慢性肝病合并慢性肾脏病患者的临床特征分析

Clinical characteristics of nephropathy in patients with chronic liver disease combined with chronic kidney disease

目的探讨慢性肝病合并慢性肾脏病(chronic kidney disease,CKD)患者的临床特征。方法纳入2020年6月至2021年12月于首都医科大学附属北京佑安医院肝病中心四科就诊的慢性肝病合并CKD患者65例,根据CKD分期分为1-2期组32例,3期组24例,4-5期组9例。比较各组患者临床特征,采用logistic回归分析慢性肝病患者CKD进展至4-5期的危险因素。结果随着CKD分期进展,血β2微球蛋白(CKD1-2期2.6 mg/L,CKD3期6.9 mg/L,CKD4-5期12.8 mg/L,P<0.01)、尿α1微球蛋白(CKD1-2期23.3 mg/L,CKD3期30.1 mg/L,CKD4-5期72.6 mg/L,P=0.001)、尿β2微球蛋白(CKD1-2期0.4 mg/L,CKD3期0.5 mg/L,CKD4-5期8.3 mg/L,P=0.005)水平显著增加,尿肌酐(CKD1-2期8881μmol/L,CKD3期5512μmol/L,CKD4-5期4388μmol/L,P<0.01)、尿钠(CKD1-2期111.4 mmol/L,CKD3期75.8 mmol/L,CKD4-5期73.2 mmol/L,P<0.01)水平显著降低;双侧肾门动脉阻力指数(右侧CKD1-2期0.69,CKD3期0.77,CKD4-5期0.74,P=0.010,左侧CKD1-2期0.69,CKD3期0.76,CKD4-5期0.78,P=0.009)及段动脉阻力指数(右侧CKD1-2期0.66,CKD3期0.71,CKD4-5期0.72,P=0.034,左侧CKD1-2期0.66,CKD3期0.69,CKD4-5期0.73,P=0.027)亦随CKD分期增加而逐渐增加。多因素logistic回归分析发现,较高的血视黄醇结合蛋白(OR=1.073,95%CI:1.006~1.145,P=0.032)、血β2微球蛋白(OR=1.932,95%CI:1.233~3.027,P=0.004)是慢性肝病合并CKD患者进展至CKD4-5期的独立危险因素。结论监测慢性肝病合并CKD患者血和尿的生物学标志物,有助于及早发现慢性肝病患者CKD进展、及时干预并改善预后。

Objective To investigate the clinical characteristics of chronic kidney disease(CKD)progression in patients with chronic liver disease combined with CKD.Methods Patients with chronic liver disease complicated with CKD admitted to our hospital from June 2020 to December 2021 were enrolled,they were divided into stage 1-2 group,stage 3 group and stage 4-5 group according to CKD staging.The clinical characteristics of patients in each group were compared.Logistic regression was used to analyze the risk factors for the progression of CKD to stage 4-5 in patients with chronic liver disease.Results A total of 65 patients with chronic liver disease complicated with CKD were included.With the progression of CKD staging,the levels of serumβ2 microglobulin(CKD1-22.6 mg/L,CKD36.9 mg/L,CKD4-512.8 mg/L,P<0.001),urinaryα1 microglobulin(CKD1-223.3 mg/L,CKD330.1 mg/L,CKD4-572.6 mg/L,P=0.001),urinaryβ2 microglobulin(CKD1-20.4 mg/L,CKD30.5 mg/L,CKD4-58.3 mg/L,P=0.005)increased significantly,while urinary creatinine(CKD1-28881μmol/L,CKD35512μmol/L,CKD4-54388μmol/L,P<0.001)and urinary sodium(CKD1-2111.4 mmol/L,CKD375.8 mmol/L,CKD4-573.2 mmol/L,P<0.001)decreased significantly.The resistance index of bilateral renal hilar artery(right CKD1-20.69,CKD30.77,CKD4-50.74,P=0.010,left CKD1-20.69,CKD30.76,CKD4-50.78,P=0.009)and segmental artery resistance index(right CKD1-20.66,CKD30.71,CKD4-50.72,P=0.034,left CKD1-20.66,CKD30.69,CKD4-50.73,P=0.027)also increased with the progression of CKD stage.Multivariate logistic regression analysis showed that higher blood retinol binding protein(OR 1.073,95%CI 1.006-1.145;P=0.032)and serumβ2-microglobulin(OR 1.932,95%CI 1.233-3.027;P=0.004)were independent risk factors for the progression of CKD4-5 in patients with chronic liver disease complicated with CKD.Conclusion Active monitoring of blood and urine biomarkers in patients with CKD in combination with chronic liver disease can help detect the progression of CKD in patients with chronic liver disease at an early stage and facilitate early intervention and prognosis improvement.