慢性乙型肝炎肝硬化失代偿期继发AKI的危险因素分析  

Analysis of risk factors for AKI secondary to decompensated cirrhosis of chronic hepatitis B

作　　者：相伟英 李杭剑 童铭炯 XIANG Weiying;LI Hangjian;TONG Mingjiong(Department of Infection,the Affiliated Hospital of Shaoxing University of Arts and Sciences,Shaoxing 312000,Zhejiang,China)

机构地区：[1]绍兴文理学院附属医院感染科,浙江绍兴3120001

出　　处：《中国现代医生》2024年第32期56-60,共5页China Modern Doctor

摘　　要：目的研究慢性乙型肝炎(chronic hepatitis B,CHB)肝硬化失代偿期继发急性肾损伤(acute kidney injury,AKI)的危险因素。方法选取2018年1月至2024年1月绍兴文理学院附属医院诊治的CHB肝硬化失代偿期患者316例作为研究对象。分为CHB失代偿期组(CHBCD组,n=72)和CHB失代偿期继发AKI组(CHBCD+AKI组,n=244)。比较两组患者的临床资料差异。Spearman相关分析检测指标与血肌酐(serumcreatinine,Scr)、尿素氮(blood urea nitrogen,BUN)的相关性。多因素Cox回归分析CHB继发AKI的危险因素。受试者操作特征曲线分析预测CHB继发AKI的效能。采用Kaplan-Meier生存模型及Log rank比较两组患者的生存期差异。结果CHBCD+AKI组患者的肝性脑病率、凝血酶原时间(prothrombin time,PT)、总胆红素(total bilirubin,TBIL)、Scr、BUN、血清胱抑素C(cystatin C,Cys-C)、Child-Pugh分级C级比例、终末期肝病模型(model of end-stage liver disease,MELD)评分均高于CHBCD组(P<0.05),白蛋白(albumin,Alb)低于CHBCD组(P<0.05)。CHBCD+AKI组患者的肝性脑病、PT、TBIL、Cys-C、Child-Pugh分级、MELD评分与Scr、BUN均呈正相关(r_(s)>0,P<0.05),与Alb均呈负相关(r_(s)<0,P<0.05)。Scr≥467.2μmol/L、BUN≥11.5mmol/L、Cys-C≥2.7mg/L、Child-Pugh分级C级、MELD评分≥15.4分为CHB失代偿期继发AKI的独立危险因素(P<0.05)。BUN、Cys-C、MELD评分在对CHB失代偿期继发AKI中的预测价值高于Scr、Child-Pugh分级。CHBCD+AKI组患者的中位生存期低于CHBCD组。结论Scr、BUN、Cys-C、Child-Pugh分级、MELD评分为CHB失代偿期继发AKI的独立危险因素,CHB失代偿期继发AKI生存期降低。Objective To study the risk factors of acute kidney injury(AKI)secondary to the decompensated stage of chronic hepatitis B(CHB)cirrhosis.Methods A total of 316 patients with decompensated CHB cirrhosis diagnosed and treated in the Affiliated Hospital of Shaoxing University of Arts and Sciences from January 2018 to January 2024 were divided into CHB cirrhosis decompensated group(CHBCD group,n=72)and CHB cirrhosis decompensated secondary AKI group(CHBCD+AKI group,n=244).Compare the differences in clinical data between two groups of patients.Spearman rank correlation analysis detects the correlation between indicators and serum creatinine(Scr)and blood urea nitrogen(BUN).Multivariate Cox regression analysis of risk factors for AKI secondary to CHB cirrhosis.Effectiveness of receiver operating characteristic curve were analyzed in predicting AKI secondary to CHB cirrhosis.Kaplan-Meier survival model and Log rank were used to compare the difference in survival time between two groups of patients.Results The hepatic encephalopathy rate,prothrombin time(PT),total bilirubin(TBIL),Scr,BUN,cystatin C(Cys-C),Child-Pugh grade C proportion,and model of end-stage liver disease(MELD)score in CHBCD+AKI group were significantly higher than those in CHBCD group(P<0.05),and Alb was significantly lower in patients in CHBCD group(P<0.05).In CHBCD+AKI group,hepatic encephalopathy,PT,TBIL,Cys-C,Child-Pugh classification,and MELD score were positively correlated with Scr and BUN(r_(s)>0,P<0.05),and negatively correlated with Alb(r_(s)<0,P<0.05).Scr≥467.2μmol/L,BUN≥11.5mmol/L,Cys-C≥2.7mg/L,Child-Pugh grade C,and MELD score≥15.4 points were independent signs of AKI secondary to the decompensated stage of CHB cirrhosis.BUN,Cys-C,and MELD scores were more effective than Scr and Child-Pugh grades in predicting AKI secondary to the decompensated stage of CHB cirrhosis.The median survival time of patients in CHBCD+AKI group was significantly lower than that of CHBCD group.Conclusion Scr,BUN,Cys-C,Child-Pugh grade,and MELD score are in

关 键 词：慢性乙型肝炎肝硬化 失代偿期 急性肾损伤 危险因素 

分 类 号：R575.2[医药卫生—消化系统]