门静脉主干内径与肝硬化并发急性肾损伤的关系研究  

The relationship between portal vein diameter and acute kidney injury in cirrhosis patients

作　　者：王旭[1,2] 张炜 吴永贵[1] 

机构地区：[1]安徽医科大学第一附属医院肾内科,合肥230022 [2]安徽医科大学附属安庆医院肾内科,安庆246003

出　　处：《安徽医科大学学报》2018年第5期778-781,共4页Acta Universitatis Medicinalis Anhui

基　　金：国家自然科学基金(编号:81301660)

摘　　要：目的探讨门静脉主干内径(PVD)与肝硬化患者并发急性肾损伤(AKI)的关系。方法选取肝硬化并发AKI患者(AKI组)84例,和肝硬化非AKI患者(对照组)60例,比较两组间PVD的水平,并分析PVD与肝硬化并发AKI的相关性;将AKI组分为门静脉高压组(PH组,PVD≥13 mm)53例和非门静脉高压组(非PH组,PVD<13 mm)31例,比较两组间的各项生理生化指标,并对比两组患者住院期间AKI进展情况及三月死亡率。结果 AKI组的PVD水平显著高于对照组,差异有统计学意义(P<0.05);多因素二元Logistic回归分析表明在控制各项危险因素后,PVD水平与肝硬化患者AKI的发病密切相关(OR=1.705,95%CI:1.345~2.154,P<0.001)。PH组Child-Pugh评分、血浆凝血酶原时间(PT)、血浆凝血酶原国际标准化比率(INR)、活化部分凝血活酶时间(APTT)均高于非PH组(P<0.05),而平均动脉压、血小板总数(PLT)、纤维蛋白原(Fib)、白蛋白(ALB)、胆碱酯酶、血钠水平均低于非PH组,差异有统计学意义(P<0.05);相关性分析显示,PVD水平与AKI组平均动脉压、ALB、胆碱酯酶、血钠呈负相关性(P<0.05);PH组患者AKI进展率及三月死亡率高于非PH组(P<0.05)。结论PVD增宽可能是肝硬化并发AKI的独立危险因素,并与住院期间AKI进展及患者预后密切相关。Objective To explore the relationship between portal vein diameter（ PVD） and acute kidney injury（ AKI） in cirrhosis patients. Methods A total of 84 cirrhosis patients with AKI（ AKI group） and 60 cirrhosis patients without AKI（ the control group） were enrolled into this study,the PVD level in groups was compared and its correlation with AKI in cirrhosis was analyzed. Then AKI group was divided into the portal hypertension group（ PH group,PVD level≥13 mm,53 patients） and non-portal hypertension group（ non-PH group,PVD level 13 mm,31 patients）,the physiological and biochemical indicators,the progression of AKI and the 3-month mortality were compared between the two groups. Results The PVD level of AKI group was significantly higher than that in control group（ P〈0.05）. Multi-factor binary logistic regression analysis showed that the PVD level was closely related to the incidence of AKI in cirrhosis patients after controlling the risk factors（ OR = 1. 705,95% CI： 1. 345 ~ 2. 154,P〈0. 001）. The Child-Pugh score,prothrombin time（ PT）,international normalized ratio（ INR）,and activated partial thromboplastin time（ APTT） of PH group were higher than those in the non-PH group（ P〈0.05）. The mean arterial pressure,the total number of platelets（ PLT）,fibrinogen（ Fib）,albumin（ ALB）,cholinesterase,serum sodium levels were lower than those in the non-PH group（ P〈0.05）. The correlation analysis showed that the PVD level was negatively correlated with the mean arterial pressure,ALB,cholinesterase and serum sodium in AKI group（ P〈0.05）. The rate of AKI progression and the 3-month mortality in PH group were higher than those in non-PH group（ P〈0.05）. Conclusion PVD broaden may be an independent risk factor for AKI in cirrhosis,and is closely related to the progression of AKI during hospitalization and prognosis of patients.

关 键 词：肝硬化 急性肾损伤 门静脉主干内径 

分 类 号：R692[医药卫生—泌尿科学] R575.2[医药卫生—外科学]