改善全球肾脏病预后工作组标准对I型心肾综合征预后的判断价值  

KDIGO criteria is superior for prognosis of cardiorenal syndrome type I

作　　者：蔡璐[1] 梁馨苓[1] 李志莲[1] 陈源汉[1] 安胜利[2] 董伟[1] 谭宁[3] 黎励文[1] 史伟[1] 

机构地区：[1]广东省人民医院肾内科广东省医学科学院,广州510080 [2]南方医科大学 [3]广东省心血管病研究所

出　　处：《中华肾脏病杂志》2013年第11期797-802,共6页Chinese Journal of Nephrology

基　　金：广州市科技计划项目（2013J4100064）

摘　　要：目的评估改善全球肾脏病预后工作组（KDIGO）的急性肾损伤（AKI）标准在预测I型心肾综合征（CRS）患者短期预后的价值，并与危险、损伤、衰竭、肾功能丧失、终末期肾病（RIFLE）工作组和急性肾损伤网络工作小组（AKIN）的标准进行对比分析。方法收集2005年7月至2012年7月广东省人民医院急性心力衰竭（AHF）患者的临床资料。以院内死亡为观察终点，入院首次血肌酐（Scr）为基线Scr，采用Kaplan—Meier曲线评估KDIGO、RIFLE、AKIN的AKI诊断标准，测算KDIGO诊断但RIFLE或AKIN漏诊的I型CRS患者的院内病死率，采用Cox回归分析I型CRS患者院内死亡的危险因素。结果共732例AHF患者入组，RIFLE或AKIN标准漏诊例数154例（21．0％）。KDIGO标准与RIFLE、AKIN标准在判断I型CRS发生率的差异有统计学意义（54．7％比38．6％，54．7％比50．1％，均P〈0．01）。Kaplan—Meier生存分析结果显示，KDIGO诊断而RIFLE或AKIN漏诊的AKI患者院内存活率低于未发生AKI患者（LogrankP=0．011）。Cox回归分析表明，KDIGO诊断但RIFLE或AKIN漏诊的AKI是I型CRS患者院内死亡的独立危险因素（P〈0．01）。结论KDIGO标准在预测I型CRS患者短期院内病死率方面优于RIFLE、AKIN标准。Objective To evaluate if KDIGO （kidney disease： improving global outcomes） criteria for short-term prognosis of cardiorenal syndrome type I was superior to RIFLE （risk, injury, failure, loss of kidney function, end-stage kidney disease） and AKIN （the acute kidney injury network） criteria. Methods Data was retrospectively collected from patients with acute heart failure in Guangdong General Hospital between July 2005 and July 2012. The in-hospital mortality was regarded as outcome measures. Baseline serum creatinine was defined as first serum creatinine on admission. Kaplan-Meier curve was used to evaluate in-hospital survival by three AKI criteria and AKI by KDIGO but not RIFLE or AKIN in patients with cardiorenal syndrome type I. Cox regression was used for multivariate analysis of in-hospital mortality. Results Among 732 patients, 154 cases （21%） were diagnosed as AKI by KDIGO instead of RIFLE or AKIN. Incidence for the cardiorenal syndrome type I by KDIGO, RIFLE and AKIN were significantly different （54.7% vs. 38.6%, 54.7% vs 50.1%, P 〈 0.001）. Kaplan-Meier curve showed that in-hospital survival rates of patients with AKI diagnosed by KDIGO but not RIFLE or AKIN are lower than those without AKI （Log rank P--O.011）. Cox regression indicated that AKI by KDIGO but not RIFLE or AKIN was an independent risk factor of in-hospital mortality （P=0.008）. Conclusion KDIGO criteria is superior to RIFLE and AKIN criteria on predicting in-hospital mortality of cardiorenal syndrome type I.

关 键 词：急性肾损伤 急性心力衰竭 KDIGO标准 RIFLE标准 AKIN标准 

分 类 号：R541.7[医药卫生—心血管疾病] R692.3[医药卫生—内科学]