慢加急性肝衰竭患者急性肾损伤的特点及其对预后的影响  

The characteristics of acute kidney injury in patients with acute-on-chronic liver failure and its impact on prognosis

作　　者：李芃芃 董其刚 许军 LI Peng-peng;DONG Qi-gang;XU Jun(Department of Emergency,Wuxi No.5 People's Hospital,Jiangsu 214013,China)

机构地区：[1]无锡市第五人民医院急诊内科,江苏214013

出　　处：《肝脏》2023年第3期330-333,339,共5页Chinese Hepatology

基　　金：无锡市科技发展计划项目(N2020X009)。

摘　　要：目的分析慢加急性肝衰竭(ACLF)患者急性肾损伤(AKI)的临床特点及其影响AKI发生的危险因素。方法选取2019年1月至2022年7月无锡市第五人民医院收治的ACLF患者作为研究对象,根据是否发生AKI分为ACLF-非AKI组、ACLF-AKI组。ACLF、AKI诊断符合要求,比较ACLF-非AKI组、ACLF-AKI组临床资料,采用多变量分析影响ACLF患者AKI的危险因素。比较不同结局AKI患者临床资料。结果共纳入ACLF患者117例,其中ACLF-非AKI组73例、ACLF-AKI组44例。ACLF-非AKI组年龄、高血压、消化道出血、细菌感染、WBC、TBil、INR、PT、Scr、血清K+、CTP评分、MELD评分及90 d病死率分别为(49.3±7.9)岁、7例(9.6%)、9例(12.3%)、8例(10.9%)、(7.0±1.4)×109/L、(213.6±69.2)μmol/L、(2.2±0.9)、(33.3±2.9)s、(60.6±18.4)μmol/L、(3.8±0.6)mmol/L、(11.0±1.6)分、(17.9±3.7)分和16例(21.9%);ACLF-AKI组分别为(52.4±8.3)岁、11例(25.0%)、13例(29.5%)、11例(25.0%)、(9.0±1.6)×109/L、(272.1±87.1)μmol/L、(2.4±0.9)、(35.5±3.7)s、(106.8±30.0)μmol/L、(4.0±0.7)mmol/L、(11.5±1.8)分、(22.2±4.3)分和25例(56.8%)(P<0.05);ACLF-非AKI组Alb、eGFR及血清Na+分别为(31.4±5.1)g/L、(137.2±43.2)ml/min/1.73 m 2和(134.7±2.8)mmol/L,ACLF-AKI组分别为(27.2±5.0)g/L、(104.4±34.2)ml(min·1.73 m 2)和(132.1±2.2)mmol/L(P<0.05)。多变量分析发现年龄、消化道出血、细菌感染、TBil及PT等升高而Alb下降,ACLF患者AKI风险显著增加。44例ACLF合并AKI患者中病情缓解、进展分别为27例、17例。比较不同结局AKI患者临床资料,病情缓解患者TBil、INR、Scr、CTP评分、MELD评分及90 d病死率分别为(250.7±73.3)μmol/L、(2.3±1.0)、(78.2±15.3)μmol/L、(11.5±1.4)分、(25.9±4.5)分及10例(37.0%),病情进展患者分别为(307.2±92.6)μmol/L、(3.0±1.0)、(172.3±24.7)μmol/L、(12.4±1.5)分、(31.4±6.2)分及15例(88.2),(P<0.05);病情缓解、进展患者血清Na+分别为(132.4±2.3)mmol/L、(130.0±2.1)mmol/L,差异有统计学意义Objective To analyze the clinical features and risk factors of acute kidney injury(AKI)in patients with chronic and acute liver failure(ACLF)and the impact of AKI on the patients’outcomes.Methods A total of 117 ACLF patients admitted to our hospital from January 2019 to July 2022 were selected as the research objects.The patients were divided into ACLF-non-AKI group and ACLF-AKI group according to whether AKI occurred or not.The diagnosis of ACLF and AKI met the diagnostic criteria.The clinical data of ACLF-non-AKI group and ACLF-AKI group were compared,and the risk factors of AKI in ACLF patients were analyzed by multivariate analysis.The patients were followed-up and the clinical outcomes of the ACLF patients with or without AKI were compared.Results A total of 117 patients with ACLF were enrolled,including 73 patients in ACLF-non-AKI group and 44 patients in ACLF-AKI group.Compare the clinical data of the two groups,The age,hypertension,gastrointestinal bleeding,bacterial infection,white blood cells count(WBC),total bilirubin(TBil),international normalized ratio(INR),prothrombin time(PT),serum creatinine(Scr),serum K+,Child-Turcotte-Pugh(CTP)score,Model for End-Stage Liver Disease(MELD)score and 90-day mortality of ACLF-non-AKI group were(49.3±7.9)years,7 cases(9.6%),9 cases(12.3%),8 cases(10.9%),(7.0±1.4)×109/L,(213.6±69.2)μmol/L,(2.2±0.9),(33.3±2.9)s,(60.6±18.4)μmol/L,(3.8±0.6)mmol/L,(11.0±1.6)points,(17.9±3.7)points and 16 cases(21.9%),respectively,which were significantly lower than those of(52.4±8.3)years,11 cases(25.0%),13 cases(29.5%),11 cases(25.0%),(9.0±1.6)×109/L,(272.1±87.1)μmol/L,(2.4±0.9),(35.5±3.7)points,(106.8±30.0)μmol/l,(4.0±0.7)mmol/l,(11.5±1.8)points,(22.2±4.3)points and 25 cases(55.8%)in the ACLF-AKI group(P<0.05).The albumin(Alb)level,estimated glomerular filtration rate(eGFR)and serum Na+of ACLF-non-AKI group were(31.4±5.1)g/L,(137.2±43.2)ml/min/1.73 m 2 and(134.7±2.8)mmol/L,respectively,which were significantly higher than those of(27.2±5.0)g/L,(104.4±34.2)

关 键 词：慢加急性肝衰竭 急性肾损伤 血肌酐 多变量分析 

分 类 号：R575.3[医药卫生—消化系统]