三种肾损伤标准对慢性肾脏病患儿合并急性肾损伤的诊断及预后分析  

Diagnostic and predictive values of three criterias of acute kidney injury in children with chronic kidney disease

作　　者：裴瑜馨[1] 陈丽植[1] 姜梦婕[1] 容丽萍[1] 丘原全 曾舒涵 蒋小云[1] Pei Yuxin;Chen Lizhi;Jiang Mengjie;Rong Liping;Qiu Yuanquan;Zeng Shuhan;Jiang Xiaoyun(Department of Pediatrics,the First Affiliated Hospital of Sun Yat-sen University,Guangzhou 510000,China)

机构地区：[1]中山大学附属第一医院儿科,广州510000

出　　处：《中华儿科杂志》2021年第11期942-948,共7页Chinese Journal of Pediatrics

基　　金：国家自然科学基金(81800605);广东省基础与应用基础研究基金(2019A1515011546,2019A1515010694)。

摘　　要：目的探讨3种急性肾损伤(AKI)标准对慢性肾脏病(CKD)患儿合并AKI的诊断一致性和对预后的影响。方法回顾性分析2013年1月至2019年12月中山大学附属第一医院小儿肾脏风湿专科收治的2551例CKD患儿的临床资料,分别采用2007 pRIFLE标准、2012 KDIGO标准和2018 pROCK标准对其进行AKI的诊断及分期,并调阅所有患儿出院后门诊复诊及再次入院病历资料,对所有出院患儿进行电话随访观察,随访至出院后1年,比较3种标准诊断的不同分期CKD患儿合并AKI时的临床特征及预后。根据患儿基线肌酐是否≥200μmol/L进行亚组分析。组间比较采用方差分析、Wilcoxon秩和检验、χ2检验或Fisher确切概率法,诊断一致性采用Cohen′s Kappa分析进行评价。结果2551例CKD患儿中男1628例,女923例,年龄(8±4)岁。基础疾病最常见的为肾病综合征(1412例,55.4%),然后依次为狼疮性肾炎(286例,11.2%)和紫癜性肾炎(209例,8.2%)。CKD各分期中,以G1期最为常见(2146例,84.1%),其次为G2期(221例,8.7%)。CKD患儿根据pRIFLE、KDIGO和pROCK标准诊断AKI发生率分别为33.9%(866/2551)、26.2%(669/2551)、19.5%(498/2551)(χ2=136.3,P<0.01)。3种标准诊断AKI的一致性良好(κ=0.702),但诊断分期的一致性较差(κ=0.329)。CKD G5期患儿采用3种标准进行AKI的诊断及分期的一致性均较差(均κ<0.400)。3种标准诊断为合并AKI时的住院时长、住院费用、重症监护室(ICU)住院率、住院病死率、随访1年重复入院率及CKD分期进展率均明显高于无AKI患儿(均P<0.05)。但在基线肌酐≥200μmol/L的CKD患儿中,根据pRIFLE和pROCK标准的AKI患儿住院时长明显高于无AKI患儿[(29±15)比(19±10)d,(28±14)比(19±10)d,t=-2.4、-2.6,均P<0.05],且住院费用更高[4.6(2.0,8.5)万比2.1(1.1,3.5)万元,3.8(2.4,8.1)万比2.1(1.1,3.5)万元,Z=2.6、2.8,均P<0.05];而根据KDIGO标准诊断的AKI患儿,其住院时长和住院费用与无AKI患儿差异均无统计学意义(均P>0.05)。�Objective To compare the consistency in diagnosing and staging acute kidney injury(AKI)in children with chronic kidney disease(CKD)according to three criterias.Methods Children with CKD hospitalized in the First Affiliated Hospital of Sun Yat sen University from January 2013 to December 2019 were analyzed retrospectively.These patients underwent serum creatinine examination more than twice during hospitalization.The AKI diagnosis and staging were performed for each patient according to the 2007 pRIFLE,2012 KDIGO and 2018 pROCK criteria respectively.All the children were followed up for 1 year after discharge through outpatient visit,re-hospitalization or online consultation.The clinical characteristics and prognosis of CKD children with or without AKI that were diagnosed by 3 criteria were compared.Analysis of variance and chi-squared tests were used for the comparison among groups.Concordance between the different diagnostic criteria was evaluated using Cohen′s kappa coefficient.Result A total of 2551 children with CKD were included in this study,with an age of(8±4)years.There were 1628 boys and 923 girls.Nephrotic syndrome was the most prevalent primary disease(55.4%),followed by lupus nephritis(11.2%)and purpura nephritis(8.2%).Among all stages of CKD,CKD category G1 was the most common type(2146 cases,84.1%),followed by CKD category G2(221 cases,8.7%).AKI occurence rates according to pRIFLE,KDIGO and pROCK criteria were 33.9%(866/2551),26.2%(669/2551)and 19.5%(498/2551)respectively(χ²=136.3,P<0.01).The diagnostic consistency within three criteria for AKI was high in children with CKD(κ=0.702),but AKI staging consistency was low(κ=0.329).Both the diagnosis and staging consistency of three AKI criteria were poor in children with CKD category G5(allκ<0.400).The length of hospital stay(LOS),hospitalization costs,the occurence of intensive care unit(ICU)admission and in-hospital mortality were significantly higher in children with AKI diagnosed by different criteria(P<0.05).After 1-year follow-up,the repea

关 键 词：儿童 肾功能衰竭 慢性 诊断 急性肾损伤 

分 类 号：R726.9[医药卫生—儿科]