急性肾功能衰竭的流行病学研究

Epidemiological survey of acute renal failure

目的 对急性肾功能衰竭 (ARF)进行前瞻性研究 ,总结ARF病因和临床特点。方法 收集内、外、妇、儿等科室的ARF住院病人 ,分析其病因 ,鉴别ARF类型 (肾前性 ,肾性 ,肾后性 )以及分析各种类型所占的比例、治疗方法及预后。着重分析小管间质病变 ,药物性 ,及急性横纹肌溶解综合征所致的ARF的临床特点和预后。结果 12 5例ARF病人中 ,肾前性ARF 2 0例 ,占 16 % ;肾后性ARF 7例 ,占 5 .6 % ;肾性ARF 98例 ,占78.4% ,其中急性小管间质病变 79例 ,占肾性ARF的 80 .6 % (79/98)。感染、休克是主要原因 ;药物性ARF 2 8/12 5例 ,占ARF的 2 2 .4% ,呈上升趋势 ;横纹肌溶解综合征 11/12 5例 ,占ARF的 8.8% ,多脏器功能障碍综合征合并ARF 14/12 5例 ,占ARF的 11.2 %。肾活检 32例 ,急性小管间质病变和肾小球、小血管病变约各占 5 0 %。ARF总的死亡率 2 3.2 % ,肾实质性ARF的死亡率 2 9.6 %。结论 ARF发生率和死亡率较高 ,早期诊治有助于改善ARF的预后。

Objective To investigate the etiology and clinical features of acute renal failure(ARF) by prospective study. Method All patients with ARF were recruited from different departments. The etiology, classification clinical features and prognosis were analyzed, with emphasis on tubulointerstitial lesions, drug induced ARF and rhabdomyolysis were. Results Among 125 patients with ARF, 20/125 (16%) were pre renal, 7/125 (5.6%) post renal, and 98/125 (78.4%) renal parenchymal ARF, out of them 79/98 (80.6%) were acute tubulointerstitial lesions. Infection and shock were the leading causes of ARF. 28/125 were drug induced (22.4%) and 11/125 were caused by rhabdomyolysis (8.8%); 14/125 were combined with multiple organ dysfunction syndrome (MODS) (11.2%). 41 patients accepted renal biopsy, in which acute tubulointerstitial lesions and glomerular or vascular diseases were approximately 50% each. The total mortality rate of ARF was 23.2% while the mortality of renal parenchymal ARF was 29.6%. Conclusion The incidence and mortality of ARF remain high, early diagnosis may be beneficial in improving the prognosis of ARF.