住院慢性肾小球疾病患者感染的危险因素及预后研究

发布时间：2018-01-13 23:17

本文关键词：住院慢性肾小球疾病患者感染的危险因素及预后研究　出处：《北京协和医学院》2017年博士论文　论文类型：学位论文

【摘要】：研究背景在我国,由慢性肾脏病(chronic kidney disease,CKD)和终末期肾病(end stage renal disease,ESRD)带来的治疗负担十分巨大,其发病率与患病率仍在逐年增加。感染是慢性肾脏病患者病程中重要的并发症之一,已有许多研究证实,慢性肾脏病患者感染的发病率与致死率远高于普通人群,且较差的肾功能预示着更高的感染风险与致死率。而慢性肾小球疾病(Chronic Glomerular Disease)是慢性肾脏病的重要组成部分,在我国也是导致终末期肾病最常见的病因。其因常需要糖皮质激素和/或免疫抑制剂治疗,而有着额外的感染的风险。但目前对于慢性肾小球疾病中感染的研究很少,且除免疫抑制治疗外的其它感染危险因素的研究更少。所以,本研究旨在探究慢性肾小球疾病中感染,尤其关注不同类型的肾病中感染发生的风险,以及感染事件对肾脏结局的影响。研究目的1.分析2012-2016年间北京协和医院(以下简称我院)住院的慢性肾小球疾病患者者中感染的基本情况,如感染例数随时间的变化、感染部位、感染病原体等;比较常见的几种慢性肾小球肾炎间不同类型的感染发生例数占比的差异;2.通过病例-对照研究,考察感染发生可能的危险因素,尤其是不同肾小球疾病类型间感染发生的风险的差异;3.研究感染对IgA肾病尿蛋白缓解率及肾功能恶化的影响。研究方法分析2000年1月1日-2016年12月31日我院住院慢性肾小球疾病患者合并感染的例数随时间变化的趋势;分析2012年1月1日-2016年12月31日我院住院的慢性肾小球疾病患者中,导致住院的感染或院内感染发生的概况,主要包括感染部位、病原体类型以及感染在不同肾小球疾病中的分布,并对狼疮性肾炎、原发性膜性肾病、IgA肾病进行组间差异性比较。采用病例-对照研究的方法,使用多因素Logistic回归模型进行以下分析:(1)比较不同类型肾小球疾病患者因感染住院或发生院内感染的风险;(2)研究IgA肾病治疗过程中,因感染住院或发生院内感染事件,对尿蛋白的缓解及肾功能的恶化是否有影响。研究结果1.我院2000年-2016年间因感染住院或发生院内感染的慢性肾小球疾病病例数量具有随年份逐渐增加的趋势,2010年后的感染例数增加趋势较前变快;肺部感染是占优势的类型。2.2012年-2016年间因感染就诊于我院或于我院发生院内感染的慢性肾小球疾病例数共955例,感染部位以肺部感染最多见(79.6%),其次为血行感染(8%)和泌尿道感染(5%);感染病原体类型以细菌感染(38.8%)最常见,其次为病毒(21.9%)、真菌(17.6%)、结核(18.1%)及PCP感染(14.2%);感染病例在不同类型的肾小球疾病中的分布则以狼疮性肾炎最多见(32.1%),其次为原发性膜性肾病(12.1%)、IgA 肾病(5.5%)等。3.对上述研究对象中的狼疮性肾炎、IgA肾病及原发性膜性肾病患者进行不同类型肾小球疾病间单因素比较发现:皮肤软组织感染在狼疮性肾炎的发生率明显高于其他两组;PCP在IgA肾病中的发生率明显高于其他两组。4.不同的肾病类型间因感染住院或发生院内感染的风险不同,其中以狼疮性肾炎患者发生感染的风险最高,为IgA肾病的4倍,其次为系统性小血管炎肾受累患者、紫癜性肾炎患者;原发性肾小球肾炎感染风险相对低;肾功能出现慢性或急性损伤的患者感染风险高于无肾功能损伤者。5.IgA肾病患者中因感染住院或发生院内感染事件后,肾脏结局可能受到影响:单因素及性别、年龄校正后的Logistic回归分析显示,上述感染事件的发生是尿蛋白缓解率的降低及肾脏联合终点事件发生率增加的危险因素;纳入混杂因素后,上述感染事件的发生对尿蛋白缓解率下降并无显著影响;将全程治疗方案做为校正因素,上述感染事件的发生将增加肾脏联合终点事件发生的风险,而将初始治疗方案作为校正因素,则上述感染事件对肾脏联合终点事件的发生无显著性影响。结论1.我院肾小球疾病患者因感染入院或住院感染发生率呈逐年增长的趋势;感染部位以肺部感染为主,病原体以细菌感染为主;感染在不同肾小球疾病中的分布以狼疮性肾炎最多见,其次为原发性膜性肾病、IgA肾病。2.狼疮性肾炎患者较其他类型的肾炎更易发生皮肤软组织感染;IgA肾病患者较其他类型肾炎更易发生肺孢子虫肺炎。3.常见类型的慢性肾小球疾病患者中,狼疮性肾炎、过敏性紫癜性肾炎、系统性血管炎肾损害患者因感染住院或发生院内感染的危险性较IgA肾病、原发性膜性肾病、微小病变肾病更高;肾功能受损的患者更易感染;对以上患者应积极预防感染。4.IgA肾病患者治疗过程中发生需住院或院内感染,有降低尿蛋白缓解率及降低肾功能的可能。
[Abstract]:Research background in China, from chronic kidney disease (chronic kidney, disease, CKD) and end-stage renal disease (end stage renal disease, ESRD) brought huge burden of treatment, the incidence and prevalence is increasing year by year. Infection is one of the major complications of patients with chronic kidney disease, many studies have confirmed that infection in patients with chronic kidney disease, the incidence and mortality rate is far higher than the general population, and poor renal function indicates a higher risk of infection and mortality. Chronic glomerular disease (Chronic Glomerular Disease) is an important part of chronic kidney disease, in our country is the most common cause of end-stage renal disease. It often requires glucocorticoids and / or immunosuppressive therapy, with additional risk of infection. But the infection of chronic glomerular disease rarely, and in addition to immunosuppressive therapy abroad Study on less other risk factors of infection. Therefore, the purpose of this study is to explore the infection of chronic glomerular diseases, especially the risk of infection of different types of nephropathy, and infection events on renal outcomes. Study 1. 2012-2016 from Peking Union Medical College Hospital (hereinafter referred to as the basic conditions of our hospital) in patients with chronic glomerular disease in hospital in the infection, such as the number of cases with the change of time, the site of infection, infection of pathogens; several common chronic glomerulonephritis among different types of infection accounted for the differences in number of cases; 2. by case-control study, investigation of infection risk factors, especially the difference of the risk of infection type various glomerular diseases; 3. of infection rate and alleviate the effect of deterioration of renal function in IgA nephropathy. The method of analysis of January 1, 2000 -2016 In December 31st the number of cases in our hospital with chronic glomerular diseases and infection trends over time; analysis of the January 1, 2012 -2016 year in December 31st in our hospital in patients with chronic glomerular disease, cause of infection or hospital, including infection, pathogen infection and distribution in different types of glomerular diseases. Of lupus nephritis, membranous nephropathy, IgA nephropathy, compare the difference between groups. A case-control study was conducted, using multivariate Logistic regression model was used to analyze the following: (1) comparison of different types of patients with glomerular disease due to the risk of infection or hospitalization of nosocomial infection (2); Study on IgA nephropathy in the treatment process, due to infection of hospitalized or nosocomial infection event, whether the deterioration of renal function and relieve the protein in urine. The results of 1. in our hospital in 2000 -2016 Because the number of cases from infection in hospitalized or nosocomial infection of chronic kidney disease has with the continuous increasing trend, the number of cases of infection after 2010 increased faster than before; pulmonary infection is the dominant type of.2.2012 years -2016 years due to infection in our hospital for treatment in our hospital or the number of cases of chronic glomerular disease a total of 955 cases of nosocomial infection, the infection of pulmonary infection (79.6%), followed by blood infection (8%) and urinary tract infection (5%); pathogen infection type to bacterial infection (38.8%) was the most common, followed by virus (21.9%), fungi (17.6%), tuberculosis (18.1%) and PCP infection (14.2%); the distribution of infections in different types of glomerular diseases are most common in patients with lupus nephritis (32.1%), followed by primary membranous nephropathy, IgA nephropathy (12.1%) (5.5%) of the research object in lupus nephritis.3., IgA nephropathy and primary Different types of glomerular diseases between single factor of membranous nephropathy patients: comparison of skin and soft tissue infection in lupus nephritis was significantly higher than that of the other two groups; PCP in IgA nephropathy was significantly higher than the other two groups of different types of.4. nephropathy due to the risk of infection or hospitalization of nosocomial infection, among them in patients with lupus nephritis occurred at highest risk of infection is 4 times of IgA nephropathy, followed by systemic vasculitis and renal involvement in patients with Henoch Schonlein purpura nephritis; primary glomerulonephritis infection risk is relatively low; renal injury in patients with acute or chronic infection risk than those without renal function injury in patients with.5.IgA nephropathy due to infection or hospitalization of nosocomial infection after renal outcomes may be affected by the single factor and gender, age adjusted Logistic regression analysis showed that the infection of hair thing Life is a risk factor for the rising incidence of urinary protein decreased and the remission rate of kidney combined end point events; into the confounding factors, the occurrence of infection events on urine protein remission rate decrease were not significantly affected; full treatment as a correction factor of the occurrence of the infection will increase the risk of renal events combined end point events. The initial treatment as a correction factor, the infection had no significant effects on the kidney combined end point events. Conclusion: 1. patients with glomerular disease due to infection in our hospital admission or hospital infection rate is increasing year by year; lung infection was the main pathogen, mainly to bacterial infection; the infection distribution in different glomerular the disease in lupus nephritis was the most common, followed by idiopathic membranous nephropathy, IgA nephropathy.2. in patients with lupus nephritis nephritis more easily than other types The occurrence of skin soft tissue infection; IgA nephropathy in patients with nephritis occurred more often than other types of Pneumocystis carinii pneumonia in patients with.3. common type of chronic glomerulonephritis, lupus nephritis, Henoch Schonlein purpura nephritis, systemic vasculitis with renal impairment due to risk of infection in hospitalized or nosocomial infection of primary IgA nephropathy. Membranous nephropathy, minimal change nephropathy higher; impaired renal function of the patients are more likely to require hospitalization or hospital infection; infection of.4.IgA nephropathy patients during the treatment of infection in patients above should actively prevent, reduce proteinuria and reduce the remission rate of renal function.

【学位授予单位】：北京协和医学院
【学位级别】：博士
【学位授予年份】：2017
【分类号】：R692.6

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