失代偿期乙肝肝硬化患者并发急性肾脏疾病的危险因素及其与临床预后的相关性分析  

Risk factors of AKD in patients with decompensated hepatitis B cirrhosis and the correlation between AKD and clinical prognosis

作　　者：李琼[1] 李俊峰[2] 毛小荣[2] LI Qiong;LI Jun-feng;MAO Xiao-rong(First Clinical Medical College,Lanzhou University,Lanzhou 730000,China)

机构地区：[1]兰州大学第一临床医学院,甘肃兰州730000 [2]兰州大学第一医院感染科,甘肃兰州730000

出　　处：《中国实用内科杂志》2024年第5期385-390,共6页Chinese Journal of Practical Internal Medicine

基　　金：甘肃省自然科学基金(20JR5RA364);甘肃省重点研发计划(21YF5FA121);兰州大学第一医院院内基金(ldyyyn2020-02,ldyyyn2020-14);甘肃省感染肝病临床医学研究中心(21JR7RA392)。

摘　　要：目的 探讨急性肾脏疾病(acute kidney disease,AKD)在失代偿期乙肝肝硬化患者中发生情况,并分析其对患者临床预后的影响。方法 筛选并纳入2020年1月至2021年12月首次就诊于兰州大学第一医院的失代偿期乙肝肝硬化住院患者,收集初次入院时的临床资料,并对患者进行90 d的随访,记录生存情况。结果 AKD在失代偿期乙肝肝硬化患者中发生率为38.3%(51/133)。并发自发性细菌性腹膜炎(SBP)(OR 12.251,95%CI 1.049~143.052)及低估算的肾小球滤过率(eGFR)(OR 0.872,95%CI 0.824~0.922)是失代偿期乙肝肝硬化患者发生AKD的独立影响因素。在预测患者90 d不良结局方面,并发AKD及高MELD评分为失代偿期乙肝肝硬化患者90 d死亡的独立危险因素。结论 并发SBP及肾功能可能是失代偿期乙肝肝硬化患者发生AKD的独立影响因素,而AKD的发生对失代偿期乙肝肝硬化患者短期不良结局有重要影响。Objective To investigate the occurrence of acute kidney disease(AKD)in patients with decompensated hepatitis B cirrhosis,and to analyze its impact on the clinical prognosis of patients.Methods The inpatients with decompensated hepatitis B cirrhosis who first visited Lanzhou University First Hospital from January 2020 to December 2021 were screened and included.The clinical data at the time of initial admission were collected,and the patients were followed up for 90 days,and the patients survival was recorded.Results The incidence of AKD in patients with decompensated hepatitis B cirrhosis was 38.3%(51/133).Concurrent SBP[odds ratio(OR)12.251,95%CI 1.049-143.052)]and low e GFR(OR0.872,95%CI 0.824-0.922)were independent influencing factors of AKD in patients with decompensated hepatitis B cirrhosis.In terms of predicting adverse 90-day outcomes,concurrent AKD and high MELD scores were independent risk factors for 90-day death in patients with decompensated hepatitis B cirrhosis.Conclusion Concurrent SBP and renal function may be the key influencing factors of AKD in patients with decompensated hepatitis B cirrhosis,and the occurrence of AKD has an important impact on the short-term adverse outcomes of patients with decompensated hepatitis B cirrhosis.

关 键 词：失代偿期 肝硬化 乙型肝炎 急性肾脏疾病 危险因素 预后 

分 类 号：R589[医药卫生—内分泌]