蜂蛰伤致横纹肌溶解症的临床特征及急性肾损伤危险因素分析

Clinical characteristics of bee sting-induced rhabdomyolysis and risk factor of acute kidney injury

目的探讨蜂蛰伤致横纹肌溶解症(RM)的临床特征及影响急性肾损伤(AKI)的危险因素。方法回顾性分析2013年6月至2018年6月西南医科大学附属医院收治的241例蜂蛰伤患者的临床资料,按照是否发生RM分为RM组(58例)和无RM组(183例),比较两组一般情况、住院天数、AKI发生率、多器官功能障碍综合征(MODS)发生率、病死率及实验室指标,并采用多因素logistic回归法分析蜂蛰伤致AKI的危险因素。结果蜂蛰伤患者RM发生率为24.1%(58/241)。RM组较无RM组更容易发生溶血、血尿、少尿或无尿、凝血异常、急性肝损伤(均P<0.05)。RM组患者AKI发生率为48.3%(28/58)、MODS发生率为94.8%(55/58)、病死率为25.9%(15/58),均显著高于无RM组患者(均P<0.05)。两组患者入院时ALT、AST、IBiL、乳酸脱氢酶(LDH)、尿素氮(BUN)、血肌酐(Scr)、TG、超敏肌钙蛋白(cTn)I、肌酸激酶同工酶(CK-MB)、血钾离子、血钙离子、WBC、Hb、PLT、PT、APTT等指标比较,差异均有统计学意义(均P<0.05)。多因素logistic回归分析发现,蜂蛰伤致RM、溶血、男性、白蛋白≤35 g/L是蜂蛰伤后发生AKI的独立危险因素(均P<0.05)。结论蜂蛰伤患者尤其是男性、就诊时间过长、合并RM者应尽早采取综合救治措施,可减少RM、AKI及MODS的发生风险。

Objective To explore the clinical characteristics of bee sting-induced rhabdomyolysis(RM)and risk factor of acute kidney injury(AKI).Methods The clinical data of 241 patients with bee sting admitted to the Affiliated Hospital of The Southwest Medical University from June 2013 to June 2018 were retrospectively analyzed,including 58 cases with RM and 183 cases without RM.The clinical characteristics,laboratory test results,length of hospital stay,the incidence of AKI and multiple organ dysfunction syndrome(MODS)and mortality between the two groups were compared.Multivariate logistic regression was used to analyze the risk factors of AKI caused by bee sting.Results The incidence of RM after bee sting was 24.1%(58/241).The rates of hemolysis,hematuresis,oliguria or anuria,coagulopathy and acute liver injury in RM group were significantly higher than those in non-RM group(all P<0.05).Patients with RM had higher incidence of AKI,MODS and mortality than those without RM(all P<0.05).At admission,there were significant differences in ALT,AST,IBiL,lactate dehydrogenase(LDH),blood urea nitrogen(BUN),serum creatinine(Scr),TG,hypersensitive troponin(cTn)I,creatine kinase isoenzyme(CK-MB),blood K+,blood Ca2+,WBC,Hb,PLT,PT and APTT between the two groups(P<0.05).Multivariate logistic regression analysis indicated that RM,hemolysis,gender and ALB≤35 g/L were independent risk factors for AKI after bee sting(P<0.05).Conclusion To reduce the risk of RM,AKI and MODS for patients with bee sting,it is necessary to give comprehensive treatment measures as soon as possible.