截瘫伴肾脏损害的危险因素

Risk Factors of Renal Injury in Patients with Paraplegia

目的:了解慢性截瘫患者合并肾脏损害的发生率,引起肾脏损害的危险因素。方法:采用横断面研究与回顾性研究相结合的方法,查阅原始记录、问卷调查、现场查体和相关的实验室检查收集截瘫患者的临床资料和家族史、合并症及生化方面的指标,计算每位患者的肾小球滤过率(GFR)。将GFR 1～3期各为一组、4～5期各为一组,分别为RF1～RF4组,对各组指标进行比较。结果:84例中达到GFR 3～5期者达44例,占52.38%。RF4组截瘫病程明显长于其他组(P<0.05),FR4组糖尿病发生率明显高于其他组(P<0.05),血糖水平也明显高于其余三组(P<0.05);FR3组和FR4组高血脂病程明显长于其余两组(P<0.05);FR3组和FR4组肺部感染发生率高于其余两组(P均<0.05);褥疮和活动性褥疮的数目与肾脏损害关系较为密切(P<0.05);RF3组和RF4组尿路结石的病程明显长于其他两组(P<0.05);各组蛋白尿的多少有统计学差异,蛋白尿越多肾脏损害越重(P<0.05);各组尿检红细胞数量有统计学差异,肾脏损害越重尿检红细胞越多(P<0.05);而各组在截瘫病因、截瘫程度、泌尿道手术史、肾脏病家族史、高血压史、尿路感染、生活行为习惯(如饮食、吸烟、饮酒、运动锻炼等)、肾毒性药物使用史、神经原膀胱、冠心病等方面差异不大。结论:慢性截瘫病人肾脏损害发生率高,肾脏损害的发生与截瘫病程、糖尿病、高血脂、肺部感染、尿路结石、褥疮和蛋白尿、血尿等有一定关系,临床应对危险因素加以控制。

Objective：To investigate the prevalence of renal injury and to seek the risk factors for renal injury in patients with paraplegia. Methods： Combined the crosssectional method and retrospective method, we collected the clinic data through referriug the original records, questionnaire survey, spot physical examination and laboratory examination. GFR of each patient was calculated. These patients were classified according to GFR staging. Patients at stage 1 to 3 were classified as group RFI to RF3 respectively, and patients at stage 4 to 5 were classed RF4. Indexes were compared among these groups. Qualitative data was treated with X2 test or Ridit analysis, and Quantitative data variance analysis. Results： There were 44 of 84 paraplegic patients with renal injury whose GFR reached stage 3 to 5. The duration of paraplegia in group RF4 was significantly longer compared with those in the other groups （P〈0.05）. The prevalence of diabetes in group RF4 was significantly higher compared with those in the other groups （X2 test, P〈 0.05）, and their serum glucose levels were higher than those in the other three groups （variance analysis, P 〈 0.05）. The prevalence of pulmonary infection in group RF3 and group RF4 was higher than those in the other two group （X2 test, P〈 0.05, respectively）. Decubitus ulcer and the number of decubitus ulcer procedures were correlated with renal injury（P〈0.05）. The duration of urinary tract lithiasis in group RF3 and RF4 was significantly longer than those in other groups（variance analysis, P〈 0.05）. There was significant difference in the .severity of albuminuria among these groups. The more severe was albuminuria, the more severe was renal injury （ridit analysis P 〈 0.05）. There was significant difference in the severity of urine erythrocyte among these groups, which was positively correlated with renal injury （ridit analysis, P 〈 0.05）. But there were no difference with pathogen of paraplegia, severity of paraplegia, history of urinary tract surgery, family history of kictney disease, history of hypertension, urinary tract infection, daily habit （diet, smoking, drinking, exercising, etc）, history of using nephritoxicity drug or coronary heart disease among each group. Conclusion：The prevalence of renal injury with chronic paraplegia was high, and renal injury was correlated with duration of paraplegia, diabetes, hyperlipidemia, pulmonary infection, urinary tract stone, decubitus ulcer, albuminuria and urine erythrocyte, etc. However, further study is needed.