新型冠状病毒肺炎下肾脏损伤相关的Meta分析  

Kidney damage in coronavirus disease 2019: a meta-analysis

作　　者：李天宇 甘文渊 陈文莉 Li Tianyu;Gan Wenyuan;Chen Wenli(Department of Clinical Medicine,School of Medicine,Jianghan University,Wuhan 430056,China;Department of Nephrology,Wuhan Central Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430014,China)

机构地区：[1]江汉大学医学院临床医学系,武汉430056 [2]华中科技大学同济医学院附属武汉市中心医院肾内科,武汉430014

出　　处：《中华肾脏病杂志》2021年第6期499-506,共8页Chinese Journal of Nephrology

摘　　要：目的评价肾脏损害对新型冠状病毒肺炎(coronavirus disease 2019,COVID-19)患者病情进展及预后的影响。方法全面检索中国知网、万方中国学术期刊库、Pubmed、EMBASE和Cochrane数据库,检索时段设定为2019年12月至2020年6月。对文献进行资料提取,应用RevMan 5.2进行分析。结果纳入文献15篇,共计COVID-19病例11448例。Meta分析结果显示,COVID-19患者合并急性肾损伤(acute kidney injury,AKI)后接受重症监护病房(intensive care unit,ICU)治疗的比例明显高于未合并AKI患者(OR=10.83,95%CI 9.43~12.45,Z=33.53,P<0.001),其中,亚洲组COVID-19患者合并AKI占比3.4%,接受ICU治疗占比74.1%,亚组分析显示亚洲组COVID-19患者合并AKI后接受ICU治疗的比例明显高于未合并AKI患者(OR=18.66,95%CI 9.85~35.34,Z=8.98,P<0.001);欧美组COVID-19患者合并AKI占比36.5%,接受ICU治疗的占比53.3%,亚组分析显示欧美组COVID-19患者合并AKI后接受ICU治疗的比例明显高于未合并AKI患者(OR=10.58,95%CI 9.18~12.21,Z=32.40,P<0.001);COVID-19合并AKI患者的死亡风险明显高于未合并AKI患者(OR=56.46,95%CI 15.86~200.96,Z=6.23,P<0.001);COVID-19合并肾损害患者病情恶化及死亡的风险高于未合并肾损害患者(OR=6.40,95%CI 4.14~9.90,Z=8.36,P<0.001),亚组分析显示COVID-19合并尿蛋白阳性患者病情恶化及死亡的风险高于未合并尿蛋白阳性患者(OR=6.27,95%CI 3.88~10.14,Z=7.49,P<0.001),COVID-19合并血肌酐升高患者病情恶化及死亡的风险高于未合并血肌酐升高患者(OR=7.13,95%CI 2.58~19.72,Z=3.79,P<0.001)。结论COVID-19患者合并AKI或仅是合并尿蛋白阳性、血肌酐升高都是病情加重甚至死亡的危险因素,建议在COVID-19患者的诊疗上,通过优化诊疗方案,避免或减少可能增加肾脏负担的措施,并密切关注患者的肾脏损伤情况,在肾脏损伤出现的早期即予以保护和治疗,避免AKI的发生。对已发生的AKI,应及时予以替代治疗,缓解肾脏损害,避免患者病�Objective To assess the impact of kidney damage on the progression and prognosis of coronavirus disease 2019(COVID-19)patients.Methods The databases including CNKI,Wanfang Chinese Academic Journal Database,Pubmed,EMBASE and Cochrane databases were searched.The data retrieval period was from December 2019 to June 2020.During this period,RevMan 5.2 was used to extract and analyze data from the literature.Results In this study,15 articles,covering 11448 COVID-19-related cases,were selected from the target databases.Meta-analysis results indicated that,for COVID-19 patients with acute kidney injury(AKI),the proportion of COVID-19 patients with AKI who received intensive care unit(ICU)treatment was significantly higher than that of patients without AKI(OR=10.83,95%CI 9.43-12.45,Z=33.53,P<0.001).Among them,the Asian group of COVID-19 patients with AKI accounted for 3.4%of all COVID-19 patients.The Asian group of COVID-19 patients with AKI who received ICU treatment accounted for 74.1%of all COVID-19 patients with AKI.Meta-analysis showed that the proportion of COVID-19 patients with AKI in the Asian group receiving ICU treatment was significantly higher than that of COVID-19 patients without AKI(OR=18.66,95%CI 9.85-35.34,Z=8.98,P<0.001).COVID-19 patients with AKI in the European and American groups accounted for 36.5%of all COVID-19 patients,and the European and American groups of COVID-19 patients with AKI who received ICU treatment accounted for 53.3%of all COVID-19 patients with AKI.Meta-analysis showed that the proportion of COVID-19 patients with AKI in the European and American groups receiving ICU treatment was significantly higher than that of COVID-19 patients without AKI(OR=10.58,95%CI 9.18-12.21,Z=32.40,P<0.001).The death risk of COVID-19 patients with AKI was significantly higher than that of patients without AKI(OR=56.46,95%CI 15.86-200.96,Z=6.23,P<0.001).COVID-19 patients with renal impairment had a higher risk of worsening and death than those without renal impairment(OR=6.40,95%CI 4.14-9.90,Z=8.36,P<0.0

关 键 词：急性肾损伤 蛋白尿 META分析 新型冠状病毒肺炎 血肌酐 

分 类 号：R563.1[医药卫生—呼吸系统] R692[医药卫生—内科学]