肝硬化患者合并慢性肾脏疾病患病率分析

Prevalence of chronic kidney disease in patients with liver cirrhosis

目的分析不同类型肝硬化患者合并慢性肾脏病(chronic kidney disease,CKD)的患病率。方法选取2016年7月至2017年7月于首都医科大学附属北京地坛医院就诊的肝硬化者为研究对象,应用MDRD公式计算患者的肾小球滤过率(estimatedglomerular filtration rate,eGFR),分析不同类型肝硬化患者合并CKD的患病率。结果本研究共纳入2779例肝硬化患者,其中男性1821例,女性958例,诊断乙型肝炎后肝硬化1498例,丙型肝炎后肝硬化315例,酒精性肝硬化495例,自身免疫性肝病后肝硬化471例。eGFR <60 ml/(min·1.73 m2)者92例(3.31%),60 ml/(min·1.73 m2)<eGFR <90ml/(min·1.73m2)者467例(16.80%),乙型肝炎后肝硬化患者、丙型肝炎后肝硬化病患者、酒精性肝硬化患者和自身免疫性肝病后肝硬化患者合并CKD的患病率分别为3.00%(45/1498)、4.13%(13/315)、2.02%(10/495)和5.10%(24/471),差异有统计学意义(χ~2=8.27,P=0.041)。肝硬化患者中男性合并CKD的患病率为2.80%(51/1821),女性合并CKD的患病率为4.28%(41/958),差异有统计学意义(χ~2=4.29,P=0.038)。≥60岁肝硬化患者合并CKD的患病率为4.13%(66/1161),显著高于<60岁肝硬化患者的0.93%(15/1618),差异有统计学意义(χ~2=68.73,P<0.001)。Child-Pugh A级、B级和C级肝硬化患者合并CKD的患病率分别为0.89%(8/896)、2.25%(23/1023)和7.09%(61/860),差异有统计学意义(χ~2=58.41,P <0.001)。进行抗病毒治疗和未进行抗病毒治疗的乙型肝炎后肝硬化患者合并CKD的患病率分别为3.67%(44/1197)和0.33%(1/301),差异有统计学意义(χ~2=45.00,P <0.001)。结论≥60岁老年患者、女性、自身免疫性肝病后肝硬化和Child Pugh C级肝硬化患者更易出现慢性肾脏疾病。

Objective To analyze the prevalence of chronic kidney disease （CKD） in patients with liver cirrhosis. Methods Patients with liver cirrhosis in Beijing Ditan Hospital, Capital Medical University from July 2016 to July 2017 were selected. The estimate glomerular filtration rate （eGFR） was calculated by MDRD formula. The prevalence of CKD in different types of patients with liver cirrhosis was analyzed. Results A total of 2779 patients with liver cirrhosis were collected, including 1821 males and 958 females, 1498 cases were diagnosed as cirrhosis of hepatitis B, 315 cases were diagnosed as cirrhosis of hepatitis C, 495 cases were diagnosed as alcoholic cirrhosis and 471 cases were diagnosed as autoimmune cirrhosis. There were 92 cases （3.31%） whose eGFR 〈 60 ml/（min·1.73 m 2 ） and 467 cases （16.80%） whose eGFR were 60～90 ml/（min·1.73 m 2 ）. The rate of CKD in patients with hepatitis B cirrhosis, hepatitis C cirrhosis , alcoholic cirrhosis autoimmune cirrhosis were 3.00% （45/1498）, 4.13% （13/315）, 2.02% （10/495） and 5.10% （24/471）, respectively, with statistically significant difference （χ 2 = 8.27, P = 0.041）. The prevalence rate of CKD in male and female patients with liver cirrhosis were 2.80% （51/1821） and 4.28% （41/958）, respectively, with statistically significant difference （χ 2 = 4.29, P = 0.038）. The prevalence rate of patients over 60 years old was significantly higher than those under 60 years old [（4.13% （66/1161） vs 0.93% （15/1618）], with statistically significant difference （χ 2 = 68.73, P 〈 0.001）. The prevalence of CKD in patients with Child-Pugh grade A, B and C were 0.89% （8/896）, 2.25% （23/1023） and 7.09% （61/860）, respectively, with statistically significant difference （χ 2 = 58.41, P 〈 0.001）. The prevalence of CKD in patients with hepatitis B cirrhosis with or without antiviral therapy were 3.67% （44/1197） and 0.33% （1/301）, respectively, with statistically significant difference （χ 2 = 45.00, P 〈 0.001）. Conclusion Patients of liver cirrhosis over 60 years old, female, with autoimmune cirrhosis and Child Pugh C grade are more likely to develop to chronic kidney disease.