急性肾损伤患者发生3型心肾综合征的影响因素分析

发布时间：2018-02-28 05:37

本文关键词： 急性肾损伤心肾综合征影响因素分析　出处：《中国全科医学》2017年17期 　论文类型：期刊论文

【摘要】：目的探讨急性肾损伤(AKI)患者发生3型心肾综合征(CRS)的危险因素。方法回顾性分析中国人民解放军第二军医大学陆军总医院临床医学院2013—2015年出院诊断为AKI的135例患者的临床资料,依据是否发生继发性心脏损伤将AKI患者分为3型CRS组37例及非3型CRS组98例。统计两组患者一般资料、实验室检查指标、预后、治疗、住院时间及费用等。采用多因素Logistic回归分析AKI患者发生3型CRS的影响因素。结果 3型CRS组与非3型CRS组患者性别、AKI分期、是否存在钙磷紊乱、尿酸正常与否、纤维蛋白原正常与否、预后、是否采用肾脏替代治疗比较,差异均无统计学意义(P0.05);3型CRS组与非3型CRS组患者AKI诱因、是否存在左心室舒张功能减退、是否有慢性肾病病史、胆固醇正常与否、D-二聚体正常与否比较,差异均有统计学意义(P0.05)。3型CRS组与非3型CRS组患者平均动脉压、超敏C反应蛋白、肌酐、尿素氮、肾小球滤过率、同型半胱氨酸水平比较,差异均无统计学意义(P0.05);3型CRS组与非3型CRS组患者年龄、肌酐/尿素氮、住院时间、住院费用比较,差异均有统计学意义(P0.05)。多因素Logistic回归模型结果显示,年龄[OR=1.714,95%CI(1.437,2.094)]、左心室舒张功能减退[OR=10.331,95%CI(3.129,34.112)]、慢性肾病病史[OR=13.076,95%CI(2.345,72.911)]、胆固醇升高[OR=9.983,95%CI(1.590,62.666)]是AKI患者发生3型CRS的独立影响因素(P0.05)。结论感染后肾小球肾炎及使用肾毒性药物是导致AKI的主要诱因,尽管AKI的治疗技术不断进步,但其引起的3型CRS发病率依然较高,且发生继发性心脏损伤使得AKI患者住院时间延长,医疗费用增加。年龄、左心室舒张功能减退、慢性肾病病史及胆固醇升高是AKI患者发生3型CRS的危险因素。
[Abstract]:Objective to investigate the risk factors of type 3 cardiorenal syndrome (CRS) in patients with acute renal injury (ABI). Methods the clinical data of 135 patients with AKI diagnosed as AKI were retrospectively analyzed in the College of Clinical Medicine, Army Hospital, second military Medical University of China from 2013 to 2015. The patients with AKI were divided into 3 type CRS group (37 cases) and non-3 type CRS group (98 cases) according to the occurrence of secondary cardiac injury. Multivariate Logistic regression analysis was used to analyze the factors influencing the occurrence of type 3 CRS in AKI patients. Results the patients in type 3 CRS group and non-type 3 CRS group had sex CRS stage, whether there was disorder of calcium and phosphorus, and whether uric acid was normal or not. Whether fibrinogen is normal or not, prognosis and renal replacement therapy are not statistically significant. There are no significant differences in AKI inducement, left ventricular diastolic dysfunction and history of chronic nephropathy in patients with P0.05 CRS and non-type 3 CRS. There were significant differences in the average arterial pressure, hypersensitive C-reactive protein, creatinine, urea nitrogen, glomerular filtration rate between P0.05C3-type CRS group and non-type 3 type CRS group. There was no significant difference in homocysteine levels between CRS group and non-type CRS group. There were significant differences in age, creatinine / urea nitrogen, length of stay and hospitalization cost. The results of multivariate Logistic regression model showed that there was no significant difference in the level of homocysteine. Age [OR1.71495], left ventricular diastolic dysfunction (OR10.33195 CIQ 3.12934.112), history of chronic nephropathy [OR13.07695CII 2.345-72.911], high cholesterol (OR9.98395CII 1.590 62.666) were the independent influencing factors of type 3 CRS in AKI patients (P 0.055.Conclusion: glomerulonephritis after infection and the use of nephrotoxic drugs are the main factors leading to AKI. Although the treatment technology of AKI continues to improve, the incidence of type 3 CRS is still relatively high, and secondary heart injury results in prolonged hospitalization, increased medical costs and decreased left ventricular diastolic function in patients with AKI. History of chronic nephropathy and elevated cholesterol are risk factors for type 3 CRS in patients with AKI.
【作者单位】：中国人民解放军第二军医大学陆军总医院临床医学院急诊科;
【分类号】：R54;R692.5

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