KDIGO急性肾脏病定义对住院患者急性肾功能不全的诊断价值

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摘要目的：探讨肾脏科住院患者急性肾脏病（AKD）的发病及预后情况，了解AKD新定义在诊断急性肾功能不全中的临床价值。方法：回顾性分析2016年1月至2016年12月在上海交通大学医学院附属新华医院肾脏科住院、有完整病史资料的患者1 984例的AKD发生率、病因、临床特点以及肾脏预后情况。AKD和急性肾损伤（AKI）诊断标准采用2012年KDIGO指南标准。采用logistic回归分析影响AKD肾脏预后的危险因素。结果： AKD发生率为5.29%（105例），其中70例符合AKI诊断，35例符合非AKI的AKD诊断。AKD病因方面，肾前性占43.8%，肾性占40.0%，肾后性占3.8%。与AKI患者相比，非AKI的AKD患者合并慢性基础疾病比例和24 h尿蛋白水平显著增高，血肌酐达峰速度显著减慢，血清白蛋白水平显著降低。AKI和非AKI的AKD患者在肾脏转归上差异无统计学意义。Logistic回归分析显示，收缩压高（OR=1.03）、合并慢性肾脏病（OR=4.95）、肌酐达峰速度慢（OR=0.98）和低血红蛋白（OR=0.96）是影响AKD患者血肌酐未回归基线水平的独立危险因素。结论：AKD标准较AKI标准对诊断急性肾功能不全的敏感性更高，非AKI的AKD患者临床表现与AKI患者存在差异，但肾脏预后并不优于AKI。收缩压高、合并慢性肾脏病、肌酐达峰速度慢和低血红蛋白是影响AKD患者肾脏转归的危险因素。

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关键词 ：急性肾脏病, 急性肾损伤, 发病率, 危险因素

Abstract：Objective: To investigate the incidence and clinical characteristics of acute renal impairment in hospitalized patients using the 2012 Kidney Disease Improving Global Outcomes (KDIGO) definition-acute kidney disease (AKD) and assessed the risk factors associated with the adverse outcome of AKD. Methods: A retrospective analysis of 1984 patients receiving treatment in the ward of Renal Division of Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from January 1st 2016 to December 31st 2016, using the 2012 KDIGO AKD/AKI definitions to identify patients with AKD (AKI and non-AKI AKD). The incidence, clinical characteristics and prognosis of AKI and AKD non-AKI patients were compared. Logistic regression was used to identify risk factors associated with adverse outcomes of AKD. Results: A total of 105 patients (5.29%) were diagnosed with AKD, of which 70 met the AKI criteria and 35 were classified as non-AKI AKD. Pre-renal, intrinsic and post-renal AKD accounted for 43.8%, 40.0% and 3.8% respectively. Compared with AKI patients, patients diagnosed with non-AKI AKD had higher proportion of co-morbidity and higher 24-hour proteinuria, lower serum albumin and slower serum creatinine (Scr) rising velocity. Logistic regression revealed that systolic blood pressure (OR=1.03), CKD history (OR=4.95), Scr rising velocity (OR=0.98) and hemoglobin (OR=0.96) were independent risk factors for adverse renal outcomes of AKD. Conclusion: The 2012 KDIGO AKD criteria identified more patients with acute renal impairment. Higher systolic blood pressure, CKD history, lower Scr rising velocity and lower Hemoglobin were independent risk factors for adverse outcome of AKD. AKD patients diagnosed as non-AKI had the same renal prognosis compared with the patients who met the AKI criteria. The results of this study underline the value of AKD diagnostic criteria and support its application in the clinical practice.

Key words： acute kidney disease acute kidney injury incidence risk factors

收稿日期: 2018-02-14

基金资助:国家自然科学基金青年基金资助项目（81500507）；上海交通大学医学院附属新华医院优秀青年人才培养计划（2015001）。

通讯作者: 林芙君，副主任医师，Email：seatoneal@hotmail.com

作者简介: 宗雪（1987-），女，江苏镇江人，主治医师，博士。

链接本文:

https://xb.wmu.edu.cn/CN/ 或 https://xb.wmu.edu.cn/CN/Y2018/V48/I7/504

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