基于倾向评分匹配法分析病毒感染与重症肺炎患者发生急性肾损伤的关系  

Relationship between viral infection and acute kidney injury in patients with severe pneumonia based on propensity score matching

作　　者：孙晴 郭丹宁 杜霞 马梦青 SUN Qing;GUO Daning;DU Xia;MA Mengqing(Department of Nephrology,Sir Run Run Hospital Affiliated to Nanjing Medical University,Nanjing 211166,China;不详)

机构地区：[1]南京医科大学附属逸夫医院肾内科,南京211166 [2]南京医科大学附属南京医院肾内科

出　　处：《山东医药》2024年第33期44-47,共4页Shandong Medical Journal

基　　金：国家自然科学基金资助项目(82170698);江苏省卫生健康委医学科研重点项目(ZDB2020023);南京市科技发展重点项目(YKK22206)。

摘　　要：目的基于倾向评分匹配法(PSM)分析病毒感染与重症肺炎患者发生急性肾损伤(AKI)的关系,为临床治疗提供依据。方法重症肺炎患者169例,包括77例病毒感染的和92例非病毒感染的重症肺炎患者,采用1∶1的倾向评分匹配法选取60对共120例,分为病毒感染组60例和非病毒感染组60例。收集两组患者的基本资料,包括年龄、性别、体温、住院时间、合并症、入院时白细胞计数、淋巴细胞(Lym)计数、血红蛋白(Hb)、C反应蛋白(CRP)、降钙素(PCT)、凝血酶原时间(PT)、活化部分凝血活酶时间(APTT)、D-二聚体、钠、钾、白蛋白、住院期间PH值、PaCO_(2)、PaO_(2)、乳酸、e GFR、基线Scr、是否使用ACEI、是否使用ARB、是否使用利尿剂、是否使用降糖药以及是否使用糖皮质激素等。收集两组患者的预后资料,包括发生AKI、院内死亡、使用机械通气(MV)和持续肾脏替代治疗(CRRT)等。以发生AKI为因变量,以是否合并病毒感染为自变量,采用条件logistics回归分析法分析病毒感染与重症肺炎患者发生AKI的关系。结果两组患者年龄、性别、体温等基本资料相比,P均>0.05。病毒感染组AKI发生率、院内死亡率、使用MV率均高于非病毒感染组(P均<0.05)。条件logistics回归分析结果显示,病毒感染是重症肺炎患者发生AKI的独立危险因素(OR=2.982,95%CI:1.068~8.329,P=0.037)。结论采用PSM法排除混杂因素后,病毒感染是重症肺炎患者发生AKI的独立危险因素。Objective To analyze the relationship between viral infection and acute kidney injury(AKI)in severe pneumonia patients using propensity score matching(PSM),in order to provide clinical treatment guidance.Methods A total of 169 patients with severe pneumonia,including 77 virus-infected patients and 92 non-virus-infected patients,were selected by a 1:1 propensity score matching method,and were divided into the virus-infected group of 60 cases and non-virus-infected group of 60 cases.The basic data of patients in the two groups were collected,including age,sex,temperature,length of stay,complications,white blood cell count at admission,lymphocyte(Lym)count,hemoglobin(Hb),C-reactive protein(CRP),calcitonin(PCT),prothrombin time(PT),activated partial thromboplastin time(APTT),D-dimer,sodium,potassium,albumin,PH during hospitalization,PaCO_(2),PaO_(2),lactic acid,eGFR,baseline Scr,whether ACEI was used,whether ARB was used,whether diuretics were used,whether hypoglycemic agents were used,and whether glucocorticoids were used.Prognostic data,including AKI,in-hospital death,use of mechanical ventilation(MV)and continuous renal replacement therapy(CRRT),were collected in both groups.Results No significant differences were found in the age,gender,body temperature,or other basic data between these two groups(all P>0.05).The incidence of AKI,in-hospital mortality and MV use rate in the virus infection group were higher than those in the non-virus infection group(all P<0.05).The results of conditional Logistics regression analysis showed that viral infection was an independent risk factor for AKI in patients with severe pneumonia(OR=2.982,95%CI:1.068-8.329,P=0.037).Conclu⁃sion After the confounding factors were excluded by PSM,viral infection was an independent risk factor for AKI in patients with severe pneumonia.

关 键 词：病毒感染 肾损伤 急性肾损伤 肺炎并发症 倾向评分匹配法 

分 类 号：R692[医药卫生—泌尿科学]