急性肾损伤患者发生3型心肾综合征的影响因素分析

Influencing Factors of Patients with Acute Kidney Injury Developing Type 3 Cardiorenal Syndrome

目的探讨急性肾损伤(AKI)患者发生3型心肾综合征(CRS)的危险因素。方法回顾性分析中国人民解放军第二军医大学陆军总医院临床医学院2013—2015年出院诊断为AKI的135例患者的临床资料,依据是否发生继发性心脏损伤将AKI患者分为3型CRS组37例及非3型CRS组98例。统计两组患者一般资料、实验室检查指标、预后、治疗、住院时间及费用等。采用多因素Logistic回归分析AKI患者发生3型CRS的影响因素。结果 3型CRS组与非3型CRS组患者性别、AKI分期、是否存在钙磷紊乱、尿酸正常与否、纤维蛋白原正常与否、预后、是否采用肾脏替代治疗比较,差异均无统计学意义(P>0.05);3型CRS组与非3型CRS组患者AKI诱因、是否存在左心室舒张功能减退、是否有慢性肾病病史、胆固醇正常与否、D-二聚体正常与否比较,差异均有统计学意义(P<0.05)。3型CRS组与非3型CRS组患者平均动脉压、超敏C反应蛋白、肌酐、尿素氮、肾小球滤过率、同型半胱氨酸水平比较,差异均无统计学意义(P>0.05);3型CRS组与非3型CRS组患者年龄、肌酐/尿素氮、住院时间、住院费用比较,差异均有统计学意义(P<0.05)。多因素Logistic回归模型结果显示,年龄[OR=1.714,95%CI(1.437,2.094)]、左心室舒张功能减退[OR=10.331,95%CI(3.129,34.112)]、慢性肾病病史[OR=13.076,95%CI(2.345,72.911)]、胆固醇升高[OR=9.983,95%CI(1.590,62.666)]是AKI患者发生3型CRS的独立影响因素(P<0.05)。结论感染后肾小球肾炎及使用肾毒性药物是导致AKI的主要诱因,尽管AKI的治疗技术不断进步,但其引起的3型CRS发病率依然较高,且发生继发性心脏损伤使得AKI患者住院时间延长,医疗费用增加。年龄、左心室舒张功能减退、慢性肾病病史及胆固醇升高是AKI患者发生3型CRS的危险因素。

Objective To investigate the risk factors of patients with acute kidney injury（AKI） developing type 3 cardiorenal syndrome （CRS）.Methods The clinical data of 135 patients who had been diagnosed with AKI discharged in Chinese PLA Army General Hospital,the Affiliated Clinical Hospital of Second Military Medical University from 2013 to 2015 were retrospectively analyzed.The patients with AKI were divided into type 3 CRS group（37 patients） and non-type 3 CRS group（98 patients） according to whether they had secondary cardiac injury or not.The general data,laboratory examination indicators,prognosis,treatment,hospital stays and cost of the two groups were collected.Multivariable Logistic regression analysis was used to analyze risk factors of patients with AKI developing type 3 CRS.Results There were no significant differences in gender,staging of AKI,whether there was disorder of calcium and phosphate,uric acid,whether fibrinogen was normal,prognosis and whether use renal replacement therapy between type 3 CRS group and non-type 3 CRS group（P〉0.05）.There were significant differences in inducement of AKI,whether there was diastolic dysfunction of left ventricular,whether having history of chronic nephrosis or not,whether cholesterol was normal or not,whether D-double polymer was normal between type 3 CRS group and non-type 3 CRS group（P〈0.05）.There were no significant differences in mean arterial pressure,hypersensitive C-reactive protein,creatinine,urea nitrogen,glomerular filtration rate,homocysteine level between type 3 CRS group and non-type 3 CRS group （P〉0.05）.There were significant differences in age,creatinine/urea nitrogen,hospital stays and cost between type 3 CRS group and non-type 3 CRS group（P〈0.05）.Multivariate Logistic regression analysis showed that age〔OR=1.714,95%CI（1.437,2.094）〕,diastolic dysfunction of left ventricular〔OR=10.331,95%CI （3.129,34.112）〕,history of chronic kidney disease〔OR=13.076,95%CI（2.345,72.911）〕,and increased level of cholesterol〔OR=9.983,95%CI（1.590,62.666）〕 were independent risk factors of patients with AKI developing type 3 CRS.Conclusion Infected glomerulonephritis and use of nephrotoxic drugs are the two main causes of AKI.Despite advances in medical technology for the treatment of AKI,the incidence of type 3 CRS in patients with AKI is still high and the secondary cardiac injury has extended hospital stays and increased medical costs.Age,diastolic dysfunction of left ventricular,history of chronic kidney disease and increased level of cholesterol are independent risk factors of patients with AKI developing type 3 CRS.