慢性乙型肝炎病毒感染相关肝硬化患者的肾功能及危险因素分析

Assessment of renal function and risk factors for renal impairment in patients with hepatitis B virus-related liver cirrhosis

目的调查慢性乙型肝炎病毒感染相关的成年初治肝硬化患者肾功能情况，并探讨其危险因素。方法日呗胜收集860名于2011年1月1日-2011年12月31日在南方医院肝病中心住院治疗的慢性乙肝病毒感染相关成年肝硬化且既往未接受过抗乙肝病毒治疗的患者资料，应用child．Pugh评分系统对患者进行肝功能分级、采用美国肾脏病基金会组织推荐的MDRD公式计算肾小球滤过率（GlomerularFiltrationRate，GFR），评估目标人群肾功能受损（eGFR〈60m№耐1．73衍）的发生率，同时分析影响肾功能的危险因素。结果共有296名患者被纳入分析，结果显示肝硬化患者肾功能受损的发生率为8．45％（25，296），child．PughC级患者肾功能受损发生率显著高于child-PughB级和child-PughA级（17．2％[17/99]vs6．67％[7/105]vs1．09％[1/92]，P〈0．001）；年龄、高尿酸血症、child．Pugh评分均为肾功能受损的危险因素。结论随着肝硬化患者肝功能的恶化，肾功能受损发生率显著上升，应密切监测肾功能，以指导患者临床用药。

Objective To evaluate the renal function in treatment-naiyce patients with hepatitis B virus （HBV） related cirrhosis and to identify the risk factors for renal impairment. Methods We collected the data of 860 HBV-related cirrhosis patients hospitalized in our unit between Jan 1, 2011 and Dec 31, 2011. Liver function of the patients was assessed with Child-Pugh score system, and the renal function with estimated glomerular filtration rate （eGFR） calculated by Modification of Diet in Renal Disease （MDRD） equation recommended by Kidney Disease Outcomes Quality Initiative （K/DOQI）. We investigated the prevalence of renal impairment （eGFR〈60 ml/min/1.73 m^2） among these patients and explored the risk factors for renal impairment. Results Of the 860 patients, 296 had complete clinical data and were included in our analysis. The overall inddence of renal impairment among the enrolled patients was 8.45% （25/296）. Patients with Child-Pugh stage C showed a significantly higher incidence of renal impairment than those with stages B and A （17.17% [17/99] vs 6.67%[7/105] vs 1.09% [1/ 92], P〈0.001）. Age, history of hyperuricemia, and Child-Pugh score were identified as the risk factors for renal impairment in these patients. Conclusion In patients with HBV-related liver cirrhosis, the incidence of renal impairment increases significantly with deterioration of the liver function, and renal function should be regularly monitored in these patients for appropriate antiviral treatment.