66例妊娠合并急性肾损伤临床分析  

Clinical analysis of 66 cases of pregnancy complicated with acute renal injury

作　　者：孙雪娟[1] 裴娟[1] 陈幸[1] 张恒远[1] 姚理京 李思雅 李弋南[1] 黄继义[1] SUN Xue-juan;PEI Juan;CHEN Xing;ZHANG Heng-yuan;YAO Li-jing;LI Si-ya;LI Yi-nan;HUANG Ji-yi(The First Affiliated Hospital of Xiamen University,the Teaching Hospital of Fujian Medical University,the First Hospial of Xiamen,Xiamen,Fujian 361003,China)

机构地区：[1]厦门大学附属第一医院福建医科大学教学医院厦门市第一医院,福建厦门361003

出　　处：《中国妇幼保健》2023年第19期3629-3632,共4页Maternal and Child Health Care of China

基　　金：福建省厦门市科技局医疗卫生指导性项目(3502Z20214ZD2096)。

摘　　要：目的探讨妊娠相关急性肾损伤(P-AKI)的病因、临床特点、肾脏预后、影响因素及母亲与胎儿的转归。方法回顾性分析2016年1月—2020年12月厦门大学附属第一医院产科收治孕产妇25875例。根据2012年KDIGO-AKI指南,纳入P-AKI患者66例,分为AKI1-3期;根据肾功能恢复情况分为恢复组、部分恢复组及维持或进展组。收集患者基本信息、实验室检查、肾功能转归及母婴结局等。结果P-AKI 66例,发生率2.55‰。P-AKI病因:子痫/重度子痫前期38例(57.6%),梗阻性肾病4例(6.1%),HELLP综合征3例(4.5%)。合并慢性肾脏病31例(47.0%)。产妇死亡1例。产科并发症胎膜早破8例(12.1%),胎儿生长发育迟缓8例(12.1%),胎儿窘迫缓8例(12.1%),胎盘早剥6例(9.1%)。不良妊娠结局35例(50.0%),含早产、死产及流产。肾功能恢复34例(51.5%),部分恢复16例(24.2%),维持11例(16.7%),进展1例(1.5%),失访4例(6.1%)。各组年龄、肾脏基础疾病、基础肌酐水平及白蛋白水平影响急性肾损伤的预后比较差异有统计学意义(P<0.05)。结论子痫/子痫前期、尿路梗阻、HELLP综合征是P-AKI的主要病因。P-AKI母体预后及肾功能恢复尚可,但妊娠结局较差。需要提高对AKI在妊娠中的重要性的认识,以改善母婴的短期和长期预后。Objective To investigate the etiology,clinical features,renal prognosis and influence factors of pregnancy-related acute kidney injury(P-AKI),and the outcomes of mother and fetus.Methods A retrospective analysis was performed on 25,875 cases of maternal patients admitted to the First Affiliated Hospital of Xiamen University from January 2016 to December 2020.According to the 2012 KDIGO-AKI guidelines,66 patients with P-AKI were included,divided into AKI stage 1-3;Based on the recovery of renal function,they were divided into recovery group,partial recovery group,maintain or progressive group.Patients'demographic information,laboratory examinations,renal function outcome,prognosis of mothers and infants were gethered.Results 66 cases of P-AKI(incidence of 2.55%o).The etiology of P-AKI:eclampsia/severe preeclampsia in 38 cases(57.6%),obstructive nephropathy in 4 cases(6.1%),and HELLP syndrome in 3 cases(4.5%).P-AKI with chronic kidney disease was found in 31 patients(47.0%).Maternal death was found in 1 patient.Obstetric complications:premature rupture of fetal membranes in 8 cases(12.1%),fetal growth retardation in 8 cases(12.1%),fetal distress in 8 cases(12.1%),and placental abruption in 6 cases(9.1%).Adverse pregnancy outcomes were found in 35 cases(50.0%),including premature birth,still-birth and abortion.Renal function was recovered in 34 cases(51.5%),partially recovered in 16 cases(24.2%),maintained in 11 cases(16.7%),and progressed in 1 case(1.5%),loss to follow-up 4 cases(6.1%).In terms of affecting AKI prognosis,significant differences were found in age,renal underlying disease,baseline level of creatinine and albumin among groups(P<0.05).Conclusion Eclampsia/preeclampsia,obstructive nephropathy and HELLP syndrome were the main causes of P-AKI.The maternal prognosis and renal function recovery of P-AKI were tolerable,but the pregnancy outcome was not optimistic.Increasing awareness of the importance of AKI in pregnancy is needed to improve short-and long-term outcomes for mothers and fetals.

关 键 词：妊娠 急性肾损伤 预后 

分 类 号：R714.25[医药卫生—妇产科学]