原发性肾病综合征并发急性肾损伤的危险因素分析的病例对照研究  

Risk Factors for Primary Nephrotic Syndrome Complicated by Acute Kidney Injury Analysis

作　　者：张美娟 朱斌[1] 朱彩凤[1] 裘怡[1] 袁博寒[1] 孙玥[1] 刘玲 李先法[1] 毛俐婵[1] 李秋芬[1] 程晓霞[1] 陈洪宇[1] ZHANG Meijuan;ZHU Bin;ZHU Caifeng(Department of Nephrology,Guangxing Hospital Affiliated to Zhejiang University of Traditional Chinese Medicine,Hangzhou,310007)

机构地区：[1]浙江省中医药大学附属广兴医院(杭州市中医院)肾内科,杭州310007

出　　处：《中国中西医结合肾病杂志》2018年第11期960-964,共5页Chinese Journal of Integrated Traditional and Western Nephrology

基　　金：浙江省基础公益项目(No.LGF18H050005);浙江省医药卫生科技计划项目(No.2015KYA191);杭州市科技发展计划项目(No.20140733Q33);浙江省中医药科技计划项目(No.2013ZA091)

摘　　要：目的:探索原发性肾病综合征(primary nephrotic syndrome,PNS)并发急性肾损伤(acute kidney injury,AKI)的危险因素分析,以便在疾病的发生发展过程中,尽早针对性地干预防治危险因素,利于改善预后、肾功能的恢复以及提高患者生存率等。方法:采用病例对照研究方法,收集共136例原发性肾病综合征患者,其中61例患者并发急性肾损伤,75例患者非急性肾损伤患者,包括一般资料、实验室指标、病理资料等,分析各项指标与原发性肾病综合征患者是否并发急性肾损伤的相关性。结果:(1)本次研究结果显示,原发性肾病综合征的各种病理类型均可发生急性肾损伤,其中尤以系膜增生性肾小球肾炎、膜性肾病为多见,占全体原发性肾病综合征并发急性肾损伤患者的91. 6%。(2)在原发性肾病综合征患者疾病的发展过程中,大量蛋白尿、血白蛋白水平下降、血尿酸水平升高可能诱发该患者发生急性肾损伤。(3)通过二分类Logistic回归分析,24 h尿蛋白定量(β=0. 368,OR=1. 444,P <0. 05),血尿酸升高(β=0. 013,OR=1. 013,P <0. 05),感染(β=2. 091,OR=8. 092,P <0. 05)是原发性肾病综合征患者并发急性肾损伤的危险因素。结论:感染、大量蛋白尿、血尿酸水平升高是原发性肾病综合征患者并发急性肾损伤的独立危险因素。Objective: To explore risk factors of acute kidney injury in primary nephrotic syndrome. So that we could avoid the development of these risk factors or intervene these risk factors early to improve the prognosis,the recovery of renal function and the survival rate. Methods: In his matched Case-control study,we collected a total of 136 patients with primary nephrotic syndrome,of which 61 patients complicated with acute kidney injury and 75 cases of patients without acute kidney injury,including general clinical information,laboratory indexes and pathological data,to analyze the risk factors to develop acute kidney injury in nephrotic syndrome patients. Results: The results shown( 1) Various pathological types of primary nephrotic syndrome complicated with acute kidney injury,especially in mesangial proliferative glomerulonephritis and membranous nephropathy,which was at proportion of 91. 6%for primary nephrotic syndrome complicated with acute kidney injury.( 2) Heavy proteinuria,lower serum albumin levels and elevated levels of uric acid were associated with increased risk of acute kidney injury.( 3) Through the binary logistic regression analysis,we found that 24 hours urinary protein quantitative( β = 0. 368,OR = 1. 444,P < 0. 05),serum uric acid( β = 0. 013,OR = 1. 013,P <0. 05),and infection( β = 0. 013,OR = 1. 013,P < 0. 05) in patients with primary nephrotic syndrome were independent risk factors for acute kidney injury. Conclusion: Infection,heavy proteinuria,elevated serum uric acid levels and infection were the risk factors for acute kidney injury in the patients with primary nephrotic syndrome.

关 键 词：原发性肾病综合征 急性肾损伤 危险因素 

分 类 号：R692[医药卫生—泌尿科学]