298例乙型肝炎肝硬化患者合并肾功能不全情况分析  

Clinical analysis of 298 cases of liver cirrhosis and renal dysfunction

作　　者：左璐[1] 孙凤霞[1] 王宪波[1] 王晓静[1] 刘龙[1] 杨玉英[1] 周桂琴[1] 杨莉[1] 

机构地区：[1]首都医科大学附属北京地坛医院中西医结合一科,北京100015

出　　处：《中华肝脏病杂志》2014年第7期504-508,共5页Chinese Journal of Hepatology

摘　　要：目的 利用估算的肾小球滤过率（eGFR）对北京地坛医院住院的298例乙型肝炎肝硬化患者合并肾功能不全隋况进行分析.方法 检索2011年1月至2012年7月北京地坛医院病案数据库中乙型肝炎肝硬化住院患者,排除合并高血压、糖尿病、恶性肿瘤及其他系统各种严重疾病者.比较通过血肌酐（SCr）与eGFR评价肾功能不全的一致性;比较代偿期和失代偿期患者肾功能不全情况;比较不同性别和年龄段患者肾功不全情况;筛选肾功能不全的影响因素.计量资料组间比较用t检验,多组数据比较用方差分析;计数资料比较用x2检验;Mantel-Haenszel法控制混杂变量;多因素分析采用逐步logistic回归. 结果 共筛选出符合条件的乙型肝炎肝硬化患者298例,其中代偿期患者41例,失代偿期患者257例.通过SCr评价的肾功能不全者共20例（6.7％）,依据eGFR结果评价的肾功能不全者共62例（20.8％）,两种方法评价的差异有统计学意义（x2 =42.00,P＜0.05）.肝硬化失代偿期与代偿期并发肾功能不全的患者分别为56例（21.8％）和6例（14.6％）,eGFR水平分别为（117.75±32.60） ml·min-1·（1.73 m2）-1和（112.72±24.01） ml·min-1·（1.73 m2）-1,差异均无统计学意义（P值均＞0.05）.女性患者和男性患者肾功能异常发生率分别为22.7％ （17/75）和20.2％ （45/223）,eGFR水平分别为（110.07±26.60） ml· min-1· （1.73m2）-1和（112.49±33.05）ml· min-1· （1.73 m2）-1,差异均无统计学意义（P值均＞0.05）.20 ～ 40岁组、＞40 ～ 60岁组和＞60岁组患者肾功能异常率分别为5.7％ （4/70）、22.5％ （40/178）和36.0％ （18/50）,eGFR值分别为（123.43±24.42）ml· min-1·（1.73 m2）-1、（111.18±33.57） ml· min-1·（1.73 m2）1和（98.20±27.04）ml· min-1·（1.73 m2）-1,差异均有统计学意义（P值均＜0.05）.按年龄分层后,eGFR与肝功能是否失代偿及患者性别无关（P值均＞ 0.05）.�Objective To evaluate the renal function of 298 liver cirrhosis cases among the patient population of Beijing Ditan Hospital.Methods The medical database of Beijing Ditan Hospital was retrospectively searched for patients with liver cirrhosis （compensated and decompensated）.Patients were excluded from the study according to the presence of concomitant serious diseases,such as hypertension,diabetes,and malignancies.The consistency of renal insufficiency was evaluated by the glomerular filtration rate （eGFR） or serum creatinine （SCr） level,which were applied to the simplified modification of diet in renal disease （MDRD） equation.The renal function was compared between groups stratified according to compensated/decompensated status,sex,and age.The factors affecting renal insufficiency were screened.Measurement data were compared using the t-test and count data were compared using the chi-square test.Multiple sets of data were compared using analysis of variance.Correlations were assessed using multivariate logistic regression analysis,and the confounding variables were controlled with the Mantel-Haenszel method.Results A total of 298hospitalized patients with liver cirrhosis were included in the study,among which 41 had compensated cirrhosis and 257 had decompensated cirrhosis.Twenty patients （6.7%） with renal insufficiency were identified by SCr measurement and 62 patients （20.8%） were identified by eGFR,and the number identified was significantly different between the two groups （x2 =42.00,P 〈 0.05）.Fifty-six （21.8%） patients had decompensated cirrhosis and 6 （14.6%） patients had decompensated cirrhosis with renal dysfunction; the eGFR levels for these two groups were （117.75 ± 32.60） ml·min-1·（1.73 m2）-1 and （112.72 ± 24.01） ml·min-1·（1.73 m2）-1 respectively and the difference was not statistically significant （P 〉 0.05）.The incidence of renal dysfunction among female patients was 22.7% （17/75）,and the incidence among male patients was 20.2% �

关 键 词：肝炎 乙型 慢性 肝硬化 肾功能不全 临床分析 

分 类 号：R575.2[医药卫生—消化系统] R512.62[医药卫生—内科学]