蜂蛰伤后临床特点及发生急性肾损伤的危险因素分析

Clinical features and risk factors of acute kidney injury following bee stings

目的分析蜂蛰伤流行病学资料,初步探讨蜂蛰伤致急性肾损伤(acute kidney injury,AKI)的危险因素。方法回顾性分析简阳市人民医院2014年9月至2016年9月收治的164例蜂蛰伤患者病例资料,根据是否发生AKI分为AKI组及非AKI组,比较2组的一般情况及相关血液检验指标,采用Logistic回归分析蜂蛰伤致AKI的危险因素。结果 164例蜂蜇伤患者中发生AKI 16例(占9.75%)。2组在蜇伤程度、蜂种类及心血管病史方面比较,无统计学差异。AKI组就诊时间较非AKI组晚,多器官功能衰竭发生率及病死率明显高于非AKI组(P<0.01)。蜂蛰伤主要集中在7~9月及10~12月,分别占53.04%,37.80%,一天中发生蜂蛰伤最多在6:00~12:00这一时间段,占46.95%。2组患者在蜂蛰伤后出现的临床症状比较,全身皮疹、头昏头痛、呼吸困难、恶心呕吐、心悸胸闷、意识改变均无统计学差异,AKI组患者出现肉眼血尿症状明显高于非AKI组,具有统计学差异(P<0.01)。2组患者的实验室指标比较均具有统计学差异。多因素Logistic回归分析表明,出现肉眼血尿(OR=8.623,95%CI 1.656~44.919,P=0.011)、白细胞高于20×10~9/L(OR=37.689,95%CI4.149~342.363,P=0.001)、超敏肌钙蛋白I大于100 ng/L(OR=5.718,95%CI 1.100~29.716,P=0.038)是蜂蜇伤患者发生AKI的独立危险因素。结论蜂蛰伤后应关注是否出现肉眼血尿,监测患者白细胞及超敏肌钙蛋白,尽早给予血液净化治疗,以降低病死率。

Objective To retrospectively analyze the clinical features and risk factors of acute kidney injury（ AKI） following bee stings. Methods A retrospective study was conducted on patients with suspected bee stings in People ＇s Hospital of Jianyang from September 2014 to September 2016. The patients were divided into AKI group and non-AKI group according to the occurrence of AKI. The clinical and laboratory data were collected and the risk factors were analyzed by logistic regression. Results Sixteen cases（9. 75%） suffered AKI in 164 patients. There was no statistically significant difference between the two groups in the extent of the sting,the type of bee and history of cardiovascular diseases. The bee stings mainly occurred during 6：00 to 12：00（46. 95%）,87（53. 04%） during July to September and 62（37. 8%）during October to December. The clinical manifestations after bee stings included skin rash,headache/dizziness,dyspnea,nausea/vomiting,palpitation,chest tightness and consciousness,showing no statistically significant difference between two groups. The gross hematuria was significantly higher in AKI group than in non-AKI group（ P〈0. 01）. The laboratory examination results of two groups were statistically different. The results of logistic regression analysis showed that gross hematuria（ OR = 8. 623,95% CI 1. 656-44. 919,P= 0. 011）,lencocyte 20 ×10~9/L（ OR = 37. 689,95% CI 4. 149-342. 363,P = 0. 001）,and cTnI 100ng/L（ OR = 5. 718,95% CI 1. 100-29. 716,P = 0. 038） were the independent risk factors of AKI in patients with bee stings. Conclusions Bee stings should focus on whether gross hematuria,blood monitoring and high-sensitivity troponin,give blood purification treatment as soon as possible,to reduce the death rate.