过度训练致急性肾损伤的临床研究

Clinical Study of Overtraining-Induced Acute Kidney Injury

目的:了解过度训练致急性肾损伤(OTIAKI)的发病情况及临床特点。方法:对我院9年间(2001年5月～2010年8月)因5km武装越野跑住院患者的临床病理特点和预后进行分析。结果:83例患者符合入选标准,单纯尿检异常32例,横纹肌溶解症24例,横纹肌溶解伴急性肾衰竭27例。重症OTIAKI的患者除肾脏损害外,还可表现为意识障碍、抽搐、肌痛、棕色尿,血清UREA、CR、CK、CK-MB、LDH、ALT、HBDH等指标明显异常。肾脏病理检查提示为肾小球和肾小管的轻微病变。83例患者死亡1例,病死率为1.2%。结论:过度训练致急性肾损伤已成为近年来急性肾衰竭的重要病因;血清酶升高的幅度越大,病情越重;血清酶水平恢复越慢,预后越差;早期应用肾剂量的多巴胺和山莨菪碱有助于肾功能的恢复,病情严重者及时行血液净化治疗。

Objective：Objective To investigate the incidence and clinical feature of overtraining-induced acute kidney injury（OTIAKI）.Methods：The clinical and pathological feature and pronosis of patients hospitalized in the period between May,2001 and August,2010 due to five-kilometer armed cross-country race were analysed.Results：83 patients were selected according to the inclusion criteria.In these selected cases,thirty-two were only abnormal of urine test,twenty-four were diagnosised with rhabdomyolysis;twenty-seven were rhabdomyolysis with acute renal failure（ARF）.In all the twenty-seven cases,besides manifestations of ARF,disturbance of conciousness,convulsion,muscle pain and swelling of extremitates,black urine could be seen.The serum UREA、CR、CK、CK-MB、LDH、ALT、HBDH were significantly elevated in patients with ARF on RM.In the eighty-three cases,eighty-two were cured with a cure rate of 98.8 percent;1 cases died with the death rate of 1.2 percent.Conclusion：OTIAKI has become one of the important causes of ARF in recent years.The higher the serum enzymes levels,the more severe the condition was.Consequently,the more slowly the recovery process and the worse the prognosis would be.The administration of renal-dose dopamine and Anisodamine in the early stage were useful for the recovery of renal function.Early blood purification was performed as soon as ARF was confirmed.