急性/亚急性肝衰竭患者急性肾损伤发生率和预后分析  

Prevalence of acute kidney injury and its impact on prognosis in patients with acute/subacute liver failure

作　　者：刘松涛[1] 孟庆华[1] 刘梅[1] 韩亚男 王金环[1] 闾军[1] Liu Songtao;Meng Qinghua;Liu Mei(Department of Medical Oncology,You’an Hospital,Capital Medical University,Beijing 100069,China)

机构地区：[1]首都医科大学附属北京佑安医院肿瘤内科,北京市100069 [2]临汾市第三人民医院肝病二科

出　　处：《实用肝脏病杂志》2024年第2期222-225,共4页Journal of Practical Hepatology

基　　金：北京市医院管理中心“登峰”人才培养计划项目(编号:DFL20221502);北京佑安医院中青年人才联合攻关项目(编号:BJYAYY-GG2019-01)。

摘　　要：目的分析急性/亚急性肝衰竭(ALF/SALF)患者急性肾损伤(AKI)发生率及其对预后的影响。方法2016年1月~2021年7月我院收治的ALF/SALF成人患者,参照2015年国际腹水俱乐部制定的标准诊断AKI,应用多因素COX生存回归分析影响生存率的因素。结果在纳入的378例患者中,ALF 77例,SALF 301例;91例(24.1%)发生了AKI,其中ALF患者为42.9%,显著高于SALF患者的19.3%(P<0.05);在91例AKI患者中,肾前性氮质血症(PRA)4例(4.4%),肝肾综合征(HRS)54例(59.3%),急性肾小管坏死(ATN)22例(24.2%),其他类型11例(12.1%);未并发AKI的ALF患者28 d和90 d病死率分别为45.5%和47.7%,显著低于并发AKI的78.8%和90.9%(P<0.05),未并发AKI的SALF患者28 d和90 d病死率分别为23.0%和26.7%,显著低于并发AKI患者的69.0%和74.1%(P<0.05);经COX生存回归分析显示,诊断为ALF、发生AKI和INR高水平与患者28 d和90 d病死率独立相关。结论ALF患者发生AKI的比例显著高于SALF患者,也是导致死亡的重要原因。Objective This study was conducted to analyze the prevalence of acute kidney injury(AKI)and its impact on prognosis in patients with acute/subacute liver failure(ALF/SALF).Methods The patients with ALF/SALF were encountered in our hospital between January 2016 and July 2021,and the AKI was diagnosed based on the criteria proposed by International Club of Ascites in 2015.The multivariate COX survival regression analysis was applied to predict the prognostic factors.Results Out of 378 patients with liver failure,the ALF was diagnosed in 77 cases and SALF in 301 cases;the incidence of AKI in patients with ALF was 42.9%,significantly higher than 19.3%in patients with SALF(P<0.05);among the 91 patients with AKI,the prerenal azotemia(PRA)was found in 4 cases(4.4%),the hepatorenal syndrome(HRS)in 54(59.3%),the acute tubular necrosis(ATN)in 22(24.2%)and other types of renal injuries in 11 cases(12.1%);the 28-day and 90-day fatality rates in patients with ALF without AKI were 45.5%and 47.7%,much lower than 78.8%and 90.9%(P<0.05)in patients with AKI,and the 28-day and 90-day fatality rates in patients with SALF without AKI were 23.0%and 26.7%,much lower than 69.0%and 74.1%(P<0.05)in those with AKI;the multivariate COX survival regression analysis showed that the occurrence of ALF,complicated AKI and high level of INR were the independent risk factors for 28-day and 90-day survival in patients with ALF/SALF.Conclusion The complicated AKI in patients with liver failure is common,especially in those with ALF,which hints poor prognosis,and needs urgent management properly.

关 键 词：肝衰竭 急性肾损伤 预后 

分 类 号：R575.3[医药卫生—消化系统] R692[医药卫生—内科学]