失代偿性肝硬化伴发急性肾损伤的危险因素分析

发布时间：2018-04-30 07:01

本文选题：急性肾损伤 + 失代偿性肝硬化　；参考：《天津医科大学》2014年硕士论文

【摘要】：目的：观察失代偿性肝硬化病人伴发急性肾损伤后对预后的影响；探讨失代偿性肝硬化病人伴发急性肾损伤的独立危险因素；评价INR、血肌酐、血钠、总胆红素、胆碱酯酶、肾小球滤过率等指标预测失代偿性肝硬化伴发急性肾损伤的诊断价值。方法：回顾性分析2005年1月至2012年12月期间在天津市第三中心医院肝内科反复住院治疗的失代偿性肝硬化患者126例,其中单纯肝硬化组66例,肝硬化伴发急性肾损伤组60例。所有病例在初诊后的第0、1、2、3、4年这5个时间点上对病例的一般情况、实验室检查、肝肾功能指标和预后情况做系统的评估。采用SPSS17.0软件进行统计学分析。生存分析使用Kaplane Meier法,生存率比较采用log-rank检验。两组间计量资料比较采用两组独立样本的t检验,计数资料采用x2检验；采用Logistic回归分析筛选失代偿性肝硬化易伴发急性肾损伤的独立危险因素。采用受试者工作特征曲线及曲线下面积评估INR、血肌酐、血钠、总胆红素、胆碱酯酶、肾小球滤过率的对失代偿性肝硬化易伴发急性肾损伤的诊断价值。结果： 1.本研究实际平均随访时间为33.79±18.13月。在整个随访期间,单纯肝硬化组死亡12例,肝硬化伴发急性肾损伤组死亡27例。到随访截止时单纯肝硬化组的生存率为83.33%,而肝硬化伴发急性肾损伤组的生存率为55%,两组生存分析比较差异有统计学意义(x2=13.270,P=0.001)。 2. Logistic回归分析显示,血肌酐、总胆红素、INR的升高以及血钠、胆碱酯酶和肾小球滤过率的降低是失代偿性肝硬化病人易伴发急性肾损伤的独立危险因素(OR值分别为1.034、1.005、2.471、0.910、0.999、0.972,P均0.05)。 3.应用ROC曲线评估血肌酐、总胆红素、INR、血钠、胆碱酯酶和肾小球滤过率这些指标对失代偿性肝硬化伴发急性肾损伤的预测能力,结果发现：血钠的AUC为0.828,显著高于INR(0.742)、胆碱酯酶(0.714)及总胆红素(0.725),差异有统计学意义(Z值分别为2.332、3.091、2.911,P均0.05)；而其它指标之间两两比较均未见显著性差异(P0.05)。结论： 1.失代偿性肝硬化病人伴发急性肾损伤可以降低生存率并对预后产生负面影响,应对急性肾损伤的发生提高警惕,做到早期诊断,早期治疗。 2.血肌酐、总胆红素、INR的升高以及血钠、胆碱酯酶和肾小球滤过率的降低是失代偿性肝硬化病人易伴发急性肾损伤的独立危险因素。 3.血肌酐、总胆红素、INR、血钠、胆碱酯酶和肾小球滤过率等指标的变化均可预测失代偿性肝硬化病人是否易伴发急性肾损伤,其中以血钠水平降低的诊断价值最高。
[Abstract]:Objective: To observe the influence of decompensated cirrhosis with acute renal injury on prognosis; to investigate the independent risk factors of decompensated cirrhosis with acute renal injury; to evaluate INR, serum creatinine, serum sodium, total bilirubin and cholinesterase, The value of glomerular filtration rate in the diagnosis of decompensated cirrhosis with acute renal injury. Methods: From January 2005 to December 2012, 126 cases of decompensated cirrhosis were retrospectively analyzed in the Department of Hepatology, third Central Hospital of Tianjin, including 66 cases in simple cirrhosis group and 60 cases in cirrhosis with acute renal injury group. All the cases were evaluated systematically on the 5 time points of 0 ~ 1 ~ 2 ~ 2 ~ 3 ~ (th) after first diagnosis and 4 years, including general condition, laboratory examination, liver and kidney function index and prognosis. SPSS17.0 software was used for statistical analysis. Kaplane Meier method was used for survival analysis and log-rank test was used to compare survival rate. T test of two groups of independent samples and x 2 test of counting data and Logistic regression analysis were used to screen the independent risk factors of decompensated cirrhosis with acute renal injury. The diagnostic value of INR, serum creatinine, serum sodium, total bilirubin, cholinesterase and glomerular filtration rate in decompensated cirrhosis with acute renal injury was evaluated by using the operating characteristic curve and the area under the curve. Results: 1. The actual average follow-up time was 33.79 卤18.13 months. During the follow-up period, 12 cases died in simple cirrhosis group and 27 cases died in cirrhosis with acute renal injury group. At the end of follow-up, the survival rate of simple cirrhosis group was 83.33, while that of cirrhosis with acute renal injury group was 55. The difference of survival analysis between the two groups was statistically significant. 2. Logistic regression analysis showed that the increase of serum creatinine and total bilirubin, and the decrease of serum sodium, cholinesterase and glomerular filtration rate were the independent risk factors of acute renal injury in decompensated cirrhosis patients. The OR values were 1.034 卤1.0052.471 卤0.910 ~ 0.9990.972P, respectively. 3. Serum creatinine, total bilirubin, serum sodium, cholinesterase and glomerular filtration rate were evaluated by ROC curve for predicting acute renal injury associated with decompensated cirrhosis. The results showed that the AUC of blood sodium was 0.828, which was significantly higher than that of INR 0.742C, cholinesterase 0.714) and total bilirubin (0.725g). The difference was statistically significant (Z = 2.332C 3.091C 2.911C P 0.05), but there was no significant difference between other indexes (P 0.05). Conclusion: 1. The acute renal injury associated with decompensated cirrhosis can reduce the survival rate and have a negative impact on the prognosis. It is necessary to raise the vigilance for the occurrence of acute renal injury and to make early diagnosis and treatment. 2. Elevated serum creatinine total bilirubin INR and decreased serum sodium cholinesterase and glomerular filtration rate were independent risk factors for acute renal injury in patients with decompensated cirrhosis. 3. The changes of serum creatinine, total bilirubin INR, serum sodium, cholinesterase and glomerular filtration rate can predict whether decompensated cirrhosis patients are prone to acute renal injury.
【学位授予单位】：天津医科大学
【学位级别】：硕士
【学位授予年份】：2014
【分类号】：R575.2;R692.5

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