糖尿病、肝硬化及其交互作用对脓毒症患者并发急性肾损伤的影响  

Influence of diabetes,cirrhosis,and their interaction on acute kidney injury in patients with sepsis

作　　者：童丽珍 林明江 邢柏[1] TONG Lizhen;LIN Mingjiang;XING Bo(Department of Emergency,the Second Affiliated Hospital of Hainan Medical College,Hainan Province,Haikou 570100,China)

机构地区：[1]海南医学院第二附属医院急诊科,海南海口570100

出　　处：《中国医药导报》2023年第23期131-134,共4页China Medical Herald

基　　金：海南省卫生健康行业科研项目(琼卫科教〔2019〕13号-31)。

摘　　要：目的探讨糖尿病、肝硬化及其交互作用对脓毒症患者并发急性肾损伤(AKI)的影响。方法纳入2016年1月至2021年12月海南医学院第二附属医院急诊重症监护室收治的脓毒症患者,根据是否并发AKI,将患者分为两组,比较两组临床资料、生化指标检测、脓毒症相关性器官功能衰竭评价(SOFA)评分和生命体征。采用二元logistic回归模型分析脓毒症患者并发AKI的独立危险因素。采用相乘模型和相加模型分析糖尿病、肝硬化及其交互作用对脓毒症患者并发AKI的影响。结果在调整了性别、年龄、基础疾病、实验室指标、SOFA评分、生命体征等混杂因素后,二元logistic回归分析模型结果显示,在脓毒症患者中,合并糖尿病的患者并发AKI的风险为无糖尿病患者的3.587倍(95%CI:2.865,4.491),合并肝硬化的患者并发AKI的风险为无肝硬化患者的2.766倍(95%CI:2.407,3.261)。调整高血压、白细胞计数、C反应蛋白、1 h乳酸值、SOFA评分等因素后,糖尿病及肝硬化对脓毒症患者并发AKI有相加及相乘交互作用。结论糖尿病、肝硬化为脓毒症患者并发AKI的独立危险因素,两者的相乘及相加交互作用增加了脓毒症患者并发AKI的风险。Objective To explore the impact of diabetes,cirrhosis,and their interaction on patients with sepsis complicated by acute kidney injury(AKI).Methods Patients with sepsis admitted to the emergency intensive care unit of the Second Affiliated Hospital of Hainan Medical College from January 2016 to December 2021 were included and divided into two groups according to whether they had concurrent AKI.Clinical data,biochemical indicators,sequential organ failure assessment(SOFA)score,and vital signs were compared between the two groups.Binary logistic regression model was used to analyze the independent risk factors of AKI in patients with sepsis.The effects of diabetes,cirrhosis,and their interaction on AKI in patients with sepsis were analyzed by multiplicative model and additive model.Results After adjusting for confounding factors such as gender,age,underlying diseases,laboratory indicators,SOFA score,and vital signs,the results of binary logistic regression analysis model showed:among sepsis patients,the risk of AKI in patients with diabetes was 3.587 times(95%CI:2.865,4.491)that of those without diabetes,and the risk of AKI in patients with cirrhosis was 2.766 times(95%CI:2.407,3.261)that of those without cirrhosis.After adjusting for hypertension,white blood cell count,C-reaction protein,1-hour lactic acid value,SOFA score,and other factors,diabetes and cirrhosis had additive and multiplicative interaction on AKI in sepsis patients.Conclusion Diabetes and cirrhosis are independent risk factors for AKI in patients with sepsis,and their multiplicative and additive interactions increase the risk of AKI in patients with sepsis.

关 键 词：糖尿病 肝硬化 脓毒症 急性肾损伤 交互作用 

分 类 号：R587.1[医药卫生—内分泌]