老年重症急性肾功能衰竭患者预后的影响因素分析

The influencing factors for the prognosis of severe acute renal failure in elderly patients

目的探讨影响老年重症急性肾功能衰竭（SARF）患者预后的相关因素。方法老年SARF患者59例，均接受连续性血液净化（CBP）治疗，根据患者第28天存活状况，分为存活组25例，死亡组34例。在患者接受CBP治疗前和停止CBP治疗后次日晨，采血检测血常规、T细胞亚群、凝血指标、血液生化和动脉血气分析等，并进行危重病评分。结果CBP治疗前，存活组血清肌酐和血浆纤维蛋白原（Fib）较死亡组高（均为P〈0．05），CD3^＋、CD8^＋较低（均为P〈0．01），但CD4＋／CD8^＋较高（P〈0．05）；CBP首次治疗持续时间长（P〈0．05）。CBP治疗后次日晨，存活组血尿素、血钠和血磷较低（P〈0．05），阴离子间隙和血浆渗透压也较低（P〈0．05），血小板计数较高（P〈0．05），CD3^＋、CD4^＋较高（P〈0．05）。如果以CD3^＋、CD4^＋和CD8^＋的CBP治疗前后差值绝对数比较，CBP治疗后，存活组变化更大（均为P〈0．01）。两组CBP治疗前危重病评分差异无统计学意义。结论是否能有效控制原发病、首次CBP治疗持续时间、CBP治疗后对细胞免疫功能的调节作用、治疗前后患者肾功能和内环境状况等可能是影响老年SARF患者预后的主要因素。

Objective To analyze the influencing factors for the prognosis of severe acute renal failure （SARF） in elderly patients. Methods Fifty-nine elderly patients with SARF were enrolled in this study, and continuous blood purification （CBP） therapy were used. According to 28-day survivorship, the patients were assigned into survival group （n= 25） and death group （n= 34）. The blood routine, T cell subsets counts, blood clotting index, blood biochemistry, arterial blood gas analysis were measured, and critically ill score was evaluated before CBP and next morning after CBP. Results Compared with the death group, serum creatinine and plasma fibrinogen were higher （all P〈0.05）, CD3^＋ and CD8^＋ T cell were lower （all P〈0.01）, but CD4^＋/CD8^＋ was higher （P〈0. 05） before CBP. And persistence time of CBP was longer in survival group （P〈0.05）. In the next morning after CBP, survival group showed the lower levels of blood urea nitrogen, sodium and phosphonium, anion gap and plasma osmotic pressure （all P〈0.05）, and higher levels of blood platelets count, CD3^＋ and CD4^＋ T cell （P〈0. 05）. The absolute numbers of changes of CD3^＋ , CD4^＋ and CD8^＋ T cell pre- and post-CBP were larger in survival group （all P〈0. 01）. The changes of critically ill scores were not significant between 2 groups. Conclusions The persistence time of CBP in first time, the regulating effect of CBP on cellular immune function, the status of renal function and internal environment pre- or post-CBP, all influenced the prognosis of SARF in elderly patients.