重症药疹患者发生急性肾损伤的危险因素分析

Analysis of risk factors for acute kidney injury in patients with severe drug eruption

目的探讨重症药疹患者发生急性肾损伤(AKI)的危险因素。方法收集2014年1月—2020年12月广东省人民医院皮肤科收治的重症药疹患者的基本信息(性别、年龄、体重指数)、重症药疹类型、致敏药物、合并疾病、入院后首次实验室检查结果和住院期间肾功能检查结果等临床资料进行回顾性分析。将患者分为AKI组和非AKI组,比较2组患者的临床特征,并采用二元logistic回归模型分析重症药疹患者发生AKI的危险因素,计算比值比(OR)及其95%置信区间(CI)。结果纳入分析的患者共91例,男性50例,女性41例;年龄54(40,65)岁,范围9~85岁;重症药疹致敏药物为别嘌醇者48例,抗癫痫药23例,抗菌药物6例,其他药物14例;AKI组21例(AKI发生率23.1%),非AKI组70例。AKI组患者抗癫痫药物致敏者占比、基线估算肾小球滤过率和血清白蛋白、血红蛋白浓度均低于非AKI组患者[0(0/21)比32.9%(23/70)、(70±12)ml/(min·1.73 m2)比(103±6)ml/(min·1.73 m2)、26(23,30)g/L比36(34,38)g/L、(116±17)g/L比(129±15)g/L],而别嘌醇致敏者占比、合并糖尿病者占比、合并慢性肾脏病者占比和基线血清尿素氮、血清肌酐水平以及尿蛋白阳性者占比均高于非AKI组患者[81.0%(17/21)比44.3%(31/70)、28.6%(6/21)比7.1%(5/70)、28.6%(6/21)比5.7%(4/70)、7.2(4.6,12.2)mmol/L比5.0(3.8,6.4)mmol/L,103(63,134)μmol/L比67(56,79)μmol/L、47.6%(10/21)比17.1%(12/70)],差异均有统计学意义(P<0.05,P<0.05)。二元logistic回归分析结果显示,别嘌醇致敏是重症药疹患者发生AKI的独立危险因素(OR=6.588,95%CI:1.006~43.123,P=0.049),而血清白蛋白是其保护因素(OR=0.595,95%CI:0.471~0.752,P<0.001)。结论别嘌醇致敏是重症药疹患者发生AKI的独立危险因素,血清白蛋白较低的重症药疹患者易发生AKI。

Objective To investigate the risk factors of acute kidney injury(AKI)in patients with severe drug eruption.Methods Clinical data including basic information(gender,age,body mass index),type of severe drug eruption,allergenic drugs,co⁃existing diseases,first laboratory findings after admission,renal function during hospitalization,etc.in patients with severe drug eruption admitted to Department of Dermatology,Guangdong Provincial People′s Hospital from January 2014 to December 2020 were collected and analyzed retrospectively.Patients were divided into AKI group and non⁃AKI group and the clinical data were compared between the 2 groups.The risk factors of AKI in patients with severe drug eruption were analyzed by a binary logistic regression model and the odds ratio(OR)and its 95%confidence interval(CI)were calculated.Results A total of 91 patients were enrolled in the study,including 50 males and 41 females,aged 54(40,65)years with a range of 9⁃85 years.The drugs that induced severe drug eruptions were allopurinol in 48 patients,antiepileptic drugs in 23 patients,antibacterial drugs in 6 patients,and other drugs in 14 patients.There were 21 patients(AKI incidence:23.1%)in the AKI group and 70 patients in the non⁃AKI group.The proportion of patients sensitized to antiepileptic drugs,baseline estimated glomerular filtration rate,levels of serum albumin and hemoglobin in the AKI group were lower than those in the non⁃AKI group[0(0/21)vs.32.9%(23/70),(70±12)ml/(min·1.73 m2)vs.(103±6)ml/(min·1.73 m2),26(23,30)g/L vs.36(34,38)g/L,(116±17)g/L vs.(129±15)g/L],the proportions of patients sensitized to allopurinol,with diabetes mellitus,and with chronic kidney diseases,baseline serum urea nitrogen level,serum creatinine level,and proportion of urinary albumin positive patients were all higher than those in the non⁃AKI group[81.0%(17/21)vs.44.3%(31/70),28.6%(6/21)vs.7.1%(5/70),28.6%(6/21)vs.5.7%(4/70),7.2(4.6,12.2)mmol/L vs.5.0(3.8,6.4)mmol/L,103(63,134)μmol/L vs.67(56,79)μmol/L,47.6%(10/21)vs.17.1%(12/70)],and the differences were statistically significant(all P<0.05).Binary logistic regression analysis showed that allopurinol sensitization(OR=6.588,95%CI:1.006-43.123,P=0.049)was the independent risk factor for AKI in patients with severe drug eruption and serum albumin(OR=0.595,95%CI:0.471-0.752,P<0.001)was a protective factor.Conclusions Allopurinol sensitization was the independent risk factor for AKI in patients with severe drug eruption.Patients with low serum albumin were more likely to develop AKI.