不同标准评估Ⅰ型心肾综合征危险因素研究

Independent common risk factors for the diagnosis of type Ⅰ cardiorenal syndrome by different criteria

目的探讨急性肾损伤(AKI)不同国际标准确定Ⅰ型心肾综合征(CRS)的独立危险因素。方法回顾性分析2005年7月至2012年7月广东省人民医院和中山大学第一附属医院急性心力衰竭(AHF)患者的资料。以危险、损伤、衰竭、肾功能丧失、终末期肾病(RIFLE),及急性肾损伤国际组织(AKIN)、改善全球肾脏病预后组织(KDIGO)标准定义的AKI作为主要观察终点,入院前3个月内的最低血肌酐(Scr)或入院首次Scr为基线Scr。结果共入组1058例患者。KDIGO标准(52.8%)比RIFLE(37.4%)和AKIN标准(47.9%)诊断出更多的AKI患者。Logistic回归分析表明,冠心病、血浆白蛋白(ALB)<30 g/L(OR=1.437)、C反应蛋白(CRP)>29.9 mg/L(OR=2.328)、血尿酸>479μmol/L(OR=1.813)、血红蛋白(Hb)<110 g/L(OR=1.582)、入院后48 h内使用利尿剂(OR=1.499)、血管活性药物(OR=2.124)是RIFLE诊断Ⅰ型CRS的独立影响因素;ALB<30 g/L(AKIN:OR=1.490;KDIGO:OR=1.386)、Hb<110 g/L(AKIN:OR=1.963;KDIGO:OR=1.889)、CRP>29.9 mg/L(AKIN:OR=2.252;KDIGO:OR=2.681)、eGFR<60 mL/(min·1.73 m2)、尿酸>479μmol/L(AKIN:OR=3.317;KDIGO:OR=2.853)、入院后48 h内使用利尿剂(AKIN:OR=3.200;KDIGO:OR=1.556)、血管活性药物(AKIN:OR=1.907;KDIGO:OR=2.040)是AKIN、KDIGO诊断Ⅰ型CRS的独立影响因素。结论 CRP>29.9 mg/L、尿酸>479μmol/L、ALB<30 g/L、Hb<110 g/L、入院后48 h内使用利尿剂和血管活性药物可能是RIFLE、AKIN、KDIGO标准诊断Ⅰ型CRS的共同独立危险因素。

Objective To explore independent common risk factors for the diagnosis of type I cardiorenal syndrome by RI- FLE, AKIN and KDIGO criteria on acute kidney injury （AKI）. Methods Data were retrospectively collected from patients with acute heart failure in Guangdong General Hospital and the First Affiliated Hospital of Sun Yat-sen University between July 2005 and July 2012. AKI defined by RIFLE ,AKIN and KDIGO criteria was regarded as the end of observation ,and serum ereatinine was defined by the lowest serum creatinine 3 months before admission or the serum creatinine on admission. Results Among 1058 patients, more patients were diagnosed with AKI by KDIGO criteria （52. 8% ） than by RIFLE （37.4%） or AKIN criteria （47.9%）. Logistic regression analysis indicated that coronary heart disease, albumin 〈 30 g/L （Odds Ratio[OR] 1. 437） ,C reactive protein 〈29. 9 mg/L （OR 2. 328） ,uric acid 〉479 p.mol/L （OR 1. 813） ,hemoglobin 〈 110 g/L （ OR 1. 582）, use of diuretics （ OR 1. 499 ） and vasoactive agents （ OR 2. 124） within 48 hours after admission were independent factors for the diagnosis of type I cardiorenal syndrome by RIFLE ; albumin 〈 30 g/L （ AKIN ： OR 1. 490 ; KDIGO ： OR1. 386 ）, hemoglobin 〈 110 g/L （ AKIN ： OR 1. 963 ; KDIGO ： OR 1. 889 ） , C reactive protein 〈 29. 9 mg/L（AKIN： OR 2. 252; KDIGO： OR 2. 681 ）, estimated glomerular filtration rate （eGFR） 〈 60 mL/（ min · 1.73 m^2） ,uric acid 〉479 μmol/L （AKIN：OR 3. 317;KDIGO：OR 2. 853） ,use of diuretics （AKIN：OR 3. 200;KDIGO：OR 1. 556） and vasoactive agents （ AKIN ： OR 1. 907 ; KDIGO ： OR 2. 040） within 48 hours after admission might be independent factors for the diagnosis of type I cardiorenal syndrome by AKIN and KDIGO. Conclusion Albumin 〈 30 g/L, hemoglobin 〈 110 g/L, C-reactive protein 〈 29. 9 mg/L, uric acid 〉 479 μmol/L, use of diuretics and vasoactive agents within 48 hours after admission are independent common risk factors for the diagnosis of type I cardiorenal syndrome by RIFLE, AKIN and KDIGO criteria.