流行性病毒感染致危重症儿童急性肾损伤临床分析

Acute kidney injury in critically ill children infected with influenza A virus （ H1N1 ） and enterovirus 71

目的分析流行性病毒感染危重症患儿急性肾损伤（AKI）的发生情况，并探讨血肌酐及尿量在AKI诊断中的意义。方法回顾性分析急诊科住院的甲型H1N1流感病毒感染患儿（H1N1组）及肠道病毒EV71感染患儿（EV71组）临床资料。结果共28例，H1N1组18例（男6例，女12例），平均年龄5．4岁，EV71组10例（男8例，女2例），平均年龄1．1岁。（1）H1N1组4例发生AKI，平均受累脏器5．3个，2例1期患儿治疗后痊愈；2例3期患儿死亡；14例未发生AKI，平均受累脏器3．0个，死亡4例。（2）EV71组：3例发生AKI（1期）者与3例血肌酐升高45．0％～47．6％者平均受累脏器5．7个，均死亡；4例无血肌酐升高者平均受累AKI脏器3．0个，病情好转。结论流行性病毒感染所致危重症，发生AKI者受累脏器更多；H1N1感染AKI程度轻者早期积极干预预后相对好，程度重者预后差；EV71感染发生AKI则预后极差。诊断儿童AKI血肌酐较尿量的敏感性高。

Objective To analyze the clinical characteristics of acute kidney injury （AKI） in critically ill childhood patients with influenza A virus （ H1N1 ） and enterovirus 71 （ EV71 ）, and to study the significance of the serum creatinine and urine output in diagnosis of AKI. Method The clinical data of AKI in c.ritically ill children admitted to intensive care units （ICUs） with confirmed influenza A （H1N1） or enterovirus 71 infection （EV71 group） from Oct. 2009 to Oct. 2010. Result Twenty-eight critically ill children were involved in the study. In H1N1 group, there were 18 cases including 6 males and 12 females, and the average age was 5.4 years. In EVT1 group, there were 10 cases including 8 males and 2 females, and the average age was 1. 1 years. In H1N1 group： 4 cases developed AKI, whose average number of involved organ was 5.3. Two children were classified as first stage completely recovered after treatment; three children who were classified as third stage died. In 14 children without AKI, the average number of involved organ was 3.0, four of these children died. In EV71 group ： 3 cases （ first stage） developed AKI and 3 cases＇ serum ereatinine increased to 45.0 to 47.6 percent from baseline. The average number of involved organ was 5.7. All the six children died. The other 4 cases whose serum creatinine was normal, and the average number of involved organ was 3.0, recovered. Conclusion In critically ill virus-infected children, more organs were involved in the patients who developed AKI. As to influenza A （H1N1） infected critically ill children, the prognosis was comparatively better if the children were classified as AKI stage 1 and received early effective treatment. On the contrary, the prognosis was comparatively worse for those with AKI stage 3. As to EV71 infected critically ill children, the prognosis was worse once AKI developed. As to diagnosis of AKI, the sensitivity of serum creatinine criteria seemed to be superior to the urine output criteria. However, the significance of the serum ereatinine and urine output in diagnosis of AKI still needs to be investigated in the future in large scale clinical studies.