局灶节段性肾小球硬化患者常见并发症的分析

Acute kidney injury,infection and thromboembolic complications in patients with focal segmental glomerulosclerosis

目的:观察局灶节段性肾小球硬化(FSGS)患者急性肾损伤(AKI)、感染及血栓栓塞的发生率,探讨并发症发生的危险因素。方法:观察70例经临床及肾脏病理确诊的特发性FSGS患者的AKI、感染及血栓栓塞的发生率,分析并发症的临床特征及高危因素。结果:(1)70例特发性FSGS中,34例(48.6%)并发AKI、14例(20.0%)合并感染、11例(15.7%)出现血栓栓塞。(2)AKI以男性多见,其尿蛋白水平较高,血白蛋白水平较低,小管间质损伤更重,小管急性损伤的程度与AKI的分期有关;随访过程中AKI患者完全缓解率及有效率显著低于未合并AKI者。(3)感染以呼吸道感染多见,院内感染占50%;与非感染组相比,感染组患者的尿蛋白水平更高,血白蛋白、球蛋白、IgG水平则较低;随住院时间延长,感染发生率升高,院内感染所占比例增加;Logistic回归分析显示白蛋白低于20g/L和住院时间延长是感染的独立危险因素。(4)血栓栓塞包括颅内静脉窦血栓2例、颈内静脉血栓1例、右肾静脉血栓1例、股静脉血栓2例、腘静脉血栓2例和肺栓塞3例;血栓栓塞患者的循环内皮细胞计数(CECs)、血管性血友病因子(vWF)高于未合并血栓栓塞者,Logistic回归分析显示CECs和血红蛋白水平升高与血栓栓塞独立相关。结论:FSGS患者肾小管损伤、低白蛋白血症和住院时间延长、血管内皮细胞损伤和血液浓缩分别在AKI、感染、血栓栓塞的发生中起重要作用。

Objective：To analyzed the incidences and risk factors of these complications in patients with focal segmental glomerulosclerosis. Methodology：Seventy patients with FSGS were involved in this study. Acute kidney injury （AKI） was defined as a rise in serum creatinine to ≥50% above baseline or by ≥26. 5 μmol/L. Infection was diagnosed by a combination of clinical manifestations, laboratory tests and imaging examination. Thromboembolism was diagnosed by imaging methods. The risk factors for the complications were evaluated by logistic regression analysis. Results：The incidences of AKI, infection and thromboembolism were 48.6% , 20. 0%, 15.7% , respectively. The patients with AKI were more likely to be male with lower serum albumin, greater protein excretion, urine NAG and RBP, as well as more severe acute tubulo-interstitial damage in the pathological changes. At follow up, patients with an episode of AKI experienced a lower response rate. The patients with infection had a higher level of proteinuria and lower levels of serum albumin, globulin and IgG than those without infections. Prolonged hospital stay was increased the risk of infection, especially hospital acquired infecton. The levels of circulating endothelial cells （CECs） and yon Willebrand factor （vWF） were higher in patients with thromboembolism than those without. Logistic regression analysis showed that increased RBP, a lower level of serum albumin, prolonged hospital stay, the increase of CECs and hemoglobin were independent risk factors for AKI, infection and thromboembolism, respectively. Conclusion ：The incidences of AKI, infection and thromboembo- lism in patients with FSGS were 48. 6% , 20. 0% , and 15.7% , respectively. Acute tubulointerstitial lesions, hypoalbuminemia, prolonged hospital stay and endothelial cell injury as well as pachyemia played important roles in the development of these complications.