慢加急性肝衰竭与失代偿性肝硬化患者急性肾损伤的临床特点比较

Comparison of clinical characteristics of acute kidney injury in patients with acute-on-chronic liver failure or decompensated cirrhosis

目的 研究慢加急性肝衰竭(ACLF)与失代偿性肝硬化(DC)患者急性肾损伤(AKI)的临床特点。方法 70例合并AKI的ACLF与DC患者,根据原发病不同分为科研组(ACLF-AKI)和参照组(DC-AKI),各35例。检测并比较两组患者肝功能指标[丙氨酸氨基转移酶(ALT)、天冬氨酸氨基转移酶(AST)、总胆红素(TBil)、直接胆红素(DBil)、白蛋白(Alb)]、感染指标[白细胞计数(WBC)、中性粒细胞比率(N%)]、凝血指标[凝血酶原活动度(PTA)]、肾功能指标[血清肌酐(CR)]及感染情况、30与90 d内死亡或肝移植情况。结果 科研组ALT(53.47±3.69)U/L、AST(94.26±8.62)U/L、TBil(258.86±10.62)μmol/L、DBil(175.82±25.41)μmol/L均高于参照组的(28.24±3.22)U/L、(44.25±2.57)U/L、(28.45±5.35)μmol/L、(28.41±7.26)μmol/L,Alb(28.23±5.17)g/L低于参照组的(31.75±6.24)g/L,差异具有统计学意义(P<0.05)。科研组WBC(9.62±1.85)×10^(9)/L、N%(82.75±6.57)%、CR(147.62±8.95)μmol/L均高于参照组的(7.28±1.53)×10^(9)/L、(76.24±5.39)%、(123.42±8.21)μmol/L,PTA(34.26±5.59)%低于参照组的(64.53±5.27)%,差异具有统计学意义(P<0.05)。科研组感染率94.29%及30 d内死亡或肝移植发生率34.29%、90 d内死亡或肝移植发生率54.29%均高于参照组的40.00%、11.43%、20.00%,差异有统计学意义(P<0.05)。结论 与DC-AKI患者比较,ACLF-AKI患者更易发生感染,CR水平更高,疾病进展加快,增加死亡风险,临床需引起高度重视,对改善患者预后效果有积极作用。

Objective To study the clinical characteristics of acute kidney injury(AKI)in patients with acute-on-chronic liver failure(ACLF)or decompensated cirrhosis(DC).Methods 70 patients with ACLF or DC combined with AKI were divided into the research group(ACLF-AKI)and the reference group(DC-AKI)according to the primary disease,with 35 cases in each group.Both groups were detected and compared in terms of liver function indexes[alanine aminotransferase(ALT),aspartate aminotransferase(AST),total bilirubin(TBil),direct bilirubin(DBil),albumin(Alb)],infection indexes[white blood cell count(WBC),neutrophil percentage(N%)],coagulation indexes[prothrombin activity(PTA)],renal function indicators[serum creatinine(CR)],infection,and death or liver transplantation within 30 and 90 d.Results The research group had ALT of(53.47±3.69)U/L,AST of(94.26±8.62)U/L,TBil of(258.86±10.62)μmol/L and DBil of(175.82±25.41)μmol/L,which were higher than those of(28.24±3.22)U/L,(44.25±2.57)U/L,(28.45±5.35)μmol/L,and(28.41±7.26)μmol/L in the control group;Alb of(28.23±5.17)g/L in the research group was lower than that of(31.75±6.24)g/L in the control group;the differences were statistically significant(P<0.05).The research group had WBC of(9.62±1.85)×10^(9)/L,N%of(82.75±6.57)%,CR of(147.62±8.95)μmol/L,which were higher than those of(7.28±1.53)×10^(9)/L,(76.24±5.39)%,(123.42±8.21)μmol/L in the control group;PTA of(34.26±5.59)%in the research group was lower than that of(64.53±5.27)%in the control group;the differences were statistically significant(P<0.05).In the research group,the infection rate was 94.29%,the rate of death or liver transplantation within 30 d was 34.29%,and the rate of death or liver transplantation within 90 d was 54.29%,which were higher than those of 40.00%,11.43%,and 20.00%in the control group,and the differences were statistically significant(P<0.05).Conclusion Compared with DC-AKI patients,ACLF-AKI patients are more prone to infection,and has higher CR levels,accelerated disease progression,and increased the risk of death.Therefore,clinical attention should be paid to ACLF-AKI patients,which has a positive effect on improving the prognosis of patients.