横纹肌溶解症伴急性肾损伤临床特点研究  

Clinical Study of Acute Kidney Injury Induced by Rhabdomyolysis

作　　者：单福军[1] 李鑫宇[1] 贺发贵[1] 武贵群[1] 符庆瑛[1] 马路[1] 

机构地区：[1]中国人民解放军281医院中西医结合治疗肾病中心,秦皇岛066100

出　　处：《中国中西医结合肾病杂志》2017年第9期789-791,I0004,共4页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：总后勤部十二五计划项目(No.CW12J065)

摘　　要：目的:对横纹肌溶解症(RM)伴急性肾损伤(AKI)的临床特点和治疗进行总结和探讨。方法:回顾性分析我院自2004年1月~2016年12月RM伴AKI共76例患者,记录患者的病因,AKI分型,患者血生化指标:尿素(UREA)、肌酐(CRE)、谷丙转氨酶(ALT)、谷草转氨酶(AST)、乳酸脱氢酶(LDH)、肌酸激酶(CK),肾脏病理改变,就诊时间,住院天数,住院花费,治疗转归进行比较。结果:生化指标:与尿量正常型比较,少尿型和无尿型患者的UREA、CRE、CK均显著升高(P<0.05)。肾脏病理显示:肾小球病变较轻,以肾小管病变为主。免疫荧光阴性。就诊时间:尿量正常型发病至就诊时间显著短于少尿型和无尿型(P<0.05)。治疗转归:尿量正常型全部治愈,患者住院时间(9.5±5.4)天,住院花费(2 599±769)元。少尿型2例转为慢性肾衰,患者住院时间(15.2±9.7)d,住院花费(3 278±1 020)元。无尿型3例转为慢性肾衰,2例死亡,患者住院时间(22.4±12.6)d,住院花费(20 898±11 128)元。无尿型患者住院时间显著长于少尿型和尿量正常型(P<0.05),无尿型患者住院费用显著多于少尿型和尿量正常型患者(P<0.05)。结论:RM伴AKI患者肾脏病理以肾小管病变为主,损伤具有可逆性;尿量正常者预后较好;早期就诊,及时治疗是改善预后的关键。Objective： To discuss and summarize the clinical features and treatment of acute kidney injury by rhabdomyolysis. Methods： We retrospectively analyzed 76 Cases of acute kidney injury induced by rhabdomyolysis treated in our hospital in the period of Jan. 2004 to Dec. 2016. These patients was classified as type normal,oliguria and anuric. Their urea（ UREA）,creatinine（ CRE）,alanine aminotransferase（ ALT）,aspartate aminotransferase（ AST）,lactate dehydrogenase（ LDH）,creatine kinase（ CK）,renal pathology,the visiting time,hospitalization expenses,days of hospitalization and treatment outcomes were compared.Results： UREA、CRE、CK were higher in patients with type oliguria and anuric than those with normal（ P 〈0. 05）. Renal pathology showed that glomerular lesions were mild and renal tubular lesions were dominant. Immune fluorescence negative. The visiting time was shorter in patients with type normal than those in oliguria and anuric（ P〈 0. 05）. The hospitalization time of type normal was 9.5 ± 5. 4 days,significantly shorter than the hospitalization time of oliguria and anuric（ P〈 0. 05）. The hospitalization time of type anuric was 22. 4 ± 12. 6 days,longer than the hospitalization time of oliguria and normal（ P〈 0. 05）. All the patients of type normal were cured. 1 cases of type oliguria turned into chronic renal failture and 1 cases of type anuric turned into chronic renal failture. 1 cases of type anuric died. Conclusion： Renal pathological changes were mainly caused by renal tubular lesions,and the lesions were reversible. The prognosis of patients with normal urine volume was better. Early treatment is the key to improve the prognosis.

关 键 词：横纹肌溶解症 急性肾损伤 肾脏病理 血液净化 

分 类 号：R685.5[医药卫生—骨科学]