接受经颈静脉肝内门体静脉分流术的门静脉高压症患者急性肾损伤的临床特征分析  

Characteristics of acute kidney injury in portal venous hypertension patients undergoing transjugular intrahepatic portosystemic shunt

作　　者：贾萌 郭一丹 叶鹏鹏 周晓玲 罗洋 Jia Meng;Guo Yidan;Ye Pengpeng;Zhou Xiaoling;Luo Yang(Department of Nephrology,Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China;Division of Injury Prevention and Mental Health National Center for Chronic and Non-communicable Disease Control and Prevention,Chinese Center for Disease Control and Prevention,Beijing 100053,China)

机构地区：[1]首都医科大学附属北京世纪坛医院肾内科,北京100038 [2]中国疾病预防控制中心慢性非传染性疾病预防控制中心,北京100053

出　　处：《中华肾脏病杂志》2024年第9期698-704,共7页Chinese Journal of Nephrology

基　　金：首都卫生发展科研专项项目(首发2022-2-2081);中国国家铁路集团有限公司科技研究开发项目(J2022Z608)。

摘　　要：目的:分析接受经颈静脉肝内门体静脉分流术(transjugular intrahepatic portosystemic shunt,TIPS)的门静脉高压症患者急性肾损伤(acute kidney injury,AKI)的临床特征。方法:本研究为回顾性观察性研究,对2020年10月16日至2022年3月30日间首都医科大学附属北京世纪坛医院介入科TIPS患者临床资料进行回顾性分析。按2012年改善全球肾脏病预后组织(Kidney Disease:Improving Global Outcomes,KDIGO)AKI诊断标准,将患者分为AKI组和非AKI组,比较其临床特征,并采用多因素Logistic回归方法分析AKI发生的风险因素。结果:本研究纳入接受TIPS患者384例,年龄(53.17±13.35)岁;其中女性122例(31.8%)。共32例发生AKI,AKI发生率为8.3%。与非AKI组相比,AKI组患者合并糖尿病比例、基线估算肾小球滤过率<60 ml·min^(-1)·(1.73 m 2)-1比例、术中低血压比例、肝功能Child-Pugh评分、术前血清肌酐、术前血尿酸及术后门静脉压力梯度(portal venous pressure gradient,PPG)较高,而血红蛋白及血清白蛋白水平较低,差异均有统计学意义(均P<0.05)。多因素Logistic回归分析结果显示,合并糖尿病(OR=3.728,95%CI 1.262~11.013,P=0.017)、基线估算肾小球滤过率<60 ml·min^(-1)·(1.73 m 2)-1(OR=3.571,95%CI 1.356~9.400,P=0.010)、血清白蛋白水平下降(OR=0.847,95%CI 0.738~0.972,P=0.018)、TIPS术后PPG升高(OR=1.096,95%CI 1.002~1.200,P=0.045)及术中低血压(OR=7.006,95%CI 2.023~24.195,P=0.002)是接受TIPS门静脉高压症患者术后AKI发生的独立风险因素。出院时,32例AKI患者中6例(18.8%)肾功能完全恢复,24例(75.0%)部分恢复,2例(6.3%)未恢复。AKI组患者平均住院时间、住院费用及住院期间全因死亡率均显著高于非AKI组(均P<0.05)。结论:接受TIPS治疗门静脉高压症患者术后发生的AKI并不少见,其发生的常见风险因素包括糖尿病、基线肾功能异常以及容量相关风险因素。AKI显著增加此类患者住院期间的全因死亡率及医疗费用,�Objective To analyze the clinical characteristics and risk factors of acute kidney injury(AKI)in portal venous hypertension patients undergoing transjugular intrahepatic portosystemic shunt(TIPS).Methods It was a retrospective observational study.In this study,the clinical data of portal venous hypertension patients undergoing TIPS at Beijing Shijitan Hospital,Capital Medical University from October 16,2020 to March 30,2022 were collected retrospectively.According to the Kidney Disease:Improving Global Outcomes(KDIGO)definition of AKI,patients were divided into AKI group and non-AKI group.The clinical characteristics of the patients were compared between the two groups,and multivariate logistic regression was used to analyze the risk factors of AKI.Results A total of 384 patients undergoing TIPS were included in this study,whose age was(53.17±13.35)years.Among them,122(31.8%)were female,and 32 patients(8.3%)had AKI.Compared to the non-AKI group,the proportion of patients with diabetes mellitus,baseline estimated glomerular filtration rate(eGFR)<60 ml·min^(-1)·(1.73 m2)-1 and intraoperative hypotension,Child-Pugh score of liver function,preoperative serum creatinine,preoperative blood uric acid,and postoperative portal venous pressure gradient(PPG)were higher in AKI group(all P<0.05),while the levels of hemoglobin and serum albumin were lower(both P<0.05).Multivariate logistic regression results showed that combined diabetes(OR=3.728,95%CI 1.262-11.013,P=0.017),baseline eGFR<60 ml·min^(-1)·(1.73 m2)-1(OR=3.571,95%CI 1.356-9.400,P=0.010),decreased serum albumin(OR=0.847,95%CI 0.738-0.972,P=0.018),increased PPG after TIPS(OR=1.096,95%CI 1.002-1.200,P=0.045)and intraoperative hypotension(OR=7.006,95%CI 2.023-24.195,P=0.002)were independently associated with postoperative AKI in portal venous hypertension patients undergoing TIPS.Until discharge,6 patients with AKI(18.8%)had complete renal function recovery,24 patients(75.0%)partially recovered,and 2 patients(6.3%)did not recover.The length of hospital stay,hospi

关 键 词：门体分流术 经颈静脉肝内 高血压 门静脉 急性肾损伤 危险因素 预后 

分 类 号：R692[医药卫生—泌尿科学] R575[医药卫生—外科学]