乙型肝炎肝硬化患者发生慢性肾病的影响因素分析  

Influencing factors for chronic kidney disease in patients with hepatitis B cirrhosis

作　　者：杨莉[1] 时克 高方媛[1] 冉崇平 侯杰 王宪波[1] YANG Li;SHI Ke;GAO Fangyuan;RAN Chongping;HOU Jie;WANG Xianbo(Center of Integrative Medicine,Beijing Ditan Hospital,Capital Medical University,Beijing 100015,China;The First Clinical Medical College of Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]首都医科大学附属北京地坛医院中西医结合中心,北京100015 [2]北京中医药大学第一临床医学院,北京100700

出　　处：《临床肝胆病杂志》2021年第8期1817-1821,共5页Journal of Clinical Hepatology

基　　金：首都卫生发展科研专项(2018-1-2172);北京市科学技术委员会资助(Z191100006619033);国家中医药管理局重大疑难疾病中西医临床协作试点项目(2018-6-4);国家中医药管理局区域中医诊疗中心建设项目(2019-3-18)。

摘　　要：目的探讨乙型肝炎肝硬化患者3年内发生慢性肾病(CKD)的影响因素。方法纳入2014年1月—2017年7月就诊于首都医科大学附属北京地坛医院的乙型肝炎肝硬化患者376例,随访3年,根据是否发生CKD分为CKD组(n=23)和非CKD组(n=353)。收集患者一般情况和实验室指标。计量资料两组间比较采用t检验或Mann-Whitney U检验。计数资料两组间比较采用χ^(2)检验或Fisher精确概率法。采用多因素Cox逐步向前回归方法,分析乙型肝炎肝硬化患者3年内发生CKD的独立影响因素。采用受试者工作特征曲线下面积(AUC)评估影响因素对乙型肝炎肝硬化患者发生CKD的预测价值,Kalplan-Merier法进行生存分析,log-rank检验比较不同风险患者CKD累积发生率。结果Cox多因素分析显示,年龄(HR=1.078,95%CI:1.007~1.114,P=0.026)、Alb(HR=0.923,95%CI:0.860~0.989,P=0.024)、肾小球滤过率(eGFR)(HR=0.977,95%CI:0.955~0.999,P=0.037)是乙型肝炎肝硬化患者3年内发生CKD的独立影响因素。年龄、Alb、eGFR对CKD发生的预测价值较好(受试者工作特征曲线下面积分别为0.701、0.710、0.706)。Kalplan-Merier生存曲线显示,基线年龄≥55岁、Alb<32 g/L、60 ml·min-1·1.73m-2≤eGFR<76 ml·min-1·1.73m-2的患者发生CKD的风险高(χ^(2)值分别为9.647、13.621、30.940,P值均<0.05)。结论高龄、低Alb水平及eGFR较低的患者建议密切监测肾功能。Objective To investigate the influencing factors for chronic kidney disease(CKD)in patients with hepatitis B cirrhosis within 3 years.Methods A total of 376 patients with hepatitis B cirrhosis who attended Beijing Ditan Hospital,Capital Medical University,from January 2014 to July 2017 were enrolled and followed up for 3 years,and according to the presence or absence of CKD,they were divided into CKD group with 23 patients and non-CKD group with 353 patients.Related general information and laboratory markers were collected.The t-test or the Mann-Whitney U test was used for comparison of continuous data between two groups,and the chi-square test or the Fisher’s exact test was used for comparison of categorical data between two groups;a stepwise forward Cox regression analysis was used to screen out the independent influencing factors for CKD within 3 years in patients with hepatitis B cirrhosis.The area under the receiver operating characteristic curve(AUC)was used to investigate the value of the influencing factors in predicting CKD in patients with hepatitis B cirrhosis;the Kaplan-Meier method was used for survival analysis,and the log-rank test was used for comparison of the cumulative incidence rate of CKD between the patients with different risks.Results The multivariate Cox regression analysis showed that age(hazard ratio[HR]=1.078,95%confidence interval[CI]:1.007-1.114,P=0.026),albumin(Alb)(HR=0.923,95%CI:0.860-0.989,P=0.024),and estimated glomerular filtration rate(eGFR)(HR=0.977,95%CI:0.955-0.999,P=0.037)were independent influencing factors for CKD within 3 years in patients with hepatitis B cirrhosis.Age,Alb,and eGFR had a relatively good value in predicting CKD,with AUCs of 0.701,0.710,and 0.706,respectively.The Kaplan-Meier survival curve showed that the patients with baseline age≥55 years,Alb<32 g/L,and eGFR≥60 ml·min^(-1)·1.73 m^(-2)and<76 ml·min^(-1)·1.73 m^(-2)had a higher risk of CKD(χ^(2)=9.647,13.621,and 30.940,all P<0.05).Conclusion Renal function should be closely monitored for pati

关 键 词：肝硬化 肾疾病 影响因素分析 

分 类 号：R512.62[医药卫生—内科学] R575.2[医药卫生—临床医学]