肝腹水患者合用呋塞米与甘露醇致急性肾损伤风险因素分析及预测

Risk factors analysis and prediction of AKI in patients with hepatic ascites treated with furosemide and mannitol

目的:分析肝腹水患者联合使用呋塞米与甘露醇发生急性肾损伤(acute kidney injury,AKI)的风险因素并建立风险预测模型。方法:回顾性分析2017年1月至2019年12月期间在新疆医科大学第一附属医院联合使用呋塞米和甘露醇的115例肝腹水住院患者资料,对可能发生AKI不良反应的危险因素进行单因素分析及Logistics回归分析,并在此基础上建立发生AKI的风险预测模型。结果:发生AKI的患者34例(29.57%),Logistics回归分析结果显示,中性粒细胞百分比和胆汁酸2个影响因素对发生AKI有显著性影响(P<0.05)。进一步得到发生AKI的联合预测因子Y,其受试者工作特征(receiver operator characteristic,ROC)曲线的曲线下面积(area under curve,AUC)为0.709,表明有较好的预测能力。结论:中性粒细胞百分比和胆汁酸是肝腹水患者联合使用呋塞米与甘露醇发生AKI的独立危险因素,在临床治疗过程中,可将上述因素代入联合预测因子的计算公式,应注重AKI风险的评估,以保证临床用药的合理性。

OBJECTIVE To establish a risk prediction model by analyzing the risk factors of acute kidney injury(AKI)in patients with hepatic ascites treated with furosemide and mannitol.METHODS From January 2017 to December 2019,retrospective analysis was performed for clinical data of 115 cases of hospitalized AKI patients with hepatic ascites using sammy and mannitol.Single factor and Logistic regression analyses were conducted for risk factors of possible adverse effects.RESULTS There were 34 AKI patients(29.57%).Logistics regression analysis indicated that percentage of neutrophils and bile acid had significant effects on AKI(P<0.05).The co-predictor of AKI was Y and AUC of its ROC curve 0.709,hinting at an excellent predictive capability.CONCLUSION Percentage of neutrophils and bile acid are independent risk factors for the occurrence of AKI in patients with hepatic ascites treated with furosemide and mannitol.These factors may be substituted into the calculation formula of co-predictors during clinical treatments.Attention should be paid to assessing AKI risks to ensure the rationality of clinical use.