 张伟明[1] 倪兆慧[1] 钱家麒[1] 严玉澄[1] 

机构地区：[1]上海交通大学医学院附属仁济医院肾脏科,200127

出　　处：《中国危重病急救医学》2011年第7期413-417,共5页Chinese Critical Care Medicine

基　　金：基金项目：上海市医学发展基金重点研究课题（2003ZD001）;上海市科委重大科技攻关计划子课题（09dzl500300）

摘　　要：目的分析住院患者中急性肾损伤（AKI）的流行病学特点及AKI发生的危险因素，为临床更好地认识和预防AKI、改善预后提供依据。方法应用医院实验室网络系统筛选2008年1月至12月上海市一家三级综合性医院所有住院患者；以急性肾损伤网（AKIN）推荐的AKI定义选择病史完整的AKI患者组成研究队列，回顾性分析AKI住院患者的发生率、病因及分布特点；Logistic回归分析影响AKI严重程度的危险因素。结果符合入选标准的住院AKI患者共934例、发生AKI1001例次，住院患者的AKI发生率为2．4％（934／38734）。患者男女比例为1．88：1，年龄（60．82＋16．94）岁，AKI发生率随年龄升高逐渐增高，其中内科331例（占35．4％），外科592例（占63．4％），妇产科11例（占1．2％）。肾前性、肾性和肾后性AKl分别占52．O％、44．7％和3．3％。急性肾小管坏死（ATN，占37．5％）、绝对血容量不足（占33．6％）和相对血容量减少（占13．4％）是住院患者发生AKI最常见的原因。多因素Logistic逐步回归分析显示：合并慢性肾脏病（CKD）史[相对比值比（OR）=2．085，95％可信区间（95％CI）1．536～2．830，P〈0．01]、使用肾损伤药物（OR=1．438，95％CI1．087～1．901，P〈0．05）及合并肾外器官衰竭（OR=1．327，95％CI1．014～1．737，P〈0．05）是早期AKI发展成中重度AKI的独立危险因素。结论AKI是住院患者常见的临床综合征，发生率随年龄升高逐渐增加；肾前性AKI和ATN是住院AKI最常见的原因；合并CKD、肾损伤药物应用和肾外器官衰竭是发展成中重度AKI的独立危险因素。Objective To investigate the epidemiology and the risk factors of acute kidney injury （AKI） in hospitalized patients in order to help clinicians better understand and prevent AKI. Methods All patients hospitalized in Renji Hospital of Shanghai Jiao Tong University, which is a three-level General Hospital in Shanghai, during January to December of 2008 were screened by Lab Administration Network. Study group was comprised of the patients with full clinical data of AKI, as defined by Acute Kidney Injury Network （AKIN）. The incidence, etiology and distribution characteristics of hospitalized patients with AKI were retrospectively analyzed. Logistic regression analysis was used to investigate the risk factors in severity of AKI. Results Nine hundred and thirty-four patients suffering from AKI for 1 001 episodes were enrolled. The incidence of AKI in hospitalized patients was 2.4% （934/38 734）. The ratio of male to female was 1.88 ： 1. The mean age was （60.82±16. 94） years old. Higher incidence was seen with an increase in age. Three hundred and thirty-one（35.4%） patients with AKI were found in medical department, 592（63.4%） patients in surgical department and 11 （1.2 %） patients in department of gynecologic and obstetrics. Analysis of the causes of AKI showed that pre-AKI accounted for 52.0%, followed by renal parenchyma AKI （44.7%） and postrenal AKI （3.3%）. The most common reason for AKI was acute tubular necrosis （ATN, 37.5%）, followed by absolute （33.6%） and relative inadequacy of blood volume （13.4%）. Multivariate logistic regression analysis showed that chronic kidney disease （CKD） [odds ratio （OR）= 2. 085, 95% confidence interval （95%CI）： 1. 536 - 2. 830, P〈 0.01], renal injurious drugs （OR = 1. 438, 95%CI： 1. 087 - 1. 901, P〈0. 05）, and failure of organs other than kidney （OR = 1. 327, 95%CI： 1. 014 - 1. 737, P〈0.05） were independent risk factors for stage II - Ⅲ AKI. Conclusion AKI is one of the most common clinical syndromes

关 键 词：肾损伤 急性 住院患者 发生率 危险因素 病因 

分 类 号：R692[医药卫生—泌尿科学]