新疆地区急性肾损伤的流行病学调查  

Acute kidney injury in Xinjiang： a cross-sectional survey

作　　者：王顺[1] 杨磊[2] 周萍 王海瑛[4] 廖汉文[5] 贾新霞 刘健[1] 李素华[1] Wang Shun;Yang Lei;Zhou Ping;Wang Haiying;Liao Hanwen;Jia Xinxia;Liu Jian;Li Suhua(Department of Nephrology, the First Affiliated Hospital of Xinjiang Medical University, Urumqi 830054, Chin)

机构地区：[1]新疆医科大学第一附属医院肾病科,乌鲁木齐830054 [2]新疆维吾尔自治区人民医院北院骨二科 [3]新疆库尔勒市第一人民医院肾病科 [4]新疆和田地区人民医院肾病科 [5]新疆伊犁州友谊医院肾病科 [6]新疆昌吉州中医医院肾病科

出　　处：《中华肾脏病杂志》2018年第5期340-347,共8页Chinese Journal of Nephrology

基　　金：新疆维吾尔自治区自然科学基金（2015211C069）;新疆库尔勒市科技计划项目（2016-19）

摘　　要：目的了解新疆地区住院患者AKI发生的病因、疾病特征、临床诊治情况和预后情况，分析影响AKI患者预后的危险因素。方法回顾性、多中心调查新疆地区4家综合性医院2013年1月和7月收治的住院患者临床资料，按照2012年全球肾脏病预后组织（KDIGO）AKI诊断标准筛选入选者。收集AKI患者的人口学、临床资料、实验室检查、治疗措施及预后等资料。多因素二分类Logistics回归模型分析AKI漏诊的危险因素；多因素Cox回归模型分析AKI患者预后的危险因素。结果32157例成人住院患者中，AKI患者722例，排除资料不完整者，最终719例AKI患者纳入本研究，AKI总检出率为2．25％（722／32157）。AKI主要病因类型为肾前性，主要致病因素为心搏出量减少和血容量不足，其次为肾毒性药物的使用。AKI总漏诊率为72．4％（407／557）。多因素二分类Logistics回归分析结果显示，AKI分期、周围血管扩张、肾实质性因素（包括肾血管疾病、肾小球疾病、急性间质性肾炎、急性肾小管坏死等）是AKI漏诊的保护性因素。短期预后分析中，总体死亡率为12．8％（92／719）。出院时存活的AKI患者中，收集到有效数据者323例。上述AKI患者中，肾功能恢复者占43．7％（141例）；肾功能未完全恢复，但未持续透析的患者占40．2％（130例）；出院时仍在接受维持性透析的患者占16．4％（53例）。多因素Cox回归模型分析结果提示，合并DIC及休克是AKI住院期间死亡的独立危险因素，妇产科AKI患者死亡风险高于其他科室。结论新疆地区住院患者AKI主要病因类型为肾前性，主要致病因素为心搏出量减少和血容量不足。AKI的漏诊情况严重。AKI分期、周围血管扩张、肾实质性疾病等因素是AKI漏诊的保护性因素。合并DIC、休克及妇产科住院是AKI住院期间死亡的独立危险因素。Objective To evaluate the etiology, epidemiological characteristics, clinical diagnosis, and outcomes of hospitalized patients with AKI in Xinjiang, analyzing the risk factors of their clinical prognosis. Methods A muhicenter retrospective survey was conducted, investigating adult patients admitted to four hospitals in Xinjiang in January and July 2013. Patients with AKI were screened out based on KDIGO＇s inclusion and exclusion criteria. Clinical variables of patients with AKI including demographics, clinical data, laboratory tests, treatment measures and prognosis were collected. Results Among 32,157 adult hospitalized patients, there were 722 AKI patients. Excluding those with incomplete data, 719 patients were enrolled in this study. The detection rate of AKI was 2.25% （722 of 32,157） by KDIGO criteria. The main cause for AKI was pre-renal iniury, led mainly by cardiac output, low blood volume, and the use of nephrotoxic drugs. The non-recognition rate of AKI was 72.4% （407/557）. Multivariate binary logistic regression analysis showed that AKI stage, peripheral vasodilation and renal parenchyma were protective factors of the omission diagnosis. In the short-term prognostic analysis, the overall mortality rate was 12.8%（92/719）. Among the 323 patients with AKI who survived discharge, 43.7%（141） had renal function recovery; 40.2%（130） did not fully recover their renal function but ceased maintenance dialysis; 16.4% （53） were still on dialysis at discharge. Multivariate Cox regression model suggested that DIC, shock and department of obstetrics were independent risk factors for death during hospitalization of AKI. In addition, the risk of death for AKI from department of obstetrics and gynecology patients was higher than that of other departments. Conclusions The most common reason for AKI in hospitalized patients in Xinjiang was pre- renal injury. The main risk factors were low cardiac output and low blood volume. The omission diagnosis of AKI was serious; AKI stage, peripheral vasodil

关 键 词：肾功能不全 急性 诊断 预后 病因 

分 类 号：R692[医药卫生—泌尿科学]