肿瘤患者合并急性肾损伤的临床特点和危险因素分析

Characteristics and Risk Factors of Acute Kidney Injury in Patients with Tumor

目的:分析123例肿瘤合并急性肾损伤(AKI)患者的临床特点、危险因素和预后。方法:回顾性队列研究,分析123例肿瘤合并AKI患者的肿瘤部位、AKI危险因素和预后。以294例非肿瘤合并AKI患者为对照组,比较与肿瘤组在AKI分期、生化指标和预后的差异。结果:(1)肿瘤组AKI男81例,女42例,年龄6岁~91岁,平均(60.8±15.3)岁。肿瘤常见原发部位是上消化道27例(22.0%),下消化道24例(19.5%)和肝/胆管19例(15.4%)。诱发AKI的高危因素最常见的有肾前性因素(56.1%),肿瘤多处转移(55.3%),年龄≥65岁(48.8%),尿路梗阻(39.0%)等,72.4%的患者同时存在3种以上高危因素。(2)非肿瘤AKI 294例,男166例,女128例,平均年龄(68.1±18.0)岁,年龄比肿瘤组大(P<0.01)。诱发AKI的前三位高危因素分别为高龄(74.1%),肾前性因素(包括心肾综合征+有效血容量不足+肝硬化=32.6%),脓毒症30.6%。(3)肿瘤组AKI 3期比例多于非肿瘤组,分别是89.4%和69.0%(P<0.01)。肿瘤组贫血明显,血肌酐、血钾、血钙水平高于非肿瘤组,血钠低于非肿瘤组(P<0.05)。(4)与非肿瘤组相比,肿瘤组AKI住院死亡率高(47.2%VS 31.0%)(P<0.01);维持性透析病人多(16.3%VS 4.8%)(P<0.01),肾功能恢复的病人少(15.4%VS 44.2%)(P<0.01)。结论:合并AKI的肿瘤部位以消化道肿瘤多见,多数患者存在3种以上AKI危险因素,预后差于非肿瘤的AKI患者。

Objective：To analysis the characteristics and risk factors of acute kidney injury（ AKI） in cancer patients.Methods：A retrospective cohort study was conducted in 123 AKI patients with cancer and 294 AKI patients without cancer as control.AKIN criteria was used to diagnosis AKI. The types of cancer,risk factors to AKI and outcomes were evaluated. The severity of AKI,partial lab examination and outcomes were compared between the two groups. Results：（1） In cancer group,there were 81 male and 42 female. The average age was 60. 8 ± 15. 3 years. The most frequent type of cancers were upper gastrointestinal（ n = 27,22. 0%）,lower gastrointestinal（ n = 24,19. 5%）,liver and billiary tract（ n = 19,15. 4%）. The main contributing risk factors for AKI were pre-renal factors（56. 1%）,extensive metastasis（55. 3%）,age≥65 years（48. 8%）,Urinary obstruction（39. 0%）,etc. 72. 4%patents had more than 3 kinds of risk factors simultaneously.（2） The average age of non-cancer group was 68. 1 ± 18. 0 year,older than cancer group（ P 0. 01）. The first three high risk factors for AKI were age of elderly（74. 1%）,pre-renal factor（32. 6%） including cardiorenal syndrome,insufficiency of blood volume and cirrhosis,sepsis（30. 6%）.（3） The proportion of stage 3 AKI was higher than that in non-cancer group（89. 4% vs 69. 0%,P 0. 01）. Compared with the non-cancer group,the anemia was heavier,the serum creatinine was higher,the serum potassium and calcium was higher,the serum sodium was lower in cancer group（ P 0. 05）.（4） Compared with non-cancer group,the cancer group had higher hospital mortality（47. 2% vs 31. 0%,P 0. 01）,more patients needed maintenance dialysis（16. 3% vs 4. 8%,P 0. 01）,less recovery of renal function（15. 4% vs 44. 2%,P 0. 01）.Conclusion：In this cohort,the most common type of cancer complicated with AKI was gastrointestinal,most cancer patients had more than three risk factors for AKI. The prognosis of cancer patients with AKI was worse than non-cancer patients with AKI.