老年人横纹肌溶解症的临床特点及病因分析  

Clinical characteristics and etiological analysis of rhabdomyolysis in the elderly

作　　者：陈曦[1] 邹琪[2] 张新超[1] Chen Xi;Zou Qi;Zhang Xinchao(Department of Emergency,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China;Department of Hospital Infection Control,Beijing Hospital,National Center of Gerontology,Institute of Geriatric Medicine,Chinese Academy of Medical Sciences,Beijing 100730,China)

机构地区：[1]北京医院急诊科,国家老年医学中心,中国医学科学院老年医学研究院,100730 [2]北京医院医院感染管理处,国家老年医学中心,中国医学科学院老年医学研究院,100730

出　　处：《中华老年医学杂志》2021年第1期87-91,共5页Chinese Journal of Geriatrics

摘　　要：目的探讨老年人横纹肌溶解症的病因、并发症与预后关系。方法回顾性分析我院急诊科2018年1月1日至2019年12月31日横纹肌溶解患者,根据年龄分为非老年组(<65岁)及老年组(≥65岁),对比两组患者病因分布情况、合并急性肾损伤(AKI)及其与预后的关系。结果老年组2种及以上病因导致横纹肌溶解患者(40.3%、48/119)明显多于非老年组(17.0%、16/94)(χ2=13.582,P=0.000)。两组患者的病因排序有所不同,老年组患者前5位依次为感染、肌缺血/氧、内分泌代谢异常、创伤、肌疲劳,而非老年组患者为肌疲劳、感染、内分泌代谢异常、药物/毒物、创伤。与非老年组48.9%(46/94)的患者出现典型横纹肌溶解临床表现相比,老年组患者32.8%(39/119)出现典型临床表现(χ2=5.067,P=0.024),反之,老年组患者有40.3%(48/119)表现新发意识障碍,而非老年组患者仅21.3%(20/94)(χ2=7.923,P=0.005)。老年组37例患者出现AKI(38.9%、37/95),其中死亡13例(35.1%);非老年组17例出现AKI(19.3%、17/88),其中死亡4例(23.5%);老年组更易合并AKI(χ2=7.545,P=0.006),且AKI与不良预后有显著相关性(χ2=7.196,P=0.007)。结论老年患者多病因共同导致横纹肌溶解较非老年患者明显增多,老年人横纹肌溶解病因分类与非老年组有不同之处,老年组患者较少出现典型横纹肌溶解临床表现,更易合并AKI,且老年横纹肌溶解合并AKI患者预后不良。Objective To investigate the relationship of etiology and complications of rhabdomyolysis with its prognosis in the elderly.Methods Patients with rhabdomyolysis at the emergency department of our hospital from January 1,2018 to December 31,2019 were retrospectively analyzed.Based on age,patients were divided into the non-elderly group(<65 years old)and the elderly group(≥65 years old).The frequency distribution of etiological factors,concurrent acute kidney injury,and their association with prognosis were analyzed.Results The number of patients with rhabdomyolysis caused by 2 or more etiologies was higher in the elderly group than in the non-elderly group(40.3%or 48/119 vs.17.0%or 16/94,χ2=13.582,P=0.000).The frequency distribution of etiological factors was different between the two groups.The top-five etiologies were infection,muscle ischemia/hypoxia,endocrine metabolic abnormalities,trauma and muscle fatigue in the elderly group and muscle fatigue,infection,endocrine metabolic abnormalities,drugs/toxicants and trauma in the non-elderly group.Compared with the non-elderly group,the elderly group had fewer patients with typical clinical manifestations(32.8%or 39/119 vs.48.9%or 46/94,χ2=5.067,P=0.024).In contrast,patients who newly presented with disturbance of consciousness were more likely to be found in the elderly group than in the non-elderly group(40.3%or 48/119 vs.21.3%or 20/94)(χ2=7.923,P=0.005).There were 37 patients with AKI(38.9%or 37/95)in the elderly group and 13 of them died(35.1%),and there were 17 patients with AKI in the non-elderly group(19.3%or 17/88)and 4 died(23.5%),indicating the elderly were prone to AKI(χ2=7.545,P=0.006).There was a significant correlation between AKI and prognosis in the non-elderly group(χ2=7.196,P=0.007).Conclusions Rhabdomyolysis caused by multiple etiologies is more common in elderly patients than in non-elderly patients.The etiological classification of rhabdomyolysis in the elderly is different from that in the non-elderly.Elderly patients are less likely to

关 键 词：横纹肌溶解 病因 肾功能不全 

分 类 号：R685.5[医药卫生—骨科学]