动脉血乳酸水平升高与肾综合征出血热患者预后的关系

Relationship between elevated arterial blood lactate level and prognosis of patients with hemorrhagic fever with renal syndrome

目的探讨动脉血乳酸水平是否与肾综合征出血热预后相关。方法回顾性病例分析2014年1月至2018年12月期间中山大学孙逸仙纪念医院收治的肾综合征出血热患者共41例,其中男性33例(80.5%),女性8例(19.5%);年龄19~73,平均(44.2±14.0)岁。按肾功能恢复时间将患者分组,定义A组22例为快速恢复组(≤12 d),B组11例为缓慢恢复组(>12 d),C组8例为未恢复组。收集其症状特征、实验室检查、治疗恢复时间、预后等指标并进行统计学分析。根据动脉血乳酸水平分为乳酸正常组及乳酸升高组,对比两组患者平均肾功能恢复时间,行血液净化治疗比例及病死率。结果41例肾综合征出血热患者中,肾功能恢复33例(80.5%),肾功能恢复中位时间为12 d,血液透析治疗8例(19.5%),死亡2例(4.9%)。根据动脉血乳酸水平分为乳酸正常组及乳酸升高组。发现乳酸升高组患者平均肾功能恢复时间较长;行血液净化治疗比例高;病死率高。结论动脉血乳酸水平升高可能预示肾综合征出血热患者预后不佳。

Objective To investigate whether the level of arterial blood lactic acid is related to the prognosis of patients with hemorrhagic fever with renal syndrome(HFRS).Methods A total of 41 patients with HFRS admitted to the Sun Yat-sen Memorial Hospital from January 2014 to December 2018 were retrospectively analyzed,including 33 males(80.5%)and 8 females(19.5%),aged from 19 to 73 years,with an average of(44.2±14.0)years old.The patients were divided into groups according to the recovery time of renal function.22 cases in group A were defined as rapid recovery group(≤12 days),11 cases in group B as slow recovery group(>12 days),and 8 cases in group C as non recovery group.The symptom characteristics,laboratory examination,treatment recovery time and prognosis were collected and statistically analyzed.According to the level of arterial blood lactate,the patients were divided into normal lactate group and elevated lactate group.The average recovery time of renal function,the proportion of blood purification treatment and the mortality of the two groups were compared.Results Among 41 patients with hemorrhagic fever with renal syndrome,renal function recovered in 33 cases(80.5%).The median time of renal function recovery was 12 days.8 cases(19.5%)were treated with hemodialysis and 2 cases(4.9%)died.The average recovery time of renal function in the elevated lactic acid group was longer,the proportion of CRRT treatment was higher and the mortality was higher.Conclusion The increase of arterial bloodlactic acid level may predict the poor prognosis of patients with hemorrhagic fever with renal syndrome.