广西某医院2014-2018年恙虫病致急性肾损伤临床对照分析

  目的  回顾性分析广西某医院恙虫病发生急性肾损伤（acute kidney injury，AKI）的临床资料，评估AKI发病率，寻找预测AKI指标。  方法  收集广西医科大学第一附属医院2014-2018年211例患者病例资料，分为AKI组（58例）和非急性肾损伤（non-acute kidney injury，NAKI）组（153例）。对照研究两组辅助检查、治疗措施、并发症等差异情况；回归分析发生AKI相关危险因素。  结果  211例发生AKI 58例（27.49%，95%CI:1.66~1.76，P < 0.001），外斐试验166例均为阴性。两组治疗措施和并发症频数比较，AKI组需要率和发生率比NAKI组高（均有P < 0.05）。多因素Logistic回归分析模型显示出现血液系统损害（OR=4.536，95%CI:1.262~16.308），需要使用激素（OR=3.261，95%CI:1.259~8.446）和利尿剂（OR=3.870，95%CI:1.186~12.633）治疗是AKI发生危险因素；直接胆红素低（OR=0.952，95%CI:0.915~0.991）是保护因素。  结论  广西某医院恙虫病致AKI发生率位于国内外中等水平，近年外斐试验敏感性和特异性不高。恙虫病患者有血液系统损害并发症、需要用激素和利尿剂治疗是发生AKI的危险因素。

Clinical comparative analysis of acute kidney injury caused by scrub typhus in Guangxi from 2014 to 2018

  Objective  To retrospectively analyze the clinical data of patients with acute kidney injury (AKI) caused by scrub typhus in Guangxi, to evaluate the incidence of AKI, and to search for the prediction indicators of AKI.  Methods  Data of 211 patients from The First Affiliated Hospital of Guangxi Medical University from 2014 to 2018 were collected and divided into AKI group (58 cases) and non-acute kidney injury (NAKI) group (153 cases). The auxiliary examination, treatment measures and complications of the two groups were compared. Regression analysis was used to analyze the risk factors associated with AKI.  Results  There were 58 cases (27.49%, 95% CI: 1.66-1.76, P < 0.001) with AKI and 166 cases were all negative in the field test. Compared with the NAKI group, the incidence and need rate of AKI were higher than NAKI group, and the differences were statistically significant (all P < 0.05). Multivariate Logistic regression analysis showed that blood system damage (OR=4.536, 95% CI: 1.262-16.308), the use of hormones (OR=3.261, 95% CI: 1.259-8.446) and diuretics (OR=3.870, 95% CI: 1.186-12.633) were risk factors for AKI. Low direct bilirubin (OR=0.952, 95% CI: 0.915-0.991) was a protective factor.  Conclusion  The incidence of scrub typhus induced AKI in Guangxi is in the middle level at domestic and abroad. Patients with scrub typhus who have complications of blood system damage and have to be treated with hormones and diuretics are risk factors for AKI.