微小病变肾病患者急性肾损伤发病率及其危险因素分析

Incidence and risk factors of acute kidney injury in patients with minimal change disease

目的分析微小病变肾病（MCD）患者急性肾损伤发病率及其危险因素。方法2004年1月1日-2011年12月31日来自海南省万宁市人民医院肾内科127例MCD患者纳入研究，根据年龄分成中青年组（〈65岁）及老年组（≥65岁）；中青年组76例（59．8％），老年组51例（40．2％）；记录患者的基线资料及实验室检查，使用卡方检验比较中青年组与老年组AKI的发病率，同时用Logistic回归分析两组病人发生急性肾损伤（AKI）的危险因素。结果在整体人群中，23例MCD患者出现AKI（18．1％），中青年组12例（15．8％），老年组11例（21．6％），两组比较差异具有显著性意义（P=0．003）。校正心脏病史、血尿素氮及血肌酐后，高龄（每增加10年，OR1．4695％CI1．26～1．93，P=0．001）、糖尿病（OR1．4295％CI1．18～1．97，P=0．006）、较多的24h尿蛋白（OR1．0995％CI1．03～1．35，P=0．014）及较低的血清白蛋白（OR1．0395％CI 1．01—1．05，P=0．026）是MCD整体人群AKI的独立危险因素。结论MCD患者AKI的发病率较高；高龄、糖尿病、较多的24h尿蛋白及较低的血清白蛋白是MCD患者发生AKI的独立危险因素。

Objectives There were limited studies regarding the incidence and risk factors of acute kidney injury （AKI） in patients with minimal change disease （MCD）. Methods This was a retrospective study. 127 patients with MCD from department of nephrology, Wangning city people hospital, were included from February 1, 2004 to December 31, 2011. All patients were divided into two groups according to age （youth group 〈 65 years and older group I〉65 years）. A total of 127 patients with MCD were recruited, including 76 （59.8%） in the youth group and 51 （40.2%） in the older group. Basic characteristics and lab measurements in all patients were recorded and analyzed. We usedx2 methods to compare the incidence between the youth group and older group and logistic regression to evaluate risk factors of AKI. Results A total of 23 （ 18.1% ） patients occurred AKI, including 12 （ 15.8% ） in the youth group and 11 （21.6%） in the older group. After adjusting for confounding factors, older age （ increased per 10 ages, OR 1.46 95% CI 1.26 - 1.93, P = 0.001 ） , diabetes （OR 1.42 95%CI 1.18-1.97, P =0.006） , higher proteinuria （OR 1.09 95%CI 1.03 -1.35, P =0.014） and lower serum albumin （OR 1.03 95% CI 1.01 -1.05, P =0.026） were the independently risk factors of AKI in all patients with MCD. Conclusion Patients with MCD may have higher incidence of AKI. As compare to the younger patient with MCD, the older patients with MCD may have higher incidence of AKI. Older age, diabetes, higher proteinuria and lower serum albumin were the independently risk factors of AKI in all patients with MCD.