肝硬化腹水继发急性肾损伤患者相关因素分析

Analysis of risk factors for the secondary acute kidney injury in patients with cirrhotic ascites

目的探讨肝硬化腹水患者发生急性肾损伤的相关因素。方法收集105例肝硬化腹水患者的相关临床资料,根据血肌酐水平动态改变,将患者分为急性肾损伤组和非肾损伤组,回顾性分析临床资料及实验室指标与急性肾损伤的关系,观察肝硬化腹水患者继发急性肾损伤的独立危险因素。结果两组血钠水平、总胆红素水平、血氨水平、凝血酶原活动度及白细胞计数比较,差异均有统计学意义(P<0.01);急性肾损伤组自发性腹膜炎、肝性脑病及其他部位感染情况均高于非肾损伤组(P<0.05);自发性腹膜炎、总胆红素、白细胞计数、PTA、低血钠、高血氨是继发性急性肾损伤的独立危险因素(P<0.05)。结论关于肝硬化腹水患者,肝性脑病、感染、低钠血症、高胆红素血症、高血氨血症、低血浆凝血酶原活性和自发性腹膜炎均可能是其继发急性肾损伤的危险因素。

Objective To investigate the relevant risk factors for secondary acute kidney injury(AKI)in patients with cirrhotic ascites. Methods Clinical data of 105 cirrhotic ascites patients were collected.According to the dynamic change of SCr,the patients were divided into either observation or control group.The relationship of clinical data and laboratory indicators of AKI was retrospectively analyzed.The independent risk factors for the secondary AKI were determined.Results There were significant differences in serum levels of sodium,total bilrubin and ammonia,prothrombin time activity(PTA)and white blood cell count between the two groups(P<0.01).The incidence of spontaneous peritonitis,hepatic encephalopathy and other location infections in the AKI group was significantly higher than the non-AKI group(P<0.05).The spontaneous peritonitis,total bilirubin,white blood cell count,PTA,hyperammonemia,and hyponatremia may be independent risk factors for the secondary AKI in patients with cirrhotic ascites(P<0.05).Conclusion In concerning cirrhotic ascites patients,hepatic encephalopathy,infection,hyponatremia,hyperbilirubinemia,hyperammonemia,low plasma prothrombin activity and spontaneous peritonitis may be risk factors of AKI.