血清氯浓度与危重病患者急性肾损伤的关系

目的 探讨血清氯离子浓度与危重病患者急性肾损伤（AKI）的相关性。方法 回顾性分析合肥市第一人民医院2015年1月至2015年12月于ICU治疗的83例患者的临床资料，按照国际改善全球肾脏病预后组织（KDIGO）发表的AKI的定义，将入选患者分为AKI组（21例）和非AKI组（62例）。收集患者ICU治疗期间血清氯离子浓度数据。分别用Cl₀、Clmax、Clmin、Clmean表示收治ICU期间初始、最高、最低及平均血清氯离子浓度，分析血清氯离子浓度与急性肾损伤之间的关系。结果 83例患者中，21例发生AKI，占25.3%。两组患者Cl₀差异无统计学意义（P=0.410）；AKI组患者的Clmax、Clmean均高于非AKI组，Clmin低于非AKI组[（110.10±8.58）、（103.80±4.96）、（93.57±4.84）vs（105.61±3.64）、（100.67±5.21）、（96.26±4.71）]，差异有统计学意义（P<0.05）。单因素logistic回归分析显示Clmax、Clmin、Clmean是AKI发生危险因素，随着Clmax、Clmean的升高，AKI发生的风险加大，而随着Clmin的上升，AKI发生的风险有下降的趋势。结论 过高或过低的血清氯离子浓度都可能与急性肾损伤发生相关，应注意及时干预。

Relation of serum chlorine concentration and acute kidney injury in critically ill patients

Objective To investigate the connection between serum chlorine concentration and acute kidney injury (AKI) in those critically ill patients. Methods The clinical data of 83 critically ill patients, hospitalized in our ICU department from Jan 2015 to Dec 2015, were retrospectively analyzed. These patients were divided into the AKI group(21 cases)and the non-AKI group (62 cases), according to definition of acute kidney injury by the Kidney Disease Improving Global Outcomes (KDIGO). The results of serum chlorine concentrations during their ICU stays were collected, and Cl₀, Clmax, Clmin, and Clmean were referred to as the initial, maximum, minimum and mean chlorine concentration, respectively. The relationship between serum chlorine concentration and AKI was analyzed. Results Of 83 patients, 21 cases (25.3%) developed AKI, and Cl₀ of them were not significantly different from those of other 62 cases (P=0.410). Clmax and Clmean in the AKI group were significantly higher than those in the non-AKI group[(110.10±8.58) vs (105.61±3.64) mmol/L; (103.80±4.96) vs (100.67±5.21) mmol/L], but Clmin in the AKI group was significantly lower than that in the non-AKI group[(93.57±4.84) vs (96.26±4.71) mmol/L] (all P<0.05). Univariate logistic regression analysis showed that Clmax, Clmean and Clmin were all associated with AKI development, and risk of AKI development increased with the growth of Clmax and Clmean, but when Clmin rose, the risk of AKI development had a downward trend. Conclusion Much higher or lower serum chlorine concentration may be associated with AKI development in those critically ill patients, and timely interventions would be needed.