急性/亚急性肝衰竭合并急性肾损伤的临床特征分析

Clinical features of patients with acute/subacute liver failure complicated by acute kidney injury

目的初步明确急/亚急性肝衰竭(ALF/SALF)合并急性肾损伤(AKI)患者的临床特征。方法回顾性分析解放军第三〇二医院2015年1月-2016年12月收治的115例ALF/SALF患者临床资料,根据是否发生AKI分为AKI组(n=36)和无AKI组(n=79)。比较两组患者的年龄、性别、肝功能、外周血WBC水平、凝血功能、MELD评分及并发症发生情况等,观察发生AKI患者的预后情况。计量资料组间比较采用t检验,计数资料组间比较采用χ2检验。结果导致ALF/SALF的病因以药物性最为多见(49.57%),其次为不明原因(28.70%)。115例ALF/SALF患者中共36例合并AKI,AKI发生率为31.3%,其中1、2及3期发生率分别为11.30%、14.78%、5.22%。与未发生AKI的患者相比,AKI组患者年龄、WBC、中性粒细胞比值、腹水、腹腔和肺部感染率以及MELD评分均显著增高,血清Alb水平显著降低(P值均<0.05)。发生AKI的患者无效/死亡率明显高于无AKI患者(69.4%vs38.0%,χ2=9.815,P=0.002),且随AKI严重程度的增高,病死率升高,1、2及3期AKI患者无效/死亡的比例分别为61.5%、70.6%和83.3%。结论肝衰竭患者发生AKI时多存在感染或炎症反应,且AKI的发生与肝衰竭患者的病死率相关。

Objective To evaluate the clinical features of patients with acute/subacute liver failure（ALF/SALF） complicated by acute kidney failure（AKI）.Methods A retrospective analysis was performed for the clinical data of 115 ALF/SALF patients who were admitted to302 Hospital of PLA from January 2015 to December 2016,and according to the presence or absence of AKI,these patients were divided into AKI group with 36 patients and non-AKI group with 79 patients.The two groups were compared in terms of age,sex,liver function,peripheral white blood cell count（WBC）,coagulation function,Model for End-Stage Liver Disease（MELD） score,and complications,and the prognosis of AKI patients was also observed.The t-test was used for comparison of continuous data between groups,and the chi-square test was used for comparison of categorical data between groups.Results The most common cause of ALF/SALF was drug（49.57%）,followed by unknown causes（28.70%）.Of all 115 ALF/SALF patients,36 had AKI,resulting in an incidence rate of31.3%,and the incidence rates of stage 1,2,and 3 AKI were 11.30%,14.78%,and 5.22%,respectively.Compared with the non-AKI group,the AKI group had significantly higher age,WBC,neutrophil ratio,incidence rates of ascites and abdominal/pulmonary infection,and MELD score（all P〈0.05）,as well as a significant reduction in the serum level of albumin（P〈0.05）.The AKI group had a significantly higher rate of no response/death than the non-AKI group（69.4% vs 38.0%,χ2= 9.815,P = 0.002）,and the mortality rate increased with the increase in the severity of AKI.Among the patients with stage 1,2,and 3 AKI,61.5%,70.6%,and 83.3%,respectively,had no response or died.Conclusion Most of the patients with liver failure complicated by AKI have infections or inflammatory response,and the development of AKI is associated with the mortality of patients with liver failure.