新型冠状病毒肺炎合并急性肾损伤的危险因素分析  

Risk Factors of Acute Kidney Injury in Patients with Coronavirus Disease 2019

作　　者：张巧仙[1] 杨琼秀 连宁芳[3] 王彩云[3] 金咏絮[3] 陈公平[3] ZHANG Qiaoxian;YANG Qiongxiu;LIAN Ningfang;WANG Caiyun;JIN Yongxu;CHEN Gongping(Nursing Department,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China;Obstetrics and Gynecology Department,The Third People′s Hospital of Yichang,Yichang 443003,China;Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Fujian Medical University,Fuzhou 350005,China)

机构地区：[1]福建医科大学附属第一医院护理部,福州350005 [2]宜昌市第三人民医院妇产科,宜昌443000 [3]福建医科大学附属第一医院呼吸与危重症医学科,福州350005

出　　处：《福建医科大学学报》2021年第3期237-241,共5页Journal of Fujian Medical University

摘　　要：目的探讨新型冠状病毒肺炎(COVID-19)合并急性肾损伤的危险因素。方法收集2020年2月7日-3月28日在湖北省宜昌市第三人民医院非ICU住院的COVID-19患者319例,男性173例,女性146例,年龄(51.6±16.4)岁(19~75岁)。根据入院时血肌酐水平将患者分为肌酐升高组(n=27)和未升高组(n=292)。比较2组患者的一般资料和临床特征是否存在差异。采用Logistic回归分析进一步评估影响血肌酐升高的独立危险因素。结果肌酐升高组患者的年龄、男性患者比例、呼吸困难及疾病进展比例均高于肌酐未升高组(均为P<0.05),2组患者的高血压病、糖尿病、冠状动脉粥样硬化性心脏病、脑血管疾病、慢性阻塞性肺疾病(COPD)、恶性肿瘤患者的比例差别无统计学意义(均为P>0.05)。同时,与肌酐未升高组比较,肌酐升高组患者住院期间发生急性肾损伤(AKI)的比例显著升高(P=0.038)。Logistic回归分析显示,年龄(OR=1.02,P<0.05)、男性(OR=3.32,P<0.01)和呼吸困难(OR=3.23,P<0.05)是非ICU住院COVID-19患者入院肌酐升高的独立预测因素(均为P<0.05)。结论非ICU住院的COVID-19患者,尤其是老年男性患者,血肌酐基线升高并不少见,可发生AKI;动态监测肾功能对于评估COVID-19的严重程度及疾病发展具有重要的临床价值。Objective To investigate the risk factors of kidney injury in the COVID-19 patients.Methods Patients with confirmed COVID-19 in non-ICU ward from February 7 to March 28,2020 were recruited.A total of 319 participants including 173 males and 146 females were analyzed,with mean age(51.6±16.4)years(range:19-75 years).According to the level of serum creatinine on admission,they were classified into two groups,including elevated serum creatinine group and normal serum creatinine group.The differences in clinical characteristic between two group were tested.Logistic regression analysis was conducted to obtain the independent risk factors for elevated levels of serum creatinine.Results Age,the percentage of males,and the rate of dyspnea and progression were higher in the elevated serum creatinine group that those in the normal serum creatine group with a significant difference(P<0.05).However,there was no significant difference in the percentage of underlying diseases,including hypertension,diabetes,coronary heart disease,cerebral vascular diseases,COPD,and malignant tumor(P>0.05).Compared with the normal serum creatinine group,the rate of developing to acute kidney injury during hospitalization in serum creatinine group was significantly increased.Logistic regression analysis showed that age(OR=1.02,P<0.05),male(OR=3.32,P<0.01)and dyspnea(OR=3.23,P<0.05)were the independent risk factor of elevated serum creatinine in patients with COVID-19.Conclusions COVID-19 patients with elevated serum creatinine on admission in non-ICU are not rare,especially in older male with dyspnea.Therefore,the close monitoring of kidney function in patients with elevated serum creatinine is necessary.

关 键 词：新型冠状病毒肺炎 肾损伤 危险因素 

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