增强CT和重症急性胰腺炎患者发生急性肾损伤的关系  

Relationship between contrast -inhanced CT and acute kidney injury in patients with sever acute pancreatitis

作　　者：张敏[1] 刘思纯[2] 陈源汉[3] 马博[4] 李初俊[1] 朱颖钰[1] 梁馨苓[3] 

机构地区：[1]中山大学附属第六医院消化内科,广州510655 [2]中山大学附属第一医院消化内科 [3]广东省人民医院肾内科 [4]中山大学附属第一医院黄埔院区消化内科

出　　处：《中国实用医刊》2011年第20期1-2,共2页Chinese Journal of Practical Medicine

基　　金：基金项目：广东省科技计划项目（20108031600157）

摘　　要：目的研究增强CT检查和重症急性胰腺炎（SAP）患者发生急性肾损伤（AKI）的关系。方法定义急性生理功能和慢性健康状况评分系统APACHEII评分≥8分为SAP，用RIFLE标准诊断AKI。结果收集到84例SAP患者的临床资料，进行增强CT者54例。增强CT组和未进行增强CT组AKI发生率分别为59．3％和40．0％（P=0．090）。在APACHEⅡ评分≥15分的亚组中，进行增强CT（25例）和非增强CT（19例）的患者发生AKI的比例分别为68．4％和24．0％（P：0．003）。经APACHEII评分校正后，增强CT检查是AKI发生的独立危险因素（OR值1．247，95％可信区间1．195～1．387）。在APACHEII评分≥15分的患者中，进行增强CT检查使发生AKI风险显著增加（OR值4．293，95％可信区间3．101～5．087）。结论增强CT可能是SAP患者发生急性肾损伤的一个危险因素，尤其是病情严重的个体。Objective To study the relationship between contrast -inhanced CT and acute kid- ney injury （AKI） in patients with sever acute pancreatitis （SAP）. Methods The SAP was defined as the APACHE Ⅱ score 〉 or = 8 and the AKI was diagnozed by RIFLE criterion. Results Clinical data from 84 SAP patient were studied. The AKI occurrence ratio in the contrast inhanced CT group and in the non-contrast inhanced CT was 59.3% versus 40.0% （P = 0. 090）. In theAPACHE Ⅱscore 〉 or = 15 subgroup analysis, the patients with contrast inhanced CT had a higher AKI occurrence ratio than those without contrast inhanced CT （68.4% versus 24.0% , P = 0. 003）. After adjusted by the APACHE Ⅱscore, contrast inhanced CT was a risk factor for AKI occurrence （ Odds ratio 1. 247,95% confidence interval 1. 195 - 1. 387）. In the patients with APACHE Ⅱ score 〉 or = 15,contrast - inhaneed CT increased the risk for AKI （Odds ratio 4. 293,95% confidence interval 3. 101 -5.087）. Conclusions Contrastinhanced CT is a potential risk factor for AKI in SAP patients, especially in those with worse condition.

关 键 词：重症急性胰腺炎 增强CT APACHE Ⅱ评分 急性肾损伤 

分 类 号：R692[医药卫生—泌尿科学]