代偿性酸中毒、炎性反应和病因是影响急性肾损伤预后的重要因素

Compensated acidosis,inflammation and etiologies are important factors influencing the prognosis of acute kidney injury

目的分析影响急性贤损伤(AKI)预后的因素,评判不同病因对预后的影响。方法回顾性分析507例AKI病例,分为预后良好组和预后不良组,收集临床资料,根据治疗前后SCr变化,分析AKI预后的危险因素和病因对预后的影响。结果预后良好组253例(49.9%),预后不良组254例(50.1%)。预后不良组年龄较大(P<0.001),SCr基线值较高(P<0.01),贫血和低白蛋白血症的发生率较高(P<0.01和P<0.001),炎性指标更高(P<0.001)。通过Logistic回归分析建立预后模型,分析结果显示,即使代谢性酸中毒处于HCO3-降低而p H值正常的阶段,仍是影响预后的危险因素(P<0.05),MODS(P<0.001)、炎性因子(P<0.01)和少尿(P<0.01)也是影响预后的危险因素;血白蛋白(P<0.01)和血红蛋白(P<0.05)是预后的保护性因素。本研究中,AKIN 1、2期中最常见病因为重症感染导致的AKI,AKIN 3期中最常见小管间质损害,不同分期对预后的影响无显著差别。结论 1)代偿性酸中毒、MODS、炎性反应和少尿是AKI预后的危险因素;2)需重视病因对AKI临床结局的影响。

Objective To analyze the clinical characteristics of acute kidney injury（ AKI） cases and then to evaluate the different risk factors and judge the influence of different etiologies on prognosis. Methods The clinical data and laboratory results of 507 AKI cases were analyzed. Data from good and poor prognosis groups were compared and then to evaluate the influence of different clinical data and etiologies on prognosis. Results 253 cases（ 49. 9%） of 507 patients were defined as good prognosis group while 254 cases（ 50. 1%） were defined as poor prognosis. Compared with good prognosis group,patients with poor prognosis were tend to be older（ P〈0. 001）,with higher baseline serum creatinine（ P〈0. 01）,higher incidency of anemia（ P〈0. 01） and hypoalbuminia（ P〈0. 001）,as well as higher inflammatory cytokines（ P〈0. 001）. Models were established to predict the prognosis ofAKI after multivariate logistic regression analysis. The models interpreted that acidosis,even in the compensated stage,was risk factor of AKI（ P〈0. 05）; MODS（ P〈0. 001）,inflammatory cytokines（ P〈0. 01） and oliguria（ P〈0. 01） were also risk factors while albumin（ P〈0. 01） and hemoglobin（ P〈0. 05） were protective factors.The most common cause of AKI in AKIN 1 and 2 stages was severe infection while in AKIN 3 stage was tubulointerstitial damage; different AKIN staging made no significant difference in the prognosis of AKI in this study. Conclusions 1） Compensatory acidosis,MODS,inflammatory cytokines and oliguria are risk factors of AKI; 2） The risk of AKI should not be underestimated.