155例急性肾损伤病因及预后分析:急性肾损伤kdigo分级

　　【摘要】 目的 探讨急性肾损伤(AKI)的病因及预后。方法 155例AKI患者，依据年龄划分，老年组60例，非老年组95例，两组均给予常规的非透析治疗和（或）在此基础上加用透析治疗。对比分析两组患者的病因及预后。结果 老年组AKI病因主要以肾前性多见（P＜0.01），非老年组以肾性多见（P＜0.01）。老年组患者肾损害程度显著高于非老年组（P＜0.01）。老年组合并原发慢性病的百分率显著高于非老年组（P＜0.01），存在多器官功能障碍综合征（MODS）者显著多于非老年组（P＜0.01），需要血液净化治疗者显著多于非老年组（P＜0.01）。非老年组的预后显著好于老年组（P＜0.01）。结论 老年AKI患者多死于MODS、重症感染和心血管疾病、糖尿病等合并症，而非老年AKI患者死于感染多见。积极防治MODS和各种慢性疾病，可明显降低老年人AKI发病率和病死率。
　　【关键词】 急性肾损伤；老年人；病因；预后
　　文章编号：1003-1383(2012)04-0480-04
　　中图分类号：R 692.5 文献标识码：A
　　doi:10.3969/j.issn.1003-1383.2012.04.011
　　Analysis of etiology and prognosis of the acute kidney injury of 155 cases
　　ZHANG He,HUANG Weihua,NING Jun
　　(Department of Nephrology,The First People’s Hospital of Qinzhou,Qinzhou 535000,Guangxi,China)
　　【Abstract】 Objective To investigate the etiology and prognosis of acute kidney injury(AKI).
　　Methods 155 patients with AKI were divided into the elderly group (60 cases) and the young group (95 cases) according to their ages. The two groups were both treated by conventional non-dialysis and dialysis. The etiology and prognosis of both groups were analyzed and compared to each other.
　　Results The causes of AKI of the two groups were different significantly（P＜0.01）. The common causes of AKI in the elderly group were pre-renal factors, while the main causes in the young group were renal parenchyma injury.The elderly group had significantly worse injury than the young group（P＜0.01）. And they had higher rate of suffering primary chronic diseases and MODS than the young group （ P＜0.01）.Therefore,in the elderly group more patients needed blood purification treatment（P＜0.01）.The prognosis of the young group was obviously better than that of the elderly group（P＜0.01）.
　　Conclusion MODS,serious infection,cardiovascular, and diabetes complications are the main causes of death of the elderly patients with AKI,while the young patients commonly die of infection. Active prevention of MODS and other kinds of primary chronic diseases can reduce AKI incidence and mortality in the elderly patients.
　　【Key words】 acute kidney injury；elderly；etiology；prognosis
　　最早只有急性肾功能衰竭（Acute renal failure，ARF）而没有急性肾损伤(Acute kidney injury，AKI)这个概念。2005年，国际肾脏病学及危重病学领域的学者组成的急性肾损伤网络（Acute kidney injury network，AKIN）专家组，在荷兰阿姆斯特丹联合举办的研讨会上将ARF改名为AKI，对之前的RIFLE标准重新修改并制定了AKI诊断标准，即AKIN标准［1］。AKI临床上较常见，往往病情危重，病因复杂,肾功能在短时间内急骤恶化，虽然AKI是可逆的,但很多时候可因病情发展迅速,合并症多,治疗不及时而导致慢性肾脏病、终末期肾病以致终身依赖血液透析或腹膜透析，甚至导致患者死亡。有文献报道AKI的病死率高达44%［2］。据近年统计，急性肾损伤患者约占住院患者的5%，重症监护室患者的30%［3］。在一般住院患者及老年病科住院患者中，老年AKI患者占同期AKI患者总数的57%～64%。为此，我们对155例AKI患者进行病因及预后分析，为AKI的防治提供参考。