急性上消化道出血继发急性肾损伤和病情进展危险因素分析  

Risk factors of acute kidney injury and disease progression secondary to acute upper gastrointestinal hemorrhage

作　　者：王健[1] 郁毅刚[1] 林庆斌 陈玲[2] WANG Jian;YU Yigang;LIN Qingbin;CHEN Ling(Department of Emergency,The 909th Hospital of Joint Logistic Support Force(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China;Department of Gastroenterology,The 909th Hospital of Joint Logistic Support Force(Dongnan Hospital of Xiamen University),Zhangzhou 363000,China)

机构地区：[1]第九〇九医院(厦门大学附属东南医院)急诊科,漳州363000 [2]第九〇九医院(厦门大学附属东南医院)消化内科

出　　处：《肾脏病与透析肾移植杂志》2024年第3期215-219,232,共6页Chinese Journal of Nephrology,Dialysis & Transplantation

基　　金：军队后勤科研重大项目(BLB18J006)。

摘　　要：目的:探讨急性上消化道出血(AUGIB)患者继发急性肾损伤(AKI)和病情进展的危险因素。方法:回顾性分析厦门大学附属东南医院2021年1月至2023年6月收治的233例上消化道出血患者临床资料,根据入院后是否发生AKI分为AKI组(n=67)和非AKI组(n=166),AKI患者根据病情是否进展分为进展组(n=21)和无进展组(n=46)。采用单因素和多因素分析上消化道出血继发急性肾损伤和病情进展的危险因素。结果:233例AUGIB患者中消化道溃疡患者157例、食管胃底静脉曲张42例、急性胃黏膜损伤18例、食管贲门撕裂综合征10例、异物6例。AKI患者67例,发生率为28.76%,其中,21例发生AKI进展,进展率为31.34%。单因素分析发现,冠心病、肝硬化、血小板计数<50×10^(9)/L、血红蛋白计数<60 g/L、血清白蛋白<35 g/L、上消化道出血分级高危及以上AUGIB患者AKI发生率较高(P<0.05)。多因素分析发现,冠心病(OR=2.706,95%CI 1.127~6.494)、血小板计数<50×10^(9)/L(OR=3.570,95%CI 1.249~10.203)、上消化道出血分级高危及以上(OR=3.078,95%CI 1.145~8.227)是AKI发生的独立危险因素。单因素分析发现,67例AUGIB继发AKI患者中,男性、糖尿病、乙型肝炎、肝硬化、既往上消化道出血病史、血小板计数<50×10^(9)/L、血红蛋白计数<60 g/L、血清白蛋白<35 g/L、上消化道出血分级高危及以上患者AKI进展发生率较高(P<0.05)。多因素分析发现,肝硬化(OR=7.975,95%CI 1.400~45.441)、血小板计数<50×10^(9)/L(OR=19.612,95%CI 2.640~145.703)、上消化道出血分级高危及以上(OR=6.814,95%CI 1.183~27.985)是AKI进展的独立危险因素。结论:AUGIB患者要警惕AKI的发生,冠心病、血小板计数<50×10^(9)/L、上消化道出血分级高危及以上是AKI发生的独立危险因素,而肝硬化、血小板计数<50×10^(9)/L、上消化道出血分级高危及以上是AKI进展的独立危险因素。Objective:To investigate the risk factors of secondary acute kidney injury(AKI)and its risk factors of progression in patients with acute upper gastrointestinal bleeding(AUGIB).Methodology:The clinical data of 233 patients with AUGIB admitted to Dongnan Hospital Affiliated to Xiamen University from January 2021 to June 2023 were retrospectively analyzed.They were divided into AKI group(n=67)and non-AKI group(n=166)according to whether acute kidney injury(AKI)occurred after admission.67 patients with AKI were divided into progressive group(n=21)and non-progressive group(n=46)according to the progression of AKI.The risk factors of secondary acute kidney injury and progression of upper gastrointestinal hemorrhage were analyzed by univariate and multivariate analysis.Results:Among the 233 AUGIB patients,157 had digestive tract ulcers,42 had esophageal varices,18 had acute gastric mucosal injury,10 had esophageal and cardia lacerations,and 6 had foreign bodies.Among them,67 patients had AKI(2876%).Of 67 patients with AKI,21 cases of AKI progress,progress rate of 3134%.Unifactor analysis showed that in AUGIB,the incidence of AKI was higher in patients with coronary heart disease,cirrhosis,platelet count<50×10^(9)/L,hemoglobin count<60 g/L,blood albumin<35 g/L,and upper gastrointestinal bleeding grade high risk(P<005).Multivariate analysis found that,AKI was associated with coronary heart disease(OR=2706,95%CI 1127~6494),platelet count<50×10^(9)/L(OR=3570,95%CI 1249~10203),and upper gastrointestinal bleeding grade with higher risk(OR=3078,95%CI 1145~8227).Univariate analysis found that among 67 patients with AUGIB secondary AKI,The incidence of AKI progression was higher in patients with male,diabetes mellitus,hepatitis B,cirrhosis,previous history of upper gastrointestinal bleeding,platelet count<50×10^(9)/L,hemoglobin count<60 g/L,serum albumin<35 g/L,and upper gastrointestinal bleeding grade high risk(P<005).Multivariate analysis found that,Cirrhosis(OR=7975,95%CI 1400~45441),platelet count<50×10^(9)/L(OR=19612,9

关 键 词：急性上消化道出血 急性肾损伤 并发症 危险因素 

分 类 号：R573.2[医药卫生—消化系统] R692.5[医药卫生—内科学]