47例非创伤性横纹肌溶解的临床分析

Clinical analysis of 47 patients with non-traumatic rhabdomyolysis

目的:探讨非创伤性横纹肌溶解(RM)危重症并发急性肾损伤(AKI)的危险因素。方法:回顾性分析2015-11—2017-08期间我院收住院的47例RM患者资料,其中普通病房患者26例(普通组),重症监护病房患者21例(重症组),重症患者进一步分为合并AKI组(10例)和未合并AKI组(11例),对各组临床资料及实验室指标进行统计分析。结果:住院48~72h时重症组较普通组患者肌酸激酶(CK)升高更显著(P<0.05)。在病程起始阶段,入院时普通组的血小板(PLT)、淋巴细胞(L)及碳酸氢根(HCO3-)均高于重症组(P<0.05);随病程进展,住院48~72h时重症组的白蛋白(ALB)、PLT、血红蛋白(HB)、L有明显下降(P<0.05);在病情稳定后,出院前重症组ALB、HB及L水平明显低于普通组(P<0.05)。重症组中,合并AKI患者有更低的HCO3-及L水平,病程中HB下降显著,且这种下降趋势呈持续状态。HCO3-、HB与RM重症合并AKI相关(OR分别为0.697、0.922)。结论:HCO3-、L、HB、PLT、ALB可作为RM重症的评估指标,较高的HCO3-与HB水平是RM重症预后及合并AKI的保护因素。RM早期表现为酸中毒(包括代偿性酸中毒)和持续的HB下降有合并AKI的风险。

Objective：To explore the risk factors of non-traumatic rhabdomyolysis（RM）complicated with acute kidney injury（AKI）.Method：Data of 47 RM patients admitted in our hospital between November 2015 and August2017 was collected and retrospectively analyzed,including 26 cases of common patients and 21 cases of severe patients.We categorized these severe patients into two groups,one with co-existing AKI and one without.Statistical analysis was performed for clinical data of these patients.Result：48-72 hafter onset,more significantly elevated creatine kinase（CK）was found in severe patients（P〈0.05）.In the course of the initial stage,the levels of platelet（PLT）,lymphocyte（L）and bicarbonate（HCO^3-）in common group were higher than those in critical group（P〈0.05）.Along with the progression,the levels of albumin（ALB）,PLT,hemoglobin（HB）and L fell remarkably in critical group（P〈0.05）.Patients in critical group also has lower ALB,HB and L than common group at the end stage of disease（P〈0.05）.Patients of critical group with co-existing AKI had lower levels of HCO^3-and L,the level of HB decreased significantly,and this decline appeared a persistent state.Levels of HCO3-and HB were associated with severe rhabdomyolysis with AKI（OR was 0.697,0.922,respectively）.Conclusion：Levels of HCO^3-,L,HB,PLT and ALB can be used as evaluation index of critical rhabdomyolysis.Higher HB and HCO3-are protection factors.Early acidosis（including compensatory acidosis）and falling HB may promote the risk of AKI in RM.