高血压脑出血患者早期肾损伤的危险因素研究

Risk factors of early renal injury in patients with hypertensive intracerebral hemorrhage

目的 探讨高血压脑出血(HICH)患者早期肾损伤(AKI)的危险因素。方法 选取2020年7月至2022年6月江苏省海安市人民医院收治的90例HICH患者作为研究对象,根据患者早期是否发生AKI情况分为AKI组(21例)与非AKI组(69例)。采用单因素及多因素Logistic回归分析评价尿中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、尿微量白蛋白与肌酐比值(ACR)及血清同型半胱氨酸(Hcy)是否为影响HICH患者早期AKI发生的独立危险因素,采用受试者操作特征(ROC)曲线评价尿NGAL、尿ACR及血清Hcy对HICH患者早期AKI发生的预测价值。结果 AKI组输血或使用甘露醇占比及尿NGAL、尿ACR和血清Hcy水平高于非AKI组(P<0.05)。多因素Logistic回归分析结果显示,输血或使用甘露醇[OR=3.556,95%CI(1.608~7.864)]、尿NGAL[OR=1.005,95%CI(1.002~1.008)]、尿ACR[OR=1.812,95%CI(1.251~2.625)]及血清Hcy[OR=1.923,95%CI(1.455~2.542)]是影响HICH患者早期AKI发生的独立危险因素(P<0.05)。ROC曲线分析结果显示,尿NGAL、尿ACR及血清Hcy对HICH患者早期AKI发生均有预测效能(P<0.05),其曲线下面积分别为0.786[95%CI(0.680~0.892)]、0.676[95%CI(0.553~0.799)]和0.737[(95%CI(0.631~0.843)];3项指标联合预测早期AKI发生的曲线下面积为0.914[(95%CI(0.823~1.000)]。结论 尿NGAL、尿ACR及血清Hcy是影响HICH患者早期AKI发生的独立危险因素,对早期AKI发生均有一定的预测价值,且三者联合预测早期AKI发生的价值更高。

Objective To explore the risk factors of early acute renal injury(AKI)in patients with hypertensive intracerebral hemorrhage(HICH).Methods Ninety HICH patients admitted to the Hai’an People’s Hospital from July 2020 to June 2022 were enrolled.Based on the diagnostic criteria of the Kidney Disease Prognosis Quality Initiative Guidelines,the patients were divided into AKI group(n=21)and non‐AKI group(n=69).Univariate and multivariate logistic regression analyses were used to evaluate whether urinary neutrophil gelatinase‐associated lipocalin(NGAL),urinary microalbumin creatinine ratio(ACR),and serum homocysteine(Hcy)were independent risk factors affecting the early onset of AKI in HICH patients.The predictive value of urinary NGAL,urinary ACR,and serum Hcy for the early onset of AKI in HICH patients were evaluated by the receiver operating characteristic(ROC)curves.Results The proportions of blood transfusion or mannitol use,urinary NGAL,urinary ACR and serum Hcy in the AKI group were significantly higher than those in the non‐AKI group(P<0.05).Multivariate logistic regression analysis showed that blood transfusion or mannitol use(OR=3.556,95%CI:1.608‐7.864),urinary NGAL(OR=1.005,95%CI:1.002‐1.008),urinary ACR(OR=1.812,95%CI:1.251‐2.625),and serum Hcy(OR=1.923,95%CI:1.455‐2.542)were independent risk factors for early onset of AKI in patients with HICH(P<0.05).ROC curve analysis showed that the areas under the curves of urinary NGAL,urinary ACR,and serum Hcy for the prediction of early onset of AKI in patients with HICH were 0.786(95%CI:0.680‐0.892),0.676(95%CI:0.553‐0.799),and 0.737(95%CI:0.631‐0.843),respectively;the area under the curve of the 3 indicators was 0.914(95%CI:0.823‐1.000).Conclusion Urinary NGAL,urinary ACR,and serum Hcy are independent risk factors for the onset of early AKI in patients with HICH.Each factor has certain predictive value for the onset of early AKI,and the combination of the 3 factors has higher value in predicting the onset of early AKI.