中国血液净化

中国血液净化 ›› 2013, Vol. 12 ›› Issue (07): 384-389.doi: 10.3969/j.issn.1671-4091.2013.07.00

• 临床研究 • 上一篇    下一篇

102例急性肾损伤患者进行肾脏替代治疗的预后分析

陈罡1,于阳1,李雪梅2   

  1. 1. 北京协和医院
    2. 北京协和医院肾内科
  • 收稿日期:2013-05-02 修回日期:2013-05-26 出版日期:2013-07-12 发布日期:2013-07-06
  • 通讯作者: 于阳 E-mail:yuyang@medmail.com.cn

Prognostic analysis of 102 cases of acute kidney injury patients with renal replacement therapy

  • Received:2013-05-02 Revised:2013-05-26 Online:2013-07-12 Published:2013-07-06

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摘要： 目的： 探讨AKI患者进行肾脏替代治疗的时机及其对预后的可能影响。方法： 回顾性分析507例AKI患者，选取其中接受RRT的102例患者资料，分析RRT起始时的临床资料和预后的关系，应用相关性分析和Logistic多因素分析等统计方法，筛选决定RRT合适时机的重要指标。结果： 从血清肌酐、尿素氮、尿量、TCO2、血钾和AKI持续时间等指标中，筛选出与预后相关的TCO2和尿量，进一步的分析推论出MODS也是影响预后的因素。应用Logistic多因素分析建立接受RRT的AKI患者的预后预测模型，其敏感度78.8%，特异度78.0%，预测准确性达87.3%。ROC曲线下面积为0.809。Hosmer-Lemeshow拟合优度检验P=0.295。结论：（1）在同样的疾病和临床并发症背景下，在尿量＜600ml/d和TCO2＜22.2mmol/L之前进行RRT有利于肾脏恢复；（2）MODS作为独立危险因素影响AKI的预后，在MODS发生前开始RRT是改善AKI预后的关键。

关键词: 急性肾损伤, 急性肾功能衰竭, 肾脏替代治疗, 预后

Abstract: Purpose： Analyze AKI patients who undertook renal replacement therapy (RRT) to screen the important indicators to decide the appropriate timing of RRT and its influence on prognosis. Method： The clinical data of 507 AKI patients were reviewed. 102 AKI patients who undertook RRT with complete medical records were further analyzed to reveal the relationship between clinical data and prognosis. Statistical methods were used to screen the important indicators of the appropriate timing of RRT. Results： TCO2 and urine volume were screened as predict factors of prognosis after the comparsion of the relationship of data at the onset of RRT and the prognosis. Further analysis revealed that MODS was also a powerful factor. The prediction model for AKI patients who undertook RRT was established after multiple variable Logistic regression analysis. The sensitivity and specifity of the model was respectively 78.8% and 78.0%, and the area under ROC was 0.809. The Hosmer-Lemeshow goodness-of-fit tests of the model was P=0.295. Conclusion： (1) Under the senario of the same disease and clinical background, the recovery of kidney function may benefit from initiating RRT before urine output＜600ml/d and/or TCO2＜22.2mmol/L. (2) As an independent risk factor, MODS indicates a worse prognosis; the determinant of improving clinical outcome of AKI is initiating RRT before MODS occurs.

Key words: Acute kidney injury, acute renal failure, renal replacement therapy, prognosis