急性肾衰竭临床特点的变迁

Clinical Characteristics Variations of Acute Renal Failure in Children

目的探讨急性肾衰竭(ARF)的病因、临床特点、病理、治疗及转归的变化。方法回顾性分析本科诊治的183例ARF患儿的临床资料,并将近6 a(2004-2009年)与前16 a(1988-2003年)2个阶段住院ARF患儿的临床特点和转归进行比较。结果近6 a共诊治101例ARF患儿,与前16 a 82例患儿比较,患病人数明显增多。ARF病因特点也发生了明显的变化:肾性因素所占比例下降(78.1%vs 48.5%,P<0.01),而肾后性因素所占比例上升(2.40%vs 25.75%,P<0.01),2组肾前性因素比例比较差异无统计学意义(19.50%vs 25.75%,P>0.05)。不同年龄组ARF患儿病因特点不同,婴儿以肾前性因素常见,而年长儿多见于肾性因素。共30例行肾活检,其病理类型主要为系膜增生性肾小球肾炎。前16 a行血液净化治疗6例,而近6 a行血液净化治疗16例(χ2=4.18,P<0.05)。经过治疗,前16 a的82例患儿中,治愈32例(39.0%),好转27例(32.9%),未愈2例(2.5%),住院期间和放弃治疗共死亡21例(25.6%);近6 a的101例患儿中,治愈43例(42.5%),好转41例(40.6%),未愈3例(3.0%),住院期间和放弃治疗共死亡14例(13.9%)。与前16 a比较,近6 a治疗有效率明显提高(χ2=3.99,P<0.05),病死率明显降低(χ2=4.01,P<0.05)。结论 ARF的发病呈增多趋势,且病因构成发生了变化。不同年龄组ARF的病因构成不同。适时肾活检对于明确诊断、指导治疗、估计预后有重要意义。早期行血液净化治疗是ARF抢救成功的关键。

Objective To investigate the changes of etiology,clinical characteristics,pathology,therapy and prognosis of childhood acute renal failure（ARF）in 22 years. Methods The survey of children with ARF admitted from Jan.1988 to Dec.2009 was analyzed retrospectively.At the same time,the changes in clinical characteristics and prognosis between 2 periods（previous 16 years periods from 1988 to 2003 and recent 6 years from 2004 to 2009）for the children admitted to hospital were compared. Results Compared with 82 cases of previous 16 years,there were 101 cases of ARF in recent 6 years.The characteristics of etiology were also varied distinctly.The proportion of intrarenal ARF decreased（previous 78.1% vs recent 48.5%,P〈0.01）and the proportion of postrenal obstructive increased（previous 2.40% vs recent 25.75%,P〈0.01）.There was no difference in the proportion of prerenal ARF（previous 19.50% vs recent 25.75%,P〉0.05）between 2 periods,while the cases of prerenal ARF in recent 6 years were more than those in 16 years previously.Different age groups had different etio-logy characteristics.Prerenal ARF was commonly seen in babies,while intrarenal ARF was more in older children.Thirty cases out of 183 children with ARF received renal biopsy and the mesangial proliferative glomerulonephritis was the main pathological type.According to the etiology,the treatment was performed and dialysis therapy when in necessary.In previous 16 years,only 6 cases were treated by dialysis therapy,but in recent 6 years,there were 16 cases（χ2=4.18,P〈0.05）.After being treated,32 cases out of 82 cases in previous 16 years（39.0%）reco-vered,27 cases（32.9%）improved,2 cases（2.5%）unrecovered,and 21 cases（25.6%）died during in hospital and gave up treatment.And 43 cases out of 101 cases in recent 6 years（42.5%）recovered,41 cases（40.6%）improved,3 cases（3.0%） unrecovered,and 14 cases（13.9%）died during in hospital and gave up treatment.Compared with previous 16 years,the effective rate of treatment was increased ob-viously in recent 6 years（χ2=3.99,P〈0.05）and the mortality significantly decreased（χ2=4.01,P〈0.05）. Conclusions The incidence of ARF tends to increase accompanied with the proportion of ARF etiology changed.It′s different in ARF etiology among the different age groups.Renal biopsy in appropriate time has an important significance for determining diagnosis,guiding treatment and estimating prognosis.Blood purification therapy performed in the early phase is the key to rescue the children with ARF successfully.