脑出血患者发生急性肾损伤的危险因素及预后分析  

Incidence and mortality of acute kidney injury after cerebral hemorrhage in neurology care unit

作　　者：王睿 水华[1] 胡洪涛[1] 胡玉刚[1] 高月[1] 胡双 WANG Rui;SHUI Hua;HU Hong-tao;HUYu-gang;GAO Yue;HU Shuang(Department of Nephrology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院肾内科,武汉430071

出　　处：《临床肾脏病杂志》2018年第10期624-629,共6页Journal Of Clinical Nephrology

摘　　要：目的了解脑出血患者急性肾损伤(AKI)的发生情况、住院病死情况及其相关危险因素。方法回顾性分析2015年1月-2016年5月于武汉大学中南医院住院的354例脑出血患者的临床资料,以Logistic回归方程分析脑出血患者发生AKI及住院病死情况相关的独立危险因素,描绘ROC曲线,评价各独立危险因素对于脑出血患者AKI的发生及住院病死的预测价值。结果纳入354例脑出血患者AKI总发病率为35. 3%,AKI 1期、2期、3期发病率分别为22. 3%、5. 1%、7. 9%。脑出血患者总住院病死率为28. 3%,与非AKI组相比,AKI组患者的住院病死率显著增高(49. 6%vs. 7. 0%,P <0. 01),AKI 1期、2期、3期患者住院病死率分别为39. 2%,55. 6%,75. 0%。Logistic回归结果提示,使用利尿剂(OR=1. 796)、使用机械通气(OR=1. 728)、高急性生理与慢性健康状况评分(APACHEⅡ评分)(OR=1. 153)是脑出血患者发生AKI的独立危险因素。发生AKI(OR=5. 452)、贫血(OR=2. 786)、高龄(OR=1. 025)、高APACHEⅡ评分(OR=1. 198)是脑出血患者住院病死的独立危险因素。APACHEⅡ评分预测脑出血患者AKI的发生及住院病死均具有良好的准确性(AUC分别为0. 802,0. 864,均P <0. 01)。结论 AKI是脑出血患者常见的并发症,病死率高。重视AKI的早期筛查,尽早干预,是降低脑出血患者住院病死率有效措施。ObjectiveTo explore the incidence and mortality of acute kidney injury（AKI）in neurology care unit（NCU）am ong cerebral hem orrhage patients,and to determ ine the risk factors of the incidence of AKI and the m ortality of cerebral hem orrhage patients in NCU.M ethodsThe clinical data of 354 cerebral hem orrhage patients in NCU from January 2015 to M ay 2016 at Zhongnan hospital of W uhan University w ere collected retrospectively.Logistic regression w as done to analyze the risk factors of the incidence of AKI and the m ortality of cerebral hem orrhage patients in NCU,and then the receiver operating characteristic（ROC）curve w as used to evaluate the predictive value of these risk factors.ResultsAKI accounted for 35.3%in NCU am ong cerebral hem orrhage patients.The incidence of AKI w ith AKI stage 1,2,3 am ong patients w as 22.3%,5.1%and7.9%respectively.The total m ortality of cerebral hem orrhage patients in NCU w as 28.3%.The hospital m ortality of non-AKI patients in the NCU w as 7.0%,low er than 49.6%of AKI patients（P〈0.01）.The m ortality of AKI w ith AKI stage 1,2,3 am ong patients w as 39.2%,55.6%and 75.0%respectively.Logistic regression suggested that hydragogue（OR=1.796）,m echanical ventilation（OR=1.728）,and APAC H EⅡscores（OR=1.153）w ere the independent risk factors of AKI.AKI（OR=5.452）,anem ia（OR=2.7 6）,age（OR=1.025）,and APAC H EⅡscores（OR=1.198）w ere the independent risk factors of m ortality.For AKI and NCU m ortality,APAC H EⅡscores had the good correctness of prediction.ConclusionsAKI is a com m on com plication am ong cerebral hem orrhage patients in NCU,and can significantly increase NCU m ortality.W e should take early detection for AKI seriously and m ake early prevention,w hich m ight be effective to decrease NCU hospital m ortality.

关 键 词：脑出血 急性肾损伤 发病率 危险因素 

分 类 号：R743.34[医药卫生—神经病学与精神病学] R692[医药卫生—临床医学]