早产儿坏死性小肠结肠炎合并急性肾损伤的临床研究  

A clinical investigation on acute kidney injury among premature infants diagnosed with necrotizing enterocolitis

作　　者：杨霄[1] 张诗雨 刘一帆[2] 张文[2] 何秉燕[1] Yang Xiao;Zhang Shiyu;Liu Yifan;Zhang Wen;He Bingyan(Department of Neonatology,Zhongnan Hospital of Wuhan University,Wuhan 430071,China;Department of Pediatric Surgery,Zhongnan Hospital of Wuhan University,Wuhan 430071,China)

机构地区：[1]武汉大学中南医院新生儿科,武汉430071 [2]武汉大学中南医院小儿外科,武汉430071

出　　处：《中华新生儿科杂志（中英文）》2024年第11期669-673,共5页Chinese Journal of Neonatology

摘　　要：目的探讨早产儿坏死性小肠结肠炎(necrotizing enterocolitis,NEC)合并急性肾损伤(acute kidney injury,AKI)的发生率、危险因素及结局。方法回顾性选择2019年1月至2023年6月武汉大学中南医院新生儿重症监护室诊断为NEC且Bell分期Ⅱ期以上的早产儿,根据是否合并AKI分为非AKI组和AKI组,比较两组临床特点及结局,应用SPSS 26.0统计软件分析两组差异有统计学意义的指标,进一步纳入二分类logistic回归分析NEC早产儿发生AKI的危险因素。结果共纳入NEC患儿166例,其中非AKI组100例,AKI组66例。NEC患儿AKI发生率39.8%,严重AKI(2级和3级)发生率15.1%。二分类logistic回归分析显示,需手术治疗(OR=4.520,95%CI 1.381~14.792,P=0.013)与合并新生儿败血症(OR=7.191,95%CI 3.293~15.703,P<0.001)是NEC患儿发生AKI的独立危险因素。与非AKI组比较,AKI组住院时间长[54(34,75)d比42(25,61)d,P=0.027],病死率高(18.2%比5.0%,P=0.006)。严重AKI(OR=37.291,95%CI 2.892~480.874,P=0.006)是NEC患儿死亡的独立危险因素。NEC合并AKI患儿中95%在1周内血肌酐恢复正常。结论NEC早产儿易合并AKI,需要手术治疗和同时合并败血症是NEC早产儿发生AKI的独立危险因素。Objective To study the incidence,risk factors,and outcomes of acute kidney injury(AKI)in premature infants with necrotizing enterocolitis(NEC).Methods A retrospective analysis was conducted on premature infants diagnosed with NEC at Bell stage II or higher in the neonatal intensive care unit of Zhongnan Hospital,Wuhan University,from January 2019 to June 2023.Infants were categorized into non-AKI and AKI groups.Clinical characteristics and outcomes of the two groups were compared using SPSS 26.0 and factors associated with AKI were identified through binary logistic regression.Results A total of 166 infants with NEC were included in this analysis,including 100 in the non-AKI group and 66 in the AKI group.The incidence of AKI in NEC infants was 39.8%,and the incidence of severe AKI(grade 2 and 3)was 15.1%.Binary logistic regression analysis showed that surgical NEC(OR=4.520,95%CI 1.381-14.792,P=0.013)and neonatal sepsis(OR=7.191,95%CI 3.293-15.703,P<0.001)were independent risk factors for AKI in premature infants with NEC.The AKI group had longer length of hospitalization[54(34,75)d vs.42(25,61)d,P=0.027]and higher mortality(18.2%vs.5.0%,P=0.006)compared to the non-AKI group.Severe AKI was an independent risk factor for death in NEC neonates(OR=37.291,95%CI 2.892-480.874,P=0.006).Serum creatinine levels in 95%of the neonates with AKI normalized within one week.Conclusions NEC in premature infants often coincides with AKI.Surgical treatment and neonatal sepsis are independent risk factors for developing AKI in infants with NEC.

关 键 词：早产儿 坏死性小肠结肠炎 急性肾损伤 危险因素 结局 

分 类 号：R722.6[医药卫生—儿科]