住院患者急性肾损伤的发病及预后相关危险因素分析  

The incidence and risk factors associated with prognosis of acute kidney injury in hospitalized patients

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：《中华肾脏病杂志》2012年第3期194-200,共7页Chinese Journal of Nephrology

基　　金：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（09dz1500304）

摘　　要：目的探讨住院患者急性肾损伤（AKI）的发病及预后情况，寻找与预后相关的危险因素，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2009年1月至12月上海市一家三级甲等综合性医院所有住院患者，应用急性。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住院患者的发病率、病因及分布特点、患者及肾脏预后情况。Logistic回归分析影响住院AKI患者预后和肾脏预后的危险因素。结果符合人选标准的住院AKI患者共934例，住院患者的AKI发病率为2．41％（934／38734）。患者男女比例为1．88：1，平均年龄（60．82±16．94）岁，AKI发病率随着年龄的增加逐渐增高，其中63．4％为外科患者，35．4％为内科患者，1．2％为妇产科患者。病因中肾前性AKI占51．7％，急性肾小管坏死（ATN）占37．7％，急性肾小球和。肾小血管病变（AGV）占3．8％，急性小管间质性肾炎（AIN）占3．5％，肾后性AKI占3．3％。患者AKI后28d存活率为71.8％。AKI后28d时有65．7％的患者肾功能完全恢复，16．9％的患者部分恢复。17．4％的患者未恢复。AKII、Ⅱ和Ⅲ期患者的病死率分别为24．8％、31．2％和43．7％。多因素Logistic逐步回归模型结果提示，肾损伤药物史（OR=2．313）、前1周低血压史（OR=4．482）、少尿史（OR=5．267）、肾外脏器衰竭数（OR=1．376）和行肾脏替代治疗（RRT）（OR=4．221）是住院AKI患者死亡的独立危险因素；肾外脏器衰竭数（OR=1．529）和行RRT（OR=2．117）是住院AKI患者肾脏丢失的独立危险因素。结论AKI在住院患者中常见，病死率较高，AKI后可以造成患者的肾脏丢失。预后与肾损害的严重程度密切相关。肾损伤药物史、1周内低血压史、少尿史、肾外脏器衰竭数和需要行RRT是AKI患者死亡的独立危险因Objective To investigate the incidence and the prognosis of acute kidney injury （AKI） and to find out the risk factors associated with the outcome for better understanding and preventing AKI among inpatients. Methods All the hospitalized patients were screened by Lab Administration Network of Renji Hospital, Shanghai Jiaotong University School of Medicine from Jan. to Dec. 2009. Study cohort was comprised of all the patients with AKI defined by Acute Kidney Injury Network （AKIN） and with complete clinical data recorded. The incidence, etiology and distribution characteristics, prognosis of AKI in hospitalized patients were retrospectively analyzed. Logistic regression analysis was used to investigate the risk factors of patients and renal outcome. Results A total of 934 patients with AKI were enrolled. The incidence of AKI in hospitalized patients was 2.41% （934/38 734）. The ratio of male to female was 1.88：1. Age was （60.82＋16.94） years old. Increasing incidence could be seen with age rising. There was 63.4% AKI found in surgical department, 35.4% in internal medicine department and 1.2% in obstetric and gynecologic department. Pre-AKI, acute tubular necrosis （ATN）, acute glomerular and renal vascular injury （AGV）, acute interstitial nephritis （AIN） and post-AKI were accounted for 51.7%, 37.7%, 3.8%, 3.5% and 3.3% of the causes of AKI, respectively. On day 28, the survival rate was 71.8%, complete renal recovery rate was 65.7%, partial renal recovery rate was 16.9% and renal loss rate was 17.4% among all the patients with AKI. The mortality of AKI with stage I, II and III among inpatients was 24.8%, 31.2% and 43.7% respectively. Multivariate Logistic regression analysis showed that renal injury drugs [odds ratio （OR）=2.313], hypotension （OR =4.482）, oliguria （OR =5.267）, the number of failure organs except kidney （OR =1.376） and requiring renal replacement therapy （RRT）（OR=4.221） were independent risk factors for death among AKI patients. The number of fail

关 键 词：肾功能不全 急性 住院病人 预后 危险因素 病因 

分 类 号：R692[医药卫生—泌尿科学]