代偿性酸中毒、炎性反应和病因是影响急性肾损伤预后的重要因素

基础医学与临床 ›› 2015, Vol. 35 ›› Issue (5): 648-653.

代偿性酸中毒、炎性反应和病因是影响急性肾损伤预后的重要因素

陈罡¹,叶文玲²,秦岩³,陈丽萌⁴,苏颖⁵,于阳⁶,高瑞通⁷,陶建瓴¹,袁群生¹,李航⁵,李明喜⁵,李学旺⁵,李雪梅⁸

1. 中国医学科学院北京协和医院
2. 北京协和医院肾内科
3. 中国医学科学院北京协和医学院北京协和医院
4. 协和医院肾内科
5. 中国医学科学院北京协和医学院北京协和医院肾内科
6. 中国医学科学院北京协和医学院北京协和医院
7. 北京协和医院肾内科北京
8. 北京协和医院

收稿日期:2015-01-20 修回日期:2015-03-17 出版日期:2015-05-05 发布日期:2015-04-28
通讯作者: 李雪梅 E-mail:0605.mei@gmail.com
基金资助:
国家科技支撑计划;国家科技支撑计划;北京首发基金

Compensated acidosis, inflammation and etiologies are important factors influencing the prognosis of acute kidney injury

Received:2015-01-20 Revised:2015-03-17 Online:2015-05-05 Published:2015-04-28

摘要/Abstract

摘要： 目的分析影响AKI预后的因素，评判不同病因对预后的影响。方法回顾性分析507例AKI病例，分组为预后良好和预后不良组，收集临床资料，根据治疗前后SCr变化，分析AKI预后的危险因素和病因对预后的影响。结果预后良好组253例(49.9%)，预后不良组254例(50.1%)。预后不良组年龄较大(P<0.001)，SCr基线值较高(P<0.01)，贫血和低白蛋白血症的发生率较高(P<0.01和P<0.001)，炎性指标更高(P<0.001)。通过Logistic回归分析建立预后模型，表明：即使代谢性酸中毒处于HCO3-降低而pH值正常的阶段，仍是影响预后的危险因素(P<0.05)，MODS(P<0.001)、炎性因子(P<0.01)、和少尿(P<0.01)也是影响预后的危险因素；血白蛋白(P<0.01)和血红蛋白(P<0.05)是预后的保护性因素。本研究中，AKIN 1、2期中最常见病因为重症感染导致的AKI，AKIN 3期中最常见小管间质损害，不同分期对预后的影响无显著差别。结论 1）代偿性酸中毒、MODS、炎性反应和少尿是AKI预后的危险因素；2）需重视病因对AKI临床结局的影响。

关键词: 急性肾损伤，急性肾功能衰竭，代谢性酸中毒，炎症，预后，病因

Abstract: Objective To analyze the clinical characteristics of AKI cases and then to evaluate the different risk factors and judge the influence of different etiologies on prognosis. Method The clinical data and laboratory results of 507 AKI cases were analyzed. Data from good and poor prognosis groups were compared and then to evaluate the influence of different clinical data and etiologies on prognosis. Results 253 cases (49.9%) of 507 patients were defined as good prognosis group while 254 cases (50.1%) were defined as poor prognosis. Compared with good prognosis group, patients with poor prognosis were tend to be older (P<0.001), with higher baseline serum creatinine (P<0.01), higher incidency of anemia (P<0.01) and hypoalbuminia (P<0.001), as well as higher inflammatory cytokines (P<0.001). Models were established to predict the prognosis of AKI after multivariate logistic regression analysis. The models interpreted that acidosis, even in the compensated stage, was risk factor of AKI (P<0.05); MODS (P<0.001), inflammatory cytokines (P<0.01), and oliguria (P<0.01) were also risk factors while albumin (P<0.01) and hemoglobin (P<0.05) were protective factors. The most common cause of AKI in AKIN 1 and 2 stages was severe infection while in AKIN 3 stage was tubulointerstitial damage; different AKIN staging made no significant difference in the prognosis of AKI in this study. Conclusion 1. Compensatory acidosis, MODS, inflammatory cytokines and oliguria were risk factors of AKI; 2. The causes of AKI should not be underestimated.

Key words: Acute kidney injury, acute renal failure, compensated metabolic acidosis，inflammatory cytokines, prognosis, etiology

陈罡叶文玲秦岩陈丽萌苏颖于阳高瑞通陶建瓴袁群生李航李明喜李学旺李雪梅. 代偿性酸中毒、炎性反应和病因是影响急性肾损伤预后的重要因素[J]. 基础医学与临床, 2015, 35(5): 648-653.