早产儿急性肾损伤发病率及其危险因素的多中心回顾性研究

Incidence and risk factors of acute kidney injury in preterm infants:a multicenter retrospective study

目的了解早产儿急性肾损伤(AKI)发生率及其危险因素,为早产儿肾功能正确评估与治疗提供依据。方法选取2017年1月1日至2019年6月30日入住三个研究中心(北京儿童医院新生儿中心、北京妇产医院新生儿病房、北京儿童医院顺义妇儿医院新生儿病房)且7d内有2次以上血清肌酐值或尿量可进行AKI评估的住院早产儿为研究对象。回顾性分析早产儿AKI发生率,比较不同胎龄间AKI发生率差异。根据是否发生AKI,分为AKI组及非AKI组,比较两组临床特征,分析早产儿AKI发生的危险因素。结果共有763例早产儿纳入研究,22例诊断AKI,早产儿AKI发生率为2.9%。胎龄24~27+6周组、28~31+6周组、32~36+6周组,AKI发生率分别为33.3%(3/9)、3.7%(5/134)、2.3%(14/620),不同胎龄早产儿AKI发生率差异有统计学意义(χ^(2)=31.010,P<0.001)。AKI组比非AKI组男性比例更高(77.3%比53.3%)、胎龄更小[29(27,33)周比31(29,33)周]、糖尿病母亲婴儿比例更高(40.9%比19.4%)、1 min及5 min Apgar评分更低[分别为8(7,10)分比9(8,10)分,9(9,10)分比10(9,10)分]、有创及无创呼吸支持比例更高(分别为45.5%比11.3%,63.6%比19.2%)、有创呼吸支持时间更长[260(136,742)h比72(18,160)h]、住院时间更长[66(19,88)d比42(26,58)d],发生败血症(27.3%比6.5%)、需要肺泡表面活性物质治疗的呼吸窘迫综合征(40.9%比11.6%)及需要布洛芬或手术关闭的动脉导管未闭(13.6%比3.0%)、利尿剂(27.3%比3.9%)及血管活性药物使用比例(22.7%比3.6%)更高,差异均有统计学意义(均P<0.05)。多因素回归分析显示矫正胎龄、出生体重后,败血症是早产儿发生AKI的独立危险因素(P=0.039,OR=3.498,95%CI 1.065~11.490)。结论28周以下早产儿AKI发生率较高。发生AKI的早产儿胎龄更小、住院时间更长,败血症是早产儿发生AKI的独立危险因素。

Objective To estimate the incidence and risk factors of acute kidney injury(AKI)in preterm infants,and provide basis for better evaluation and treatment of renal function in preterm infants.Methods All the hospitalized premature infants who were admitted to three research centers(Department of Neonatology at Beijing Children′s Hospital;Department of Neonatology at Beijing Obstetrics and Gynecology Hospital;Department of Neonatology at Shunyi Maternal and Children′s Hospital of Beijing Children′s Hospital)from January 1,2017 to June 30,2019 and had more than two serum creatinine values or urine output were included.The incidence of AKI in preterm infants was calculated and the difference among different gestational weeks was compared.Preterm infants were divided into AKI and non-AKI groups according to AKI diagnostic criteria,and the clinical characteristics between two groups were compared,and the risk factors of AKI in preterm infants were analyzed.Results A total of 763 premature infants were included in the analysis.Twenty two cases were diagnosed with AKI.The incidence of AKI in premature infants was 2.9%.The incidence of AKI was 33.3%(3/9),3.7%(5/134),and 2.3%(14/620)in the 24-27+6 weeks,28-31+6 weeks,and 32-36+6 weeks gestational age,respectively,and the difference was statistically significant(χ^(2)=31.010,P<0.001).Preterm infants in AKI group had a higher proportion of males(77.3%vs.53.3%),lower gestational weeks[29(27,33)weeks vs.31(29,33)weeks],higher proportions of infants with diabetic mothers(40.9%vs.19.4%),lower Apgar scores at 1 and 5 minutes[8(7,10)vs.9(8,10),9(9,10)vs.10(9,10),respectively],higher proportions of invasive and noninvasive respiratory support(45.5%vs.11.3%,63.6%vs.19.2%,respectively),longer duration of invasive respiratory support[260(136,742)h vs.72(18,160)h],longer hospital stays[66(19,88)d vs.42(26,58)d],and higher rates of sepsis(27.3%vs.6.5%),respiratory distress syndrome(40.9%vs.11.6%),and patent ductus arteriosus that requiring ibuprofen or surgical closure(13.6%vs.3.0%),diuretic(27.3%vs.3.9%),and vasoactive drug use(22.7%vs.3.6%)than those in non-AKI group,and the differences were statistically significant(all P<0.05).Multivariate regression analysis showed that sepsis was an independent risk factor for AKI in preterm infants(P=0.039,OR=3.498,95%CI 1.065-11.490)after adjustment of gestational age and birth weight.Conclusion The incidence of AKI is relatively high in preterm infants with gestational age<28 weeks.Compared with preterm infants without AKI,preterm infants with AKI have smaller gestational weeks and longer hospital stay.Sepsis is an independent risk factor for AKI in preterm infants.