急性百草枯中毒患者急性肾损伤的临床特征  

Clinical features of acute kindey injury in patients with acute paraquat poisoning

作　　者：胡峰[1] 张贺[1] 陈洁[1] 杜罕[1] 薛微亮[1] 洪丽萍[1] 赵雪红[1] 何海硕[1] 杜莉[1] 

机构地区：[1]中国人民解放军第150中心医院肾病内科,洛阳471031

出　　处：《肾脏病与透析肾移植杂志》2012年第4期341-345,共5页Chinese Journal of Nephrology,Dialysis & Transplantation

摘　　要：目的:急性百草枯中毒引起的急性肾损伤(AKI)发病率较高,但相关研究多限于动物实验,故对百草枯中毒引起AKI认识不足。本研究分析急性百草枯中毒引起AKI的临床特征,进而寻找发生AKI的危险因素,争取做到早发现、早治疗,改善预后。方法:回顾性分析2009年1月～2011年12月中国人民解放军第150中心医院收治的180例急性百草枯中毒患者的症状体征、实验室检查结果、肺部影像学特征及预后。结果:180例急性百草枯中毒患者中98例(54.4%)出现AKI。服毒量<15 ml及≥15 ml患者AKI发生率分别为13.6%、78.2%,30例(16.7%)出现少尿。98例AKI患者中86例(87.8%)出现蛋白尿和(或)血尿,低分子蛋白尿、管型尿、糖尿、尿NAG升高的发生率分别为84.6%、15.3%、41.8%、66.3%。4例经肾活检者肾脏病理改变以肾小球缺血性病变、肾小管间质纤维化为特征。98例百草枯中毒合并AKI的患者死亡率为86.7%。13例存活的AKI患者随访30d,5例血清肌酐波动在123.7～247.5μmol/L,2例进展至终末期肾病,余肾功能正常。结论:急性百草枯中毒患者的AKI发生率达54.4%,同时累及肾小球及肾小管,以肾小管间质损害为主;AKI是判断中毒患者病情轻重的指标;早期呕吐、百草枯服用量≥15 ml、服毒至洗胃时间间隔长、血液净化开始时间晚、低氧血症、C反应蛋白升高、外周血白细胞升高、血糖增高是发生AKI的危险因素。Objective：to investigate the clinical manifestations of acute kidney injury （AK1） in patients with paraquat poisoning, and further explore its risk factors,strive for the early diagnosis and early intervention, and to improve the prognosis. Methodology：One hundred and eighty cases with paraquat poisoning were enrolled in this retrospective study. The clinical features of paraquat poisoning patients with AKI, and further discuss its risk factors prone to AKI. Results：Among the all cases,98 patients developed AKI, and the incidence of AK1 was 54.4%. The incidence of AKI patients with dose of poisons intake 〉115 ml and 〈 15 ml was 78.2% and 13.6% respectively. It was found oliguria in 30 cases （ 16. 7% ） and proteinuria and/or hematuria 86 cases （ 87.8% ）. In the AKI patients, hypomoleculouria, casturia, glucosuria,and elevated urinary NAG was observed in 84. 6% , 15.3% ,41.8% , and 66. 3% , respectively. The pathologic features of renal biopsy specimen showed isehemie reaction of glomerlar and tubularintistial fibrosis. The mortality rate of those patients was 54. 5%, however, with and without AKI was 86. 7% and 14. 6% , respectively. After 30 days, only 13 cases with AKI were survival,azotemia was in 5 cases and ESRD in,2 cases. Conclusion：There was a higher incidence （54.4%） of AKI in patients with PQ poisoning. The morbidity of these patients was significantly correlated with AKI （ P 〈 0. 01 ）. The risk factors to the pathogenesis of AKI were early vomiting, dose of taking poison ≥ 15 ml, peripheral blood WBC elevated, CRP elevated, hypoxemia, hypotension, hyperglucose, time interval of gastric lavage deleted, time interval of blood purification deleted. Key words acute paraquat poisoning acute kindey injury clinical features

关 键 词：急性百草枯中毒 急性肾损伤 临床特征 

分 类 号：R595.4[医药卫生—内科学]