重症狼疮性肾炎CRRT后行维持性血液透析治疗的疗效影响因素  

Factors of Influencing Efficacy of Maintenance Hemodialysis after CRRT in Severe Lupus Nephritis

作　　者：王震霓 张强 罗磊 WANG Zhen-ni;ZHANG Qiang;LUO Lei(Nephrology Endocrinology Department,Yulin Xingyuan Hospital,Yulin Shaanxi 719000)

机构地区：[1]榆林市星元医院肾病内分泌科,陕西榆林719000 [2]渭南市中心医院重症医学科,陕西渭南714000 [3]陕西省核工业二一五医院肾内科,陕西咸阳712000

出　　处：《医学临床研究》2022年第11期1676-1679,共4页Journal of Clinical Research

摘　　要：【目的】探讨重症狼疮性肾炎(LN)患者连续性肾脏替代治疗(CRRT)后行维持性血液透析(MHD)治疗的疗效影响因素。【方法】140例重症LN患者,均行CRRT后以MHD治疗,依据MHD治疗6个月后患者的临床结局,分为继续透析组(n=57)与摆脱透析组(n=83)。记录患者入组时的一般资料,比较两组患者MHD治疗前的血清肌酐(Scr)、血尿素氮(BUN)、24 h尿蛋白定量(24hpro)、血清补体C3和C4水平及抗双链DNA抗体(抗dsDNA)、抗核抗体(ANA)阳性率,计算并统计患者在MHD治疗6个月内的残余肾功能(RRF)与尿素清除率(Kt/V)。分析患者行MHD治疗6个月后仍需继续透析治疗的预测指标和影响因素。【结果】两组性别、是否合并糖尿病、BUN、血清补体C3和C4水平,抗dsDNA阳性、ANA阳性率相比较,差异均无统计学意义(P>0.05);继续透析组年龄、Scr、24hpro水平均显著高于摆脱透析组,RRF、Kt/V均显著低于摆脱透析组(P<0.05)。经受试者工作特征(ROC)曲线分析,年龄、Scr、24hpro、RRF、Kt/V预测重症LN患者仍需继续透析治疗的曲线下面积分别为0.751、0.651、0.944、0.919、0.834(均P<0.05)。经多因素Logistic回归分析证实,年龄>57.09岁、Scr>461.13μmol/L、24hpro>3.405 g/24 h、RRF<7.150 mL/min、Kt/V<1.225是患者仍需继续透析治疗的影响因素(P<0.05)。【结论】年龄、Scr、24hpro、RRF、Kt/V是重症LN患者行CRRT并以MHD治疗6个月后仍需继续透析治疗的影响因素,值得临床关注。【Objective】To investigate the influencing factors of maintenance hemodialysis(MHD)after continuous renal replacement therapy(CRRT)in patients with severe lupus nephritis(LN).【Methods】A total of 140 patients with severe LN were treated with MHD after CRRT in our hospital.According to the clinical outcome of treatment with MHD for 6 months,patients were divided into the continuous dialysis group(n=57)and the dialysis free group(n=83).General data of patients at the time of enrollment were recorded.Serum creatinine(SCR),blood urea nitrogen(BUN),24-hour urine protein quantification(24hpro),serum complement C3 and C4 levels,and the positive rates of anti-double stranded DNA antibody(anti dsDNA)and anti-nuclear antibody(ANA)of patients in the two groups before MHD treatment were compared.The residual renal function(RRF)and urea clearance rate(Kt/V)of patients within 6 months after MHD treatment were calculated.The predictive indicators and influencing factors of patients who still need to continue dialysis after 6 months of MHD treatment were analyzed.【Results】There were no significant differences in gender,diabetes mellitus,BUN,serum complement C3 and C4 levels,anti-dsDNA positivity and anti-ANA positive rate between the two groups(P>0.05).The age,Scr and 24hpro levels of the continued dialysis group were significantly higher than those of the free dialysis group,and the RRF and Kt/V were significantly lower than those of the free dialysis group(P<0.05).According to ROC analysis,the areas under the curve of age,Scr,24hpro,RRF and Kt/V in predicting the need for continuing dialysis in patients with severe LN were 0.751,0.651,0.944,0.919 and 0.834,respectively(all P<0.05).Multivariate logistic regression analysis confirmed that age>57.09 years old,Scr>461.13μmol/L,24hpro>3.405 g/24h,RRF<7.150 mL/min,Kt/V<1.225 were the influencing factors for patients to continue dialysis treatment(P<0.05).【Conclusion】Age,Scr,24hpro,RRF,Kt/V are the influencing factors for severe LN patients to continue dialysis treatme

关 键 词：狼疮肾炎 肾替代疗法/方法 肾透析 治疗结果 

分 类 号：R593.242[医药卫生—内科学]