275例急性肾损伤的临床资料及预后分析

目的 分析急性肾损伤（acute kidney injury,AKI）的病因,探讨影响其预后的危险因素,为临床更好的认识和预防AKI、改善预后提供依据.方法 回顾性分析275例AKI患者的一般资料、病因、临床特点、实验室检查及治疗情况,分析其与预后的关系.结果 纳入本研究的AKI患者275例,男181例,女94例,中位年龄为57岁,其中青年组（≤40岁）54例（占 19.6%）,中年组（40～60岁）97例（占 35.3%）,老年组（≥61岁）124例（占 45.1%）.275例患者的AKI分期中1期88例（占32%）,2期83例（占 30.2%）,3期104例（占 37.8%）.肾前性病因最常见,153例（占 55.6%）,其中感染相关性疾病最多,其次为心脑血管疾病.肾性病因中以药物性因素最多,其次为肿瘤相关性肾病.肾后性因素以尿路结石最常见,其次为肿瘤转移或浸润.多因素非条件Logistic回归分析示机械通气、血管活性药物、多器官功能障碍综合征（multiple organ dysfunction syndrome,MODS）、低蛋白血症是AKI患者死亡的独立危险因素,OR值分别为 2.445、43.530、2.801和3.118（均P＜0.01）.结论 AKI患者中,感染、心脑血管疾病等肾前性病因引起的AKI较常见,要及早诊断并积极干预.机械通气、血管活性药物、MODS、低蛋白血症是AKI患者死亡的独立危险因素.

Etiology and prognosis of 275 cases of acute kidney injury

Objective To analyze the etiology and risk factors of acute kidney injury （AKI） in order to help clinicians better understand and prevent AKI. Methods Clinical data of 275 patients with AKI, including the causes, clinical characteristics, laboratory features, treatment and outcome, were retrospectively analyzed. Association between risk factors and prognosis was analyzed. AKI was defined by the new classification criteria of the Kidney Disease Improving Global Outcomes. Results Two hundred and seventy five patients （181 males, and 94 females） were enrolled in this study, who admitted in our department between Jan. 1,2010 and Dec. 31,2012. The median age of AKI patients was 57 years （range 4-96 years）. 19.6% patients （54 cases） were less than 40 years, 35. 5% （97 cases） between 40 and 60 years, and 45. 1 % （124 cases） over 61 years. AKI was classified according to the staging system as fellows：32% of stage 1,30.2% of stage 2,and 37.8% of stage 3. The major causes of AKI were pre-renal （55.6%,153 cases）. Infectious diseases, cardiovascular and cerebrovascular diseases were major causes of pre-renal AKI. Drug and glomerulopathy associated with neoplasia were major causes of renal parenchymal, The causes of post-renal AKI were stone, malignant tumors and other causes of obstruction. Multivariate analysis showed that independent risk factors for death were mechanical ventilation （OR= 2. 445,P〈0. 01） .vasoactive agent （OR= 43. 530,P〈0.01） ,MODS （OR= 2.801 ,P〈0. 01） .and hypoproteinemia （OR= 3. 118,P〈0. 01）. Conclusions The pre-renal factors of infectious disease and cardiovascular and cerebrovascular diseases are common causes of AKI. Early diagnosis and early treatment play an important role in increasing the survival rate of AKI patients. The important risk factors of death in AKI patients are mechanical ventilation, vasoactive agent, MODS and hypoproteinemia.