急性肾损伤患者远期肾脏预后的分析  

Analysis of long-term renal outcome in patients after acute kidney injury

作　　者：张小红[1] 洪聪敏 邹臻寰[1] 李镇洲[1] 林佳群 万建新[1] 

机构地区：[1]福建医科大学附属第一医院肾内科,福州350005

出　　处：《中华肾脏病杂志》2017年第11期801-807,共7页Chinese Journal of Nephrology

基　　金：国家十二五科技支撑计划项目（2011BA110807）

摘　　要：目的追踪基础肾功能正常的住院患者发生急性肾损伤后的远期肾脏预后，并分析影响预后的临床特征及危险因素。方法回顾性分析166例基础肾功能正常且于2011年1月1日至2014年12月31日在福建医科大学附属第一医院住院期间发生AKI并存活出院患者的临床资料。所有患者于出院后至少随访2年，按2年后肾功能状态将其分成恢复组及未恢复组，对比其临床特征，并用多因素Logistic回归分析影响AKI远期肾脏预后的危险因素，进一步计算随访期间肾功能出现恶化的比例。结果共有166例患者纳入研究，其中男性114例，女性52例，平均年龄（58．1±16．6）岁。AKI1期87例，AKI2期39例，AKI3期40例。肾前性因素37例，。肾性因素113例，肾后性因素16例。出院时肾功能未恢复（P=0．002，OR=2．980）、发生AKI事件时合并感染（P=0．003，OR=2．786）是随访2年后肾功能未恢复的危险因素。出院时肾功能完全恢复组84例，出院1年后随访肾功能发现14．3％的患者（12例）进展至CKD3期及以上，2年后23．8％的患者（20例）进展至CKD3期及以上；出院时部分恢复组54例及进展组28例，1年后分别有40．7％的患者（22例）及42．9％的患者（12例）进展至CKD3期及以上，2年后分别有51．9％的患者（28例）及57．1％的患者（16例）进展至CKD3期及以上。结论发生AKI事件时合并感染、出院时肾功能未恢复是AKI后肾功能进展的危险因素。AKI后即使。肾功能完全恢复正常，仍有可能进展至CKD，需加强随访观察。Objective To follow up the longterm prognosis of acute kidney injury （AKI） patients with normal basic renal function, and to further identify the clinical features as well as risk factors associated with the prognosis of AKI patients. Methods Clinical date of 166 patients who occurred AKI episode during hospitalization from Jan 1 2011 to Dec 31 2014 in The First Affiliated Hospital of Fujian Medical University were retrospectively analyzed. All these patients had normal basic renal function and had follow-up of more than two years after discharge. According to their renal function after two years, patients were divided into recover and non-recover group. The clinical features and risk factors associated with the prognosis of AKI patients were identified using multivariate logistic regression, and the proportion of renal function progression was calculated during follow-up period. Results One hundred and sixty-six patients were enrolled in this observational study, including 114 male, 52 female with an average age of 58.1± 16.6. Eighty-seven patients were AKI stage 1, 39 AKI stage 2, and 40 AKI stage 3. Thirty-seven patients were caused by pre-renal factors, 113 patients by renal causes and 16 patients by post-renal causes. Renal function when discharged （P=0.O02, OR= 2.980） and infection （P=0.003, OR=2.786） were the risk factors of failing to restore after two years.Eighty-four patients＂ renal function returned to normal when discharged, but the number of patients whose renal function progressed to CKD 3 stage and even worse 1 year and two years later were 12 （14.3%） and 20 （23.8%） respectively. Fifty-four patients were diagnosed as partial recovery and 28 patients as non-recovery when discharged. One year later 22 （40.7%） and 12 （42.9%） patients＂ renal function progressed to CKD 3 stage and more, while those numbers became 28 （51.9%） and 16 （57.1%） two years later. Conclusions The risk factors of AKI long-term outcome include unrecovered renal function when discharged and

关 键 词：急性肾损伤 预后 肾功能不全 慢性 危险因素 

分 类 号：R692[医药卫生—泌尿科学]