老年急性肾损伤相关因素临床分析及探讨

Clinical characteristics of acute kidney injury in elderly patients

目的探讨老年急性肾损伤(AKI)患者的临床特点及血清胱抑素C(cysC)在AKI中的变化,以期提高老年人AKI的诊治水平。方法回顾性分析76例老年(≥60岁)AKI发生原因及转归,并与同期52例中青年患者(18～59岁)进行比较,同时探讨cysC在AKI中的意义。结果老年AKI病因:感染占23.7%,低血容量占17.1%,慢性肾脏病(CKD)急性加重占14.5%;肿瘤相关占11.8%,肾后性10.5%。转归:老年组死亡占28.9%,以合并重症感染、多器官功能衰竭、肿瘤、呼吸衰竭者病死率高。cysC在梗阻性肾病及非梗阻性肾病组,肌酐分别为(539.3±344.3)μmol/L vs(373.3±235.8)μmol/L(P>0.05),而相对应的cysC为(1.6±0.7)mg/L vs(2.7±0.8)mg/L(P<0.01);16例患者血肌酐开始恢复时间(7.0±2.6)天,cysC恢复时间(5.8±2.9)天。结论老年AKI发生的病因多样,主要与感染、低血容量、合并CKD、肿瘤、肾后性等因素有关。老年患者病死率高,与重症感染、多器官功能衰竭、肿瘤及呼吸衰竭有关。当cysC与血肌酐值背离时,须排除梗阻性肾病,同时cysC在AKI的恢复期的变化早于血肌酐值。

Objective To investigate the clinical characteristics of elderly patients with acute kidney injury （AKI） and assess the effectiveness of serum cystatin C（cysC） for improving the diagnosis and treatment of AKI in the elderly patients. Methods Using retrospective analysis,the elderly patients （≥ 60 years, n =76） were compared with the middle young aged patients （18-59 years, n = 52）, in order to investigate the etiology and outcome of AKI and assess the function of cysC in AKI. Results The cause of the elderly AKI ranged as the follows： infections （23.7%）, hypovolemia （ 17.1% ）, chronic kidney disease （CKD） （ 14.5%）, tumor-associated （ 11.8% ） and postrenal AKI （10.5 %）. The mortality rate in the elderly group was 28.9 %, and the elderly patients with severe infection, multiple organ failure, cancer and respiratory failure had the higher mortality. The level of serum creatinine in obstructive nephropathy group and non obstructive nephropathy group were （539.3±344.3） μmol/L vs （373.3±235.8） ptmol/L （ P 〉0.05）, meanwhile, the cysC in obstructive nephropathy group and non obstructive nephropathy group were （1.6 ± 0.7） mg/L vs （7.0±0.8）. mg/L（ P 〈0.01）. Of 16 cases,the creatinine recovery time was （7.0±2.6） days,compared with the cysC recovery time of （5.8 ± 2.9） days. Conclusion The diversity causes of AKI in elderly patients include infection,low blood volume, cancer, postrenal factors and CKD. The elderly patients with severe infection, multiple organ failure,cancer and respiratory failure had the higher mortality. CysC as a new biological indicator of AKI could differentiate diagnosis of obstructive nephropathy. In the process of AKI,cysC recovered earlier than serum creatinine.