老年和非老年急性肾梗死患者临床特征的单中心对比研究

Clinical characteristics of elderly-onset versus non-elderly-onset acute renal infarction:A single-center comparative study

目的比较老年急性肾梗死与非老年急性肾梗死患者的临床特征。方法52例经影像学证实的急性肾梗死患者,以年龄≥65岁为界分为老年组(17例)和非老年组(35例),分析比较两组患者的人口学数据、危险因素、临床表现、诊断、治疗及预后情况。结果与非老年组患者比较,老年组血栓栓塞性急性肾梗死更多见[82.4%(14例)比45.7%(16例),χ^2=6.290,P=0.012],更多合并心房颤动[64.7%(11例)比34.3%(12例),χ^2=4.290,P=0.038)].冠心病[(52.9%(9例)比8.6%(3例),P=0.001)]和肥胖[40.0%(4/10例)比8.0%(2/25例),P=0.043],更少为吸烟者(P=0.007),腰痛症状少见(P=0.038),血小板计数较低(7=0.016)。老年患者从就诊至确诊的时间短于非老年患者[18 h(2~192 h)比48 h(2〜552 h),Z=2.404,P=0.021]增强计算机体层成像是最主要的确诊方法,抗凝治疗是最主要的治疗手段。老年患者和非老年患者治疗开始至症状消失及住院的中位时间分别为3 d(1〜9 d).11 d(4〜50 d)和3 d(1〜12 d)、3 d(2〜64 d)。两组均无患者院内死亡。随访(39.4±35.8)个月,两组患者的预后差异无统计学意义(均P>0.05)。结论源于心脏疾病的血栓栓塞是老年急性肾梗死的主要病因。尽管老年患者相对早地得以确诊,但治疗后预后与非老年患者无异;同时,延迟诊断和治疗的情况仍然很常见。

Objective To compare the clinical characteristics of elderly-onset versus non-elderly-onset acute renal infarction(ARI).Methods Fifty-two patients with ARI diagnosed by contrast-enhanced computed tomography(CECT)or renal arteriography were classified into elderly group(onset age < 65 year,n=17)and non-elderly group(onset age ≥65 year,n=35).Demographic data,risk factors,initial clinical presentations,laboratory data»diagnosis»treatment and prognosis were analyzed and compared between the two groups.Results Embolic ARI was more common in elderly group than in the non-elderly group(82.4%or 14/17 vs.45.7%or 16/35,χ^2=6.290,P=0.012).Patients complicated with atrial fibrillation(64.7%or 11/17 vs.34.3%or 12/35,χ^2=4.290,P=0.038),coronary artery disease(52.9%or 9/17 vs.8.6%or 3/35,P=0.001)and obesity(40.0%or 4/10 vs.8.0%or 2/25,P=0.043)were more and smokers were less(F=0.007)in the elderly group than in non-elderly group.The incidence of lumbar pain(P=0.038)and the platelet count was lower(P=0.016)in elderly group than in non-elderly group.The median duration from hospital presentation to the diagnosis of ARI was shorter in elderly group than in non-elderly group[18 h(2-192)vs.48 h(2-552),Z=2.404,P=0.021].The CECT scan was the most common diagnostic technique and anticoagulation was the most common therapy in both groups.The median time from the beginning of treatment to disappearance of symptoms were 3 d(range,1-9)and 11 d(range,4-50),and the median time of hospital stay were 3 d(range,1-12)and 13 d(range,2-64)in the elderly and non-elderly group,respectively.There was no in-hospital mortality in both groups.There was no significant difference in the prognosis between the two groups after a mean follow-up of(39.4±35.8)months(P>0.05).Conclusions Thromboembolism due to heart disease is the main etiology of ARI in the elderly.Although elderly patients can be diagnosed relatively early,the prognosis of elderly patients is the same as that of non-elderly patients after treatment.Meanwhile)delays in diagnosis and initiating treatment for the elderly with ARI are still common.