严重急性呼吸道综合征并发肾脏损害的临床分析  

Analyze the clinical features of the severe acute respiratory syndrome(SARS) with kidney injury

作　　者：金荣华[1] 周亦伦[2] 梁连春[1] 刘惠兰[2] 段钟平[1] 文煜冰[2] 李德新[1] 张晶[1] 

机构地区：[1]北京佑安医院人工肝中心,北京100054 [2]首都医科大学附属复兴医院肾内科,北京100038

出　　处：《中国血液净化》2003年第9期490-492,514,共4页Chinese Journal of Blood Purification

摘　　要：目的　分析严重急性呼吸道综合征 (SARS)并发肾脏损害的临床特点。方法　对 89例SARS住院患者的临床症状、体征、肾功能等进行观察。对其中 8例有肾损害、12例无肾损害及 15例健康对照者分别检测了血清IL - 1β、IL - 6、TNF -α水平。对 2例SARS死亡患者进行了肾脏病理检查。结果　 89例患者中 10例 (11.11%)并发肾损害。重症SARS伴肾损害者 8例 ,明显高于轻症 ,P <0 .0 1。出现肾损害的患者中有糖尿病和 /或高血压病史的患者 7例 ,明显高于无基础疾病者 ,P <0 .0 5。SARS患者无论有无肾损害 3种细胞因子水平均明显高于对照组 ,P <0 .0 1或P <0 .0 5。有肾损害组的细胞因子水平明显高于无肾损害组 ,P <0 .0 1或P <0 .0 5。肾脏病理学检查可见肾间质灶状炎性细胞浸润等非特异改变。结论　SARS并发肾损害与病情轻重显著相关 ,有慢性基础疾病者更容易出现肾损害 ,肾损害的发生可能是SARS所致系统性炎症反应综合征在肾脏的表现。Objective To analyze the clinical features of the severe acute respiratory syndrome (SARS) with kidney injury. Methods We abstracted data on the clinical and laboratory presentation of 89 cases of SARS, specially renal function. We also assayed serum interlukin-1β(IL-1β), IL-6, tumor necrosis factor(TNF)-α level in 8 cases of SARS with kidney injury, 12 cases without kidney injury and 15 healthy care workers. Postmortem examination of kidney in 2 cases without kidney injury were performed. Results 10 cases of SARS were with kidney injury. The number of serious cases with kidney injury was much more than that of slight cases, P<0.01. 7 cases were with diabetes mellitus and/or hypertension,the number was statistically more than that of patients without accompanying diseases, P<0.05. The lever of serum IL-1β, IL-6, TNF-α was significantly higher in SARS cases than that in controls, P<0.01 or P<0.05. The lever of the three cytokines in patients with kidney injury was statistically higher than that in patients without kidney injury, P<0.01 or P<0.05. Kidney pathological observation showed no special features. Conclusions Kidney injury of SARS is associated with disease severity. Patients with basic Kidney disease were prone to have Kidney injury. Kidney injury of SARS cases may be a partial sign of systemic inflammatory response syndrome (SIRS) caused by SARS.

关 键 词：严重急性呼吸道综合征 并发症 肾脏损害 临床分析 症状 体征 肾功能 IL-1Β IL-6 TNF-Α 

分 类 号：R56[医药卫生—呼吸系统] R692[医药卫生—内科学]