广州市36762名健康体检公务员慢性肾脏病患病情况及危险因素分析

目的 分析广州市健康体检公务员慢性肾脏病的患病情况及危险因素.方法 收集2019-01～2019-12在广州市干部健康管理中心进行健康体检的36762名公务员(含部分已离退公务员)的体检资料,依据体格检查及实验室检查结果,统计蛋白尿、血尿及慢性肾脏病检出率,分析慢性肾脏病相关危险因素.结果 36762名健康体检公务员蛋...     

代谢性危险因素与病毒性肝炎

代谢性危险因素包括中心性肥胖、肝脂肪变性、胰岛素抵抗、2型糖尿病和代谢综合征。慢性乙型肝炎和慢性丙型肝炎是两种常见的慢性肝病。近年来发现它们合并代谢综合征的病例越来越多。本文将对代谢性危险因素与病毒性肝炎的关系作一简要介绍。     

慢性阻塞性肺疾病合并慢性肾脏病危险因素分析

目的探讨住院COPD患者合并慢性肾脏病的患病率及危险因素。方法对2012年1月至2013年11月住院确诊的COPD患者进行慢性肾脏病的患病率及危险因素回顾性凋查。结果在资料完整的948例COPD患者人群中,慢性肾脏病总的患病率约为24．5％,COPD合并慢性肾脏病组PaCO2、吸烟指数、血尿酸水平、糖尿病及高血压病患病率较无合并慢性肾脏病组高,而PaO2、体质量指数较无合并慢性肾脏病组低,差异有统计学意义。COPD患者合并慢性肾脏病与COPD严重程度分级无明显的相关性。经多因素Logistic回归分析表明：低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素（OR值分别为2．34、3．25、2．67和1．8,9,5％（71分别为2．01～2．75、2．95～3．77、1．99～3．27、1．18～2．63,P值均〈0．05）。结论COPD合并慢性肾脏病的患病率高,低氧血症、高碳酸血症、糖尿病、高血压病是COPD合并慢性肾脏病的危险因素,应引起重视。     

慢性肾脏病心血管疾病的新危险因素

心血管传统危险因素已不能完全解释慢性肾脏病（CKD）患者心血管疾病的高发率。CKD本身是一种血管病变状态,一系列新危险因素的研究为CKD心血管疾病的防治提供了新的干预靶点。     

原发性高血压合并慢性肾脏病的危险因素分析

目的:探讨原发性高血压(EH)住院患者中慢性肾脏病(CKD)患病率及危险因素的分析. 方法:回顾性分析2011年2月至2012年2月新疆医科大学第一附属医院高血压科住院确诊的EH患者982例,探讨EH合并CKD的发生情况,对其危险因素分别进行单因素及多因素Logistic回归分析. 结果:(1)EH患者合并蛋白尿、估算的肾小球滤过率(eGFR)下降、CKD的患者构成比分别为20.3％、5.2％、23.5％,男性和女性EH中CKD构成比为26.6％vs20.2％(P＞0.05);汉族和维族EH合并CKD的构成比为22.7％ vs 26.0％ (P＞0.05).(2)收缩压每升高20 mmHg,CKD的构成比明显增加,差异有统计学意义.(3)多因素Logistic回归分析表明,收缩压≥140mmHg(OR=1.503,95％ CI 1.021 ～2.212)、糖尿病病史(OR=1.661,95％ CI 1.174 ～2.351)、高尿酸血症(OR=1.691,95％CI 1.194 ～2.395)是EH合并CKD的独立危险因素. 结论:控制血尿酸、血糖和血压水平可减少EH合并CKD的发生和发展.     

慢性肾脏病患者动脉粥样硬化危险因素的研究进展

心血管疾病是慢性肾脏病患者最常见的并发症,而动脉粥样硬化是心血管疾病最主要的病因。对动脉粥样硬化程度及其相关危险因素进行控制,可以缓解慢性肾脏病患者的病情,降低其死亡率,在临床上有重要意义。     

糖尿病慢性并发症患病率及相关危险因素分析

糖尿病慢性并发症是糖尿病患者致残、致死的重要原因，其发病与许多危险因素有密切关系。我们调查了海口地区1999～2000年部分住院糖尿病患者504例，对其慢性并发症患病率及其危险因素作了相关分析。现报告如下。     

高龄老年患者急性肾损伤后肾功能恢复调查及危险因素分析:652例报告

目的了解高龄老年急性肾损伤(AKI)患者肾功能恢复率,临床特点及肾功能未恢复的危险因素,分析不同AKI病因对老年患者短期预后的影响及不同AKI分期与肾功能恢复的关系。方法回顾性分析2007年1月至2015年12月就诊于解放军总医院老年病房≥75岁的AKI患者652例,随访90 d,根据生存情况将患者分为生存组和死亡组,生存患者按肾功能恢复情况分为恢复组和未恢复组。收集患者基本资料、临床特征(诊断时间、平均动脉压、尿量、透析、机械通气、实验室指标和持续性AKI比例)、AKI分期及AKI病因。应用SPSS 17.0软件对数据进行分析,根据数据类型,两组间比较采用t检验、Mann-Whitney U检验、x~2检验或Fisher精确检验;AKI患者肾功能恢复的危险因素分析采用多因素logistic回归法(向前法)。结果患者中位年龄87(84~91)岁,随访90 d病死率为33.6%(219/652),存活的433例患者中,肾功能恢复组316例(73%,316/433),未恢复组117例(27%,117/433)。感染、血容量不足、心血管事件、肾毒性药物和外科手术是老年人医院获得性AKI的主要病因,其中死亡组发生感染比例明显高于生存组(53.0%vs33.0%;P0.001),肾毒性药物使用率明显低于生存组(5.5%vs15.2%;P=0.001),差异均有统计学意义。恢复组基本资料与未恢复组相比,糖尿病史比例较高,基础血清肌酐(SCr)值较低,基础估算的肾小球滤过滤(eGFR)较高,差异均有统计学意义(P0.01)。恢复组临床特征与未恢复组相比,AKI诊断时间较短,确诊AKI时SCr及SCr峰值水平较低,血尿素氮(BUN)水平较高,透析需要率和持续性AKI比例降低,差异均有统计学意义(P0.05);恢复组AKI分期与未恢复组相比,差异无统计学意义(P0.05)。多因素logistic回归分析显示基础eGFR升高(OR=0.897,95%CI0.842~0.956;P=0.001)是影响高龄老年AKI患者90 d肾功能恢复的保护因素;持续性AKI(OR=4.497,95%CI2.774~7.290;P0.001)是肾功能未恢复的危险因素。结论临床医师要识别影响老年AKI预后的关键病因,即感染及应用肾毒性药物,关注基础eGFR降低及持续性AKI的存在情况,及早检测、早期干预可能会改善老年AKI患者的肾脏预后。     

丙型病毒性肝炎肝硬化患者抗病毒疗效及影响因素分析

目的 研究丙型病毒性肝炎肝硬化患者抗病毒治疗耐受及应答情况,探讨丙型肝炎抗病毒疗效的影响因素.方法 收集慢性丙型肝炎患者52例,其中肝硬化患者13例,菲肝硬化患者39例,均给予干扰素(IFN)联合利巴韦林抗病毒治疗后,观察两组患者病毒学应答、生化学应答及不良反应发生情况.结果 丙型肝炎肝硬化组平均年龄为(58.31±8.72)岁,非肝硬化组平均年龄为(36.95±15.30),两组比较差异无统计学意义(P＞0.05).肝硬化患者快速病毒学应答率(RVR)、早期病毒学应答率(EVR)和持续病毒学应答率(SVR)分别为84.62％、100.00％和53.85％,非肝硬化患者RVR、EVR和SVR分别为92.31％、100.00％和71.79％,两组比较差异均无统计学意义(P＞0.05).两组生化学应答比较差异均无统计学意义(P＞0.05).肝硬化组患者中性粒细胞减少、血小板减少和贫血的发生率均明显高于非肝硬化组,两组比较差异均有统计学意义(P＜0.05).肝硬化组患者中有2例出现白蛋白下降和腹水,其中1例中断治疗.老年(年龄≥60岁)和采用普通IFN联合利巴韦林抗病毒治疗的患者获得SVR率明显低于中青年患者(年龄＜60岁)和采用长效IFN联合利巴韦林抗病毒治疗的患者(P＜0.05).基因1型患者的SVR率低于非基因1型,但差异无统计学意义(P＞0.05).结论 代偿期丙型病毒性肝炎肝硬化患者多能耐受抗病毒治疗,且远期疗效较好.     

上海浦东梅园社区慢性肾脏病流行病学调查

目的了解上海浦东新区部分社区人群中慢性肾脏病(CKD)的患病率以及CKD的危险因素。方法在浦东新区梅园街道,随机抽取20岁以上成年人共520名,填写调查问卷表并进行体格检查和实验室检查测得尿白蛋白/肌酐比值、尿常规和血肌酐、葡萄糖、血脂。以简化MDRD公式计算估计肾小球滤过率(eGFR)。应用SPSS11.5统计分析软件进行统计学分析。结果504名居民资料完整,经年龄性别标化后白蛋白尿的患病率是6.76%,血尿的患病率为2.82%,eGFR<60 mL/min的患病率为1.25%。按K/DOQI诊断标准,CKD的患病率为8.94%,CKD的知晓率为36.14%。Logistic回归分析显示,高血压、糖尿病、年龄是白蛋白尿的独立危险因素,年龄、高血压、糖尿病是CKD的危险因素。结论上海浦东梅园社区人群CKD的患病率8.94%,CKD的知晓率为36.14%。CKD的危险因素包括高血压、高血糖、高三酰甘油血症、年龄等。     

A meta‐analytic assessment of the risk of chronic kidney disease in patients with chronic hepatitis C virus infection

Epidemiological studies have reported conflicting results regarding hepatitis C virus (HCV) infection and the risk of chronic kidney disease (CKD). We systematically reviewed the literature to determine the risk of developing CKD in HCV‐infected individuals compared to uninfected individuals. MEDLINE and PUBMED were searched to identify observational studies that had reported an association between HCV and CKD or end‐stage renal disease (ESRD) through January 2015. Quantitative estimates [hazard ratio (HR) or odds ratio (OR)] and their 95% confidence intervals (CI) were extracted from each study. A random‐effects meta‐analysis was performed. Fourteen studies evaluating the risk of developing CKD/ESRD in HCV‐infected individuals (n = 336 227) compared to uninfected controls (n = 2 665 631) were identified‐ nine cohort studies and five cross‐sectional studies. The summary estimate indicated that individuals with HCV had a 23% greater risk of presenting with CKD compared to uninfected individuals (risk ratio = 1.23; 95% CI: 1.12–1.34). Results were similar by study type, for cohorts (HR = 1.26; 95% CI: 1.12–1.40) and cross‐sectional studies (OR = 1.21; 95% CI: 1.09–1.32). Country‐stratified analysis demonstrated a significantly increased risk between HCV and CKD in the Taiwanese subgroup (risk ratio = 1.28; 95% CI: 1.12–1.34) and the US subgroup (risk ratio = 1.17; 95% CI: 1.01–1.32). Egger regression revealed no evidence of publication bias. HCV infection is associated with a greater risk of developing and progression of CKD compared to uninfected controls.     

Development rate of chronic kidney disease in hepatitis C virus patients with advanced fibrosis after interferon therapy

Aim: The aim of this retrospective cohort study is to assess the development incidence and predictive factors for chronic kidney disease (CKD) after the termination of interferon therapy in hepatitis C virus (HCV) positive Japanese patients with liver cirrhosis. Methods: A total of 650 HCV positive, liver cirrhotic patients who were treated with interferon and showed an estimated glomerular filtration rate (eGFR) of ≥60 mL/min per 1.73 m² after the termination of interferon therapy were enrolled. CKD was defined as an eGFR of <60 mL/min per 1.73 m². End‐stage‐CKD was defined as an eGFR of <15 mL/min/1.73 m². The primary goal is the new development of CKD and end‐stage‐CKD. Results: Eighty‐five patients developed CKD, and six patients progressed to end‐stage‐CKD. The development rate of CKD was 5.2% at the 5th year, 14.5% at the 10th year and 30.6% at the 15th year. Multivariate Cox proportional hazards analysis showed that CKD occurred when patients had age increments of 10 years (hazard ratio: 2.32; 95% confidence interval [CI] 1.61–3.35; P < 0.001), eGFR decrements of 10 mL/min per 1.73 m² (hazard ratio: 1.66; 95% CI 1.27–2.16; P < 0.001), hypertension (hazard ratio: 2.00; 95% CI 1.13–3.53; P = 0.017), diabetes (hazard ratio: 1.79; 95% CI 1.02–3.14; P = 0.042), and non‐clearance of HCV (hazard ratio: 2.67; 95% CI 1.34–5.32; P = 0.005). The development rate of end‐stage‐CKD was 0.4% at the 5th year, 1.6% at the 10th year and 2.8% at the 15th year. Conclusions: The annual incidence for CKD among cirrhotic patients with HCV was determined to be about 1.0–1.5%. In addition, the annual incidence for end‐stage‐CKD is one order of magnitude lower than that of CKD.     

High prevalence of hepatitis C virus infection in the largest province of Pakistan

OBJECTIVE: To estimate the prevalence and spectrum of hepatitis C virus (HCV) infection in the general population of Pakistan. METHODS: A total of 6817 blood samples were collected randomly from apparently healthy people in the Punjab, Pakistan from March 1999 to April 2001 and September 2006 to August 2007. Detailed socioeconomic information for each participant was recorded. All the samples were tested for anti-HCV antibodies and all seropositive samples were further tested for HCV RNA by polymerase chain reaction (PCR). RESULTS: Of the total 6817 serum samples tested, 998 (14.63%) were positive for anti-HCV antibodies. HCV RNA PCR was detected in 494 (49.50%) anti-HCV-positive samples. The prevalence of anti-HCV antibodies were significantly higher in males (15.09%) than in females (12.3%) (P < 0.009). A significant difference was also noted in the anti-HCV prevalence rate among different age groups tested (P < 0.01). In a multivariate logistic regression analysis, injected drug use (adjusted OR 6.6 [95%CI 4.1-9.9]), blood transfusion (adjusted OR 5.9 [95%CI 2.9-12.3]), pricked with a needle (adjusted OR 2.2 [95%CI 1.6-3.1]), re-use of syringes (adjusted OR 1.7 [95%CI 0.8-3.6]) and being over 35 years old (adjusted OR 1.3 [95%CI 0.9-1.9]) were independent risk factors for HCV infection. CONCLUSION: The study showed a high seroprevalence of anti-HCV antibodies in a general and apparently healthy population of the Punjab province of Pakistan. Drug injection, blood transfusion and needle stuck were the factors most strongly associated with HCV infection.     

Disease progression and the risk factor analysis for chronic hepatitis C

Background/Aims: The present study aimed to assess the incidence of advanced cirrhotic complications and to identify the risk factors associated with such complications in chronic hepatitis C. Methods: The data of 1137 chronic hepatitis C patients were retrospectively reviewed. We analysed the incidence rate and risk factors for ‘disease progression’, as defined by the occurrence of an increase of at least 2 points in the Child–Pugh score, oesophageal/gastric variceal bleeding, spontaneous bacterial peritonitis, hepatic encephalopathy, death related to liver disease or development of hepatocellular carcinoma (HCC). Results: Of the 1137 patients enrolled for analysis, 490 patients received antiviral treatment. The overall annual incidence rate of disease progression was 0.8 and 3.7% for patients with and without antihepatitis C virus (anti‐HCV) therapy respectively. The development of HCC was the most common cause of disease progression. In patients with anti‐HCV therapy, treatment response, platelet level and aspartate aminotranferase:platelet ratio index (APRI) were independent factors associated with disease progression. For those without anti‐HCV therapy, older age, male sex, diabetes, platelet level and APRI were independent factors for disease progression. APRI was strongest predictor for disease progression. Conclusions: The present study demonstrated that the development of HCC was the most common cause of disease progression, and we also identified the risk factors associated with disease progression. Thus, patients at such risks need close monitoring for disease progression, and especially for detecting HCC. Moreover, the active application of antiviral therapy and efforts to improve the antiviral response are required.     

Glecaprevir/pibrentasvir for patients with chronic hepatitis C virus infection and severe renal impairment

Data are limited regarding the real‐world effectiveness and safety of glecaprevir/pibrentasvir (GLE/PIB) in patients with chronic hepatitis C virus (HCV) infection and severe renal impairment (RI). We aimed to evaluate the performance of GLE/PIB in patients with chronic kidney disease (CKD) stage 4 or 5 in Taiwan. 108 chronic HCV patients with CKD stage 4 (n = 32) or 5 (n = 76) receiving GLE/PIB for 8‐12 weeks were retrospectively recruited at 4 academic centres in Taiwan. The effectiveness was determined by sustained virologic response at off‐therapy week 12 (SVR₁₂) for evaluable (EP) and per‐protocol populations (PP). The safety profiles were also assessed. By EP and PP analyses, the SVR₁₂ rate was 99.1% (107 of 108 patients; 95% confidence interval (CI): 94.9%‐99.8%) and 100% (107 of 107 patients; 95% CI: 96.5%‐100%). The SVR₁₂ rates were 100% (95% CI: 89.3%‐100%) and 98.7% (95% CI: 92.9%‐99.8%) in patients with CKD stage 4 and 5, respectively. One patient, who declined off‐therapy follow‐up after permanently discontinuing GLE/PIB at on‐treatment week 9 due to scheduled cardiac surgery, had nonvirologic failure. Sixteen (14.8%) patients had serious adverse events (AEs), which were judged not related to GLE/PIB. The three most common AEs were pruritus (19.4%), fatigue (15.7%) and nausea (13.9%). None had ≥3‐fold upper limit of normal for total bilirubin and alanine aminotransferase levels. None of the 9 patients with hepatitis B virus (HBV) coinfection developed HBV‐associated hepatitis. In conclusion, GLE/PIB for 8‐12 weeks is effective and well‐tolerated in HCV patients with severe RI.     

Prospective study of risk factors for hepatitis C virus acquisition by Caucasian, Hispanic, and Asian American patients

Commonly known risk factors for infection with hepatitis C virus (HCV) include blood transfusion, injection drug use, intranasal cocaine use, and body tattoos. We hypothesized that Asian Americans infected with HCV may not identify with these established risk factors present in Caucasians and Hispanics, and our aim was to conduct a survey of risk factors in HCV-infected patients in these ethnic groups. In this prospective study, 494 patients infected with HCV completed a detailed risk assessment questionnaire at a liver centre in Northern California from 2001 to 2008. Among subjects participating in this study, 55% identified themselves as Caucasian, 20% as Hispanic, and 25% as Asian. Asian Americans were older, less likely to smoke or consume alcohol, and have a family history of cancer compared with Caucasians and Hispanics. The laboratory profiles were similar, and genotype 1 was the most common infection in all groups (74-75%). The great majority of Caucasians (94%) and Hispanics (86%) identified with commonly known risk factors, which was in contrast to 67% of Asians (P < 0.0001). The most common risk factors in Asians were blood transfusions (50%) and acupuncture (50%). Furthermore, 74% of Caucasians and 66% of Hispanics identified more than one major risk factor, while only 20% of Asians reported having more than one risk factor (P < 0.0001). Survey for established risk factors for acquisition of HCV may be more appropriate for risk assessment of Caucasians and Hispanics, but not for Asian Americans. These findings may guide the development of HCV screening in our increasingly diverse population.     

新疆HIV感染者/AIDS患者肾损伤的发生率及影响因素研究

目的 通过对2018年1—8月在新疆维吾尔自治区第六人民医院住院的HIV感染者/AIDS患者进行回顾性调查,了解其肾损伤(急性肾损伤、慢性肾脏病)发生率、临床特点及影响因素,为我区HIV感染者/AIDS患者肾损伤的临床诊治提供有力证据.方法 采集纳入研究的1933例HIV感染者/AIDS患者的一般信息及实验室检查等相关指标,通过SPSS 23.0软件对收集的数据进行处理与分析.结果 HIV感染者/AIDS患者急性肾损伤的发生率为4.3％,慢性肾脏病的发生率为14.0％.年龄、CD4+T细胞计数、是否服用抗菌药物、是否患有尿路感染是HIV感染者/AIDS患者合并急性肾损伤的影响因素(P均<0.05).年龄、性别、CD4+T细胞计数、是否服用抗菌药物、是否患有尿路感染是HIV感染者/AIDS患者合并慢性肾脏病的影响因素(P均<0.05).结论 HIV感染者/AIDS患者的肾损伤发生率高,临床医师应及早对肾损伤予以重视,做到早预防,早发现,早治疗.     

Hepatocellular carcinoma in 13 patients with hepatitis C virus-associated chronic hepatitis

Abstract Thirteen of 81 patients with chronic hepatitis and positive hepatitis C virus (HCV) antibody developed hepatocellular carcinoma (HCC) during a follow-up period of 54 ± 38 months. The histopathological findings in HCC-bearing liver in these patients included six cases of chronic persistent hepatitis [CPH; mean hepatitis activity index (HAI) score: 5.8] and seven cases of chronic aggressive hepatitis (CAH) 2A, or 2B (HAI) score: 13.6). Multiple biopsies of the liver in six cases revealed that five cases, including four with CPH at the time of HCC diagnosis, previously had histopathological findings identical to CAH 2A, and another case constantly had CPH during the 8-year follow-up. These findings suggest that HCV-associated HCC can occur even in patients with HCV antibody positivity and inactive or mild chronic hepatitis. This is of interest in the pathogenetic mechanisms of HCV-associated HCC.     

Prevalence of hepatitis C virus antibodies in chronic liver disease and hepatocellular carcinoma patients in India

The prevalence of antibodies to hepatitis C virus (HCV) was investigated in 129 patients with chronic liver disease (85 with chronic active hepatitis and 44 with cirrhosis) and 53 patients with hepatocellular carcinoma. The commercially available second generation anti-HCV enzyme immunoassay kit was used. Antibodies to hepatitis C virus were detected in 16.2% of the patients with chronic liver disease and in 15.1% with hepatocellular carcinoma. Of the HCV positive patients in all groups 51.7% were positive for hepatitis B virus (HBV) markers indicating present or past infection. Prevalence of HBV markers in all the three groups (CAH, cirrhosis and HCC) was higher as compared with anti-HCV prevalence. These results suggest that HCV infection may not be a major cause of chronic liver disease and hepatocellular carcinoma in India and indicate the presence of other aetiological agents.