肝硬化患者并发肾损害危险因素的回顾性分析

Retrospective analysis of risk factors for kidney injury in cirrhosis patients

目的探讨肝硬化合并肾损害患者的临床特征,进一步分析发生肾脏损伤的危险因素。方法选取2016年1月-2018年7月中国医科大学附属盛京医院感染科收治的各类原因所致肝硬化患者429例,根据Child-Turcotte-Pugh(CTP)分级标准,将患者分为CTP A级、CTP B级及CTP C级。对患者一般情况、病因、肝功能分级、肾功能及预后等因素进行比较。结果各组患者病因构成比比较,差异有统计学意义(P<0.05)。CTP C级患者血清肌酐(Scr)、胱抑素C(Cys C)高于其余两组(P<0.05),CTP A患者估算的肾小球滤过率(eGFR)高于其余两组(P<0.05)。各组患者合并肾损害发生率比较,差异有统计学意义(P<0.05),肾损害发生率随CTP分级升高有增加的趋势;多因素Logistic回归分析结果显示,CTP分级[OR=2.324(95%CI:1.495,3.614),P=0.000]、年龄[OR=3.730(95%CI:2.185,6.367),P=0.000]是肾损害发生的独立影响因素。结论肝硬化患者的肝脏储备功能与病因、Scr、Cys C及eGFR密切相关;CTP分级越高,合并肾损害的发生率越高、损害程度越重;CTP分级和年龄是肝硬化患者发生肾脏损伤的独立影响因素。

Objective To investigate the clinical characteristics in patients with cirrhosis and complicated kidney damage,and to further analyze the risk factors for kidney injury.Methods The general situation,causes and classification of liver function,kidney function and prognosis factors of 429 patients with cirrhosis admitted in the department of infectious diseases of Shengjing Hospital of China Medical University were retrospectively analyzed.Results There was statistically significance in the constituent ratio of etiology of cirrhosis(P<0.05);the levels of Scr and Cys C in CTP C patients were higher than those in the other two groups(P<0.05),and the level of e GFR was higher in CTP A group than those in others(P<0.05);there was statistically significance in the incidence of kidney injury among three groups(P<0.05),and the incidence of kidney injury has trend of increasing with the development of CTP(P<0.05);CTP classification[OR=2.324(95%CI:1.495,3.614)]and age[OR=3.730(95%CI:2.185,6.367)]were independent associated risk factors for kidney injury.Conclusions Liver reservation function in patients with cirrhosis is closely related to the etiology,Scr,Cys C and eGFR.The higher the CTP class is,the higher the incidence of kidney injury is and the greater the injury degree is.CTP class and age are independent risk factors for kidney injury in patients with cirrhosis.