289例乙型肝炎肝硬化患者肾功能评估

目的 分析不同的肾功能评估方法对289例乙型肝炎肝硬化患者肾功能评估的差异,并探讨患者发生肾功能不全的危险因素。方法 2015年1月~2015年12月于安徽医科大学第一附属医院感染病科住院的乙型肝炎肝硬化患者,分别采用血肌酐（sCr）、内生肌酐清除率（CCr）、估算的肾小球滤过率（eGFR）评估患者肾功能。对不同Child-Pugh分级患者肾功能不全程度进行评估,采用Logistic回归分析筛选出肾功能不全发生的危险因素。结果 纳入289例乙型肝炎肝硬化患者,其中Child-Pugh A级患者95例,Child-Pugh B级患者122例,Child-Pugh C级患者72例。以eGFR<90 ml.min^-1.1.73 m²为肾功能不全的判断标准,结果在本组患者中发现肾功能不全发生率为20.76%,显著高于采用sCr评估出的3.81%或cCr评估出的13.15%（P<0.05）;Child-Pugh C级患者肾功能不全发生率为29.17%,显著高于Child-Pugh A级的13.68%或Child-Pugh B级的21.31%（P<0.05）;单因素Logistic回归分析提示年龄、Child-Pugh分级、高尿酸血症、低钠血症与肾功能不全的发生有关,而多因素Logistic回归分析结果显示年龄、高尿酸血症和低钠血症是乙型肝炎肝硬化患者发生肾功能不全的独立危险因素（P<0.05）。结论 eGFR较sCr或cCr能更早地反映出乙型肝炎肝硬化患者是否存在肾功能不全,乙型肝炎肝硬化患者肾功能不全程度与Child-Pugh分级有关,但高龄、高尿酸血症和低钠血症是其发生的独立危险因素。

Evaluation of renal function in 289 patients with hepatitis B cirrhosis

Objective To investigate the prevalence of renal function insufficiency in patients with hepatitis B（HB） related cirrhosis and to explore the risk factors for renal insufficiency. Methods 289 patients with HB-related cirrhosis were recruited in our hospital between Jan.2015 and Dec. 2015. The renal function was evaluated by serum creatinine（sCr）,endogenous creatinine clearance （cCr） or the estimated glomerular filtration rate （eGFR） levels. The risk factors affecting renal function were screened by applying Logistic regression analysis. Results A total of 289 hospitalized patients with HB-related cirrhosis were enrolled,including 95 Child-Pugh class A,122 Child-Pugh class B and 72 Child-Pugh class C. The incidence of renal insufficiency assessed by eGFR as <90 ml·min^-1·1.73 m² was 20.76%,significantly higher than 3.81% assessed by sCr or 13.15% by cCr（P<0.05）;the incidence of renal insufficiency in Child-Pugh class C was 29.17%,significantly higher than 13.68% in Child-Pugh class A or 21.31% in Child-Pugh class B（P<0.05）;Univariate Logistic regression analysis showed that age,Child-Pugh classification,hyperuricemia and hyponatremia were related to the occurrence of renal insufficiency,while multivariate Logistic regression analysis identified age,hyperuricemia and hyponatremia as independent risk factors for renal insufficiency,in patients with hepatitis B-related cirrhosis（P<0.05）. Conclusion eGFR assessment might reflect the existence of renal insufficiency earlier than by sCr or cCr assessment. Development of renal insufficiency in patients with hepatitis B-related cirrhosis is associated with Child-Pugh scores,while age,hyperuricemia and hyponatremia are independent risk factors for the occurrence of renal injuries.