RIFLEAKIN和KDIGO诊断标准在百草枯中毒急性肾损伤中的应用  

Application of RIFLE, AKIN and KDIGO diagnosis criteria in acute kidney injur y in patients with paraquat poisoning

作　　者：汤永静 王菱[2] 李昌斌[2] 薛闻[2] 胡大勇[2] 李新华[2] 彭艾[1,2] 

机构地区：[1]安徽医科大学上海十院临床学院,安徽合肥230032 [2]同济大学附属上海第十人民医院肾脏风湿科,上海200072

出　　处：《中国实用内科杂志》2016年第1期53-56,共4页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(81301626;81171792;81270136;81101414)

摘　　要：目的探讨RIFLE、AKIN和KDIGO三种急性肾损伤(AKI)诊断标准对百草枯(PQ)中毒患者AKI的诊断效率及其对预后的预测能力。方法以2010年11月至2014年11月在上海市第十人民医院肾脏科就诊的PQ中毒患者为研究对象,采用前瞻性队列研究,根据AKI三种诊断标准,将患者分为AKI组和非AKI组,并根据不同诊断标准将AKI组进一步分期,比较三种诊断标准对预后的预测能力。结果 PQ中毒患者中,AKIN标准诊断AKI的发生率(29.7%,30/101),明显低于RIFLE(48.5%,49/101)和KDIGO(52.5%,53/101)(P<0.05)标准。三种诊断标准中,AKI组患者的生存率均较非AKI组明显降低(P<0.001)。不同诊断标准中,随着AKI分期水平的增加生存率逐渐降低,但差异无统计学意义(P>0.05)。AKIN对患者预后的预测能力明显低于RIFLE和KDIGO(AUC:AKIN=0.674,RIFLE=0.816,KDIGO=0.831,P<0.05),而RIFLE和KDIGO之间差异无统计学意义(P>0.05)。结论 RIFLE和KDIGO诊断标准均适用于PQ中毒患者AKI的诊断及预后的预测,而AKIN标准的诊断效率及对预后的预测能力均较差。AKI可作为PQ中毒患者预后的评估指标。Objective To compare diagnostic efficiencies and predictive abilities of KIFLE, AKIN and KDIGO criteria in acute kidney injury （AKI） in patients with paraquat （PQ） poisoning. Methods A prospective cohort study was conducted in patients with PQ poisoning admitted to Shanghai Tenth People＇s Hospital from November 2010 to November 2014. Based on RIFLE, AKIN and KDIGO criteria, all the patients were divided into AKI group and non-AKI group, and all the patients in AKI group were dassified into different stages. After 90-day follow-up period, the Chi-square tests were used to compare the mortality rates and AKI incidence rates among different groups. Survival curves were derived by Kaplan-Meier method. The area under curves （AUCs） analysis was used to compare the predictive ability for mortality among three different AKI criteria. Results In patients with PQ.poisoning, the incidence rate of AKI （29.7%, 30/101） according to AKIN criterion was significantly lower than RIFLE （48.5%, 49/101） and KDIGO （52.5%, 53/101） （P〈0.05）. The survival rates of patients in AKI groups were significantly lower than non-AKI groups （P〈0.001）. Survival rates decreased along with the increase of AKI stage according to all. the criteria, but there were no significant statistical differences among stages （P〉0.05）. The predictive ability of AKIN criterion （AUC=0.674） was significantly lower than RIFLE （AUC=0.816） and KDIGO （AUC=0.831） （P〈0.05）, while there was no significant difference between RIFLE and KDIGO （P〉0.05）. Conclusion In pQpoisoning, RIFLE and KDIGO criteria can be used to diagnose AKI and predict prognosis, but AKIN has lower diagnostic efficiency and predictive ability. AKI can be a promising indicator for prognosis and evaluation in PQ_poisoned patients.

关 键 词：急性肾损伤 百草枯中毒 RIFLE诊断标准 AKIN诊断标准 KDIGO诊断标准 

分 类 号：R692[医药卫生—泌尿科学]