慢性乙型肝炎病毒感染合并急性肾损伤的发病特点及近期预后分析

Characteristics and recent prognosis analysis of chronic hepatitis B virus infection with acute kidney injury

目的探讨慢性乙型肝炎急性肾损伤(AKI)患者的发病及预后情况,为慢性肝病AKI的临床防治提供科学依据。方法选取2017年3月-2018年3月石家庄市第五医院符合AKI定义的慢性肝病合并AKI的患者200例(AKI组)和慢性肝病未合并AKI的患者200例(对照组),回顾性分析慢性肝病AKI的发病特点及AKI患者的预后。结果慢性乙型肝炎(CHB)、肝硬化(LC)和肝细胞癌(HCC)AKI组与对照组比较,尿酸(UA)、血清肌酐(Scr)水平升高,肾小球滤过率(GFR)降低(P<0.05);LC和HCC AKI组与对照组比较,血尿素氮(BUN)水平上升(P<0.05)。不同肝病类型AKI患者中,LC、HCC与CHB比较,谷丙转氨酶(ALT)、血清白蛋白(Alb)水平和GFR下降,BUN、Scr水平升高(P<0.05)。慢性肝病AKI患者BUN、Scr与Alb呈负相关(r=-0.387和-0.217,P<0.05),BUN、Scr与总胆红素(TBIL)、和直接胆红素(DBIL)呈正相关(r=0.247、0.250、0.214和0.219,P<0.05);GFR与ALT呈负相关(r=-0.161,P<0.05),GFR与Alb呈正相关(r=0.310,P<0.05)。慢性肝病合并AKI患者中LC与CHB患者比较,腹水、脾肿大、肺部感染发生率差异有统计学意义(P<0.05)。慢性肝病AKI患者中AKIⅠ、Ⅱ、Ⅲ期病死率分别29.5%、58.1%和92.3%,不同分期间病死率差异有统计学意义(P<0.05)。结论慢性肝炎合并肾损伤患者肾脏GFR降低,Scr、UA水平升高,肝脏ALT、AST、TBIL、DBIL水平升高,肾功能损伤程度与Alb水平及TBIL密切相关。LC、HCC合并肾损伤时与其他并发症相比腹水发生较高,其次为肺部感染发病率、肝性脑病发病率。肾损伤严重程度与病死率有关。

Objective To investigate the incidence and prognosis of acute liver injury(AKI) in patients with chronic liver disease, and to provide scientific basis for clinical prevention and treatment of chronic liver disease AKI. Methods A retrospective analysis was performed on the 200 patients with chronic liver disease and AKI defined between March 2017 and March 2018 in Shijiazhuang fifth hospital, and 140 patients with chronic liver disease without AKI. To analyze the pathogenesis of chronic liver disease AKI and the prognosis of AKI patients. Results Compared with the control group, the levels of UA, Scr increased and GFR decreased in patients with chronic hepatitis, liver cirrhosis and liver cancer with acute kidney injury(P<0.05);the levels of BUN were increased in patients with liver cirrhosis and liver cancer AKI, compared with the control group(P<0.05). In patients with AKI of different types of liver diseases, the levels of ALT, Alb and GFR were significantly decreased, and the levels of BUN and Scr were significantly higher in cirrhosis and cancer than in chronic hepatitis(P<0.05). There was a negative correlation between BUN, Scr and ALB(P<0.05), and there were positive correlation between BUN, Scr and TBIL, DBIL in patients with chronic liver disease and acute kidney injury(P<0.05). The GFR was negatively correlated with ALT(P<0.05), and was positively correlated with Alb(P<0.05). Compared with the chronic hepatitis group, the incidence of ascites, splenomegaly and pulmonary infection in patients with liver cirrhosis was statistically significant(P<0.05). The mortality rates of I, II, and III stage AKI in patients with chronic liver disease were 29.5%, 58.1% and 92.3% respectively, and there was significant difference between the two groups(P<0.05). Conclusions In patients with chronic hepatitis and renal injury, renal GFR decreased, Scr and UA levels increased, liver ALT, AST, TBIL, DBIL levels increased, and renal function damage was closely related to Alb levels and TBIL. When liver cirrhosis and liver cancer combined with kidney injury, compared with other complications, ascites occurred higher, followed by the incidence of lung infection and hepatic encephalopathy. And the severity of kidney damage is related to the mortality rate.