乙型肝炎肝硬化并发急性肾损伤患者临床特点及其危险因素分析

Clinical features and risk factors of acute kidney injury in patients with viral hepatitis B-induced liver cirrhosis

目的分析总结乙型肝炎肝硬化患者并发急性肾损伤(AKI)的临床特点及其危险因素。方法 2015年4月~2020年2月我院收治的乙型肝炎肝硬化患者223例,采用ELISA法检测血清α羟丁酸脱氢酶(HBDH),使用分光光度计检测吲哚氰绿(ICG),采用简化的美国肾脏病膳食改善(MDRD)研究组发布的公式计算估算的肾小球滤过率(e GFR)。应用多因素Logistic回归分析影响乙型肝炎肝硬化并发AKI的独立危险因素。结果在本组223例乙型肝炎肝硬化患者中,并发AKI 41例(18.4%),选择82例未发生AKI患者作对照,结果 AKI组年龄≥50岁、合并糖尿病、高尿酸血症、腹水、感染和Child-Pugh C级比率分别为39.0%、26.8%、29.3%、80.5%、36.6%和53.7%,显著高于无AKI组(分别为20.7%、12.2%、13.4%、59.8%、17.1%和17.1%,P<0.05);血清HBDH和ICG水平分别为(184.2±21.3) U/L和(31.4±3.6)%,显著高于无AKI组【分别为(141.0±13.8) U/L和(15.6±1.9)%,P<0.05],而e GFR为(71.6±11.3) m L/min·(1.73 m^(2))^(-1),显著低于无AKI组【(113.8±13.4) m L/min·(1.73 m^(2))^(-1),P<0.05];Logistic回归分析显示年龄≥50岁[OR(95%CI)为3.0(1.1~8.6)]、合并糖尿病[OR(95%CI)为1.9(1.1~3.3)]、伴有高尿酸血症[OR(95%CI)为2.8(1.1~7.3)]、存在腹水[OR(95%CI)为2.6(1.0~6.6)]、伴有感染[OR(95%CI)为5.1(1.2~22.6)]、肝功能Child-Pugh C级[OR(95%CI)为3.6(1.5~8.9)]、血清HBDH水平高[OR(95%CI)为2.8(1.2~6.3)]和e GFR水平低[OR(95%CI)为2.4(1.3~4.4)]均为乙型肝炎肝硬化患者并发AKI的独立危险因素(P<0.05)。结论乙型肝炎肝硬化患者,特别是失代偿期患者,存在一些并发AKI的危险因素,如年龄大、伴有糖尿病、高尿酸血症、腹水、感染、肝功能分级为C级等。针对AKI发生的高危人群,临床应予以高度关注,及时诊治,才可能改善预后。

Objective The aim of this study was to analyze the clinical features and risk factors of acute kidney injury( AKI) in patients with viral hepatitis B-induced liver cirrhosis( LC). Methods A total of 223 patients with hepatitis B cirrhosis were admitted to our hospital between April 2015 and February 2020,and the AKI incidence was found. Serum hydroxybutyratedehydrogenase( HBDH) and indocyanine green( ICG) were detected. The estimated glomerular filtration rate( e GFR) was calculated. The independent risk factors for occurrence AKI were analyzed by multivariate Logistic regression analysis. Results Out of the 223 patients with LC,41 patients( 18.4%) were found having AKI,and we selected 82 patients without AKI based on age and gender pair for control;the results showed that the percentages of aged ≥ 50 yr,with diabetes,hyperuricemia,ascites,infection and Child-Pugh class C in patients with AKI were 39.0%,26.8%,29.3%,80.5%,36.6% and 53.7%,all significantly higher than( 20. 7%,12. 2%,13. 4%,59. 8%,17. 1% and 17. 1%,respectively,P < 0. 05);serum HBDH and ICG levels in patients with AKI were( 184.2±21.3) U/L and( 31.4±3.6) %,both significantly higher than [( 141.0± 13.8) U/L and( 15.6± 1.9) %,respectively,P<0.05],while the e GFR was( 71.6±11.3) m L/min·( 1.73 m^(2))^(-1),significantly lower than [( 113.8±13.4)m L/min·( 1.73 m^(2))^(-1),P<0.05]in patients without AKI;the multivariate Logistic regression analysis demonstrated that aged ≥50 yr[OR( 95%CI) : 3. 0( 1. 1-8.6) ],complicated by diabetes[OR( 95%CI) : 1.9( 1.1-3.3) ],with hyperuricemia [OR( 95%CI) : 2.8( 1. 1-7. 3) ],with ascites [OR( 95% CI) : 2. 6( 1. 0-6.6) ],with infection [OR( 95% CI) : 5. 1( 1. 2-22. 6) ],Child-Pugh class C [OR( 95% CI) : 3. 6( 1. 5-8. 9) ],high serum HBDH level [OR( 95% CI) : 2. 8( 1. 2-6. 3) ] and lower e GFR[OR( 95%CI) : 2.4( 1.3-4.4) ] were all the independent risk factors for occurrence of AKI in patients with LC induced by CHB( P < 0. 05). Conclusion AKI is more prone to patients with hepatitis B-induced liver cirrhosis,and some risk factors,such as eldly patients,with concomitant diabetes,hyperuricemia,ascites,infection,and poor liver functions,should be taken into consideration clinically,which means early diagnosis and appropriate management might improve the prognosis.