血红蛋白水平对非创伤性横纹肌溶解综合征并发急性肾衰竭的影响

Effect of hemoglobin on non-traumatic rhabdomyolysis with acute renal failure

目的探讨血红蛋白(hemoglobin,Hb)水平对非创伤性横纹肌溶解综合征(rhabdomyolysis,RM)并发急性肾衰竭的影响,并分析该疾病的病因、临床特征及转归。方法回顾性分析2011年7月1日至2014年11月26日我院住院的RM患者30例,将其分为RM合并急性肾衰竭(acute renal failure,ARF)组和RM未合并ARF组,进行2组临床资料(性别、年龄、诊断时间、肌痛、肌无力、茶色尿、多器官功能衰竭等临床特征,CK、Mb、ALT、BUN、LDH、Hb、SCr等实验室指标)的统计分析处理。结果 30例RM患者均有肌酸激酶(creatine kinase,CK)、乳酸脱氢酶(lactate dehydrogenase,LDH)、丙氨酸氨基转移酶(cerealthirdtransaminase,ALT)、血肌酐(SCr)、天冬氨酸氨基转移酶(aspartate transaminase,AST)、肌红蛋白(myoglobin,Mb)增高。13例(占43.3%)合并ARF患者Hb水平为(89.8±22.7)g/L,SCr水平为(533.7±355.7)μmol/L,尿素氮(BUN)水平为(0.0244±0.0146)mmol/L;17例未合并ARF患者Hb水平为(109.3±15.2)g/L,SCr水平为(209.4±159.5)μmol/L,BUN水平为(0.0179±0.0178)mmol/L,2组比较,BUN(P=0.003<0.01)及SCr(P=0.002<0.01)均有统计学差异。30例患者治疗后29例均好转或痊愈,患者的Hb水平逐渐恢复,都在100g/L以上(1例多发性骨髓瘤患者的Hb水平为70 g/L)。1例因肺部感染死亡,12例患者肾功能基本恢复,1例基础病为多发性骨髓瘤的患者ARF转为慢性肾功能不全。结论低Hb水平可以增加RM并发ARF的发生率,推测Hb水平可能是RM并发ARF的危险因素之一。因此认为,及时诊断RM,监测Hb水平对预防ARF有重要意义。

Objective To investigate the effect of hematoglobin level on rhabdomyolysis（RM） complicated with acute renal failure（ARF） and to identify its etiological factors, clinical features and outcome. Methods Data of 30 RM patients admitted in our hospital between July 1st 2011 and No- vember 26th 2014 was collected and retrospectively analyzed. We categorized these patients into two groups, one with co-existing ARF and one without. Statistical analysis was performed for clinical data of these patients. Results Elevated creatine kinase（CK）, myoglobin（Mb）, lactate dehydrogenase （LDH）, ALT, AST and serum creatinine（SCr） was found in all the patients. Hb, SCr and BUN were （89. 8 ± 22. 7） g/L and （533. 7 ± 355. 7） μmol/L and （0. 0244 ±0. 0146） retool/L, in the 13 patients with ARF, and were （109. 3 ± 15.2） g/L, （209. 4 ±159. 5） μmol/L and （0. 0179 ± 0. 0178） mmol/L in the 17 patients without ARF. The t-test for the difference in Hb level between the two groups indicated statistical significance（P = 0. 009）, which was further confirmed by logistic regression. The difference in BUN and SCr between the two groups were both significant, with P = 0. 003 and 0. 002 respectively. Conclusions Low Hb level could increase the risk of developing ARF in RM patients, which could be a risk factor for this situation. We conclude that monitoring Hb for patients diagnosed with RM is of large importance.