乙型肝炎肝硬化患者并发急性肾损伤危险因素分析

Risk factors for acute kidney injury in patients with hepatitis B-induced liver cirrhosis

目的分析探讨乙型肝炎肝硬化患者并发急性肾损伤(AKI)的危险因素。方法2018年3月~2020年3月于我院进行治疗的乙型肝炎肝硬化患者136例,通过电子病历收集一般资料和实验室指标,根据相关标准诊断诊断并发AKI者40例,无AKI者96例。应用Logistic回归分析影响AKI发生的危险因素。结果单因素分析结果表明,并发AKI患者失代偿期肝硬化占比为52.5%,显著高于无AKI患者的31.3%(P<0.05),腹水发生率为55.0%,显著高于无AKI患者的29.2%(P<0.05),并发肝性脑病发生率为22.5%,显著高于无AKI患者的4.2%(P<0.05),而两组性别、年龄、病程、Child-Pugh分级差异无统计学意义(P>0.05);多元Logistic回归分析结果显示肝硬化分期、腹水和并发肝性脑病是乙型肝炎肝硬化患者发生AKI的独立危险因素(P<0.05)。结论乙型肝炎肝硬化患者发生肝功能失代偿、腹水或并发肝性脑病容易诱发AKI,临床需要行针对性的预防措施,以提高生存率。

Objective The purpose of this study was to analyze the risk factors of acute kidney injury(AKI)in patients with hepatitis B-induced liver cirrhosis(LC).Methods 136 patients with hepatitis B-induced LC were admitted to our hospital between March 2018 and March 2020,and the clinical data were retrieved from HIS system.The AKI in 40 patients was diagnosed met with related guidelines,and the Logistic regression was applied to analyze the risk factors that affect the occurrence of AKI.Results The univariate analysis showed that the percentage of decompensated liver cirrhosis in patients with AKI was 52.5%,significantly higher than 31.3%(P<0.05)in those without,the incidence of ascites was 55.0%,significantly higher than 29.2%(P<0.05)in patients without AKI,and the hepatic encephalopathy was 22.5%,significantly higher than 4.2%(P<0.05)in those without,while there were no significant differences respect to age,gender,disease course and Child-Pugh class between the two groups(P>0.05);the multivariate Logistic regression analysis showed that compensated or decompensated liver functions,ascites,and hepatic encephalopathy were the independent risk factors for AKI occurrence in patients with hepatitis B-induced LC(P<0.05).Conclusion The patients with hepatitis B-induced LC might have AKI,especially in those with risk factors such as decompensated liver cirrhosis,ascites and complicated hepatic encephalopathy.