摘要
目的探讨医院获得性急性肾功能衰竭(HAARF)与社区获得性急性肾功能衰竭(CAARF)在流行病学、病因学和预后等方面的异同及其相关因素。方法搜集北京大学第三医院1994年1月—2003年12月诊断为ARF的成人出院患者临床资料,重新确认ARF诊断并进行相关鉴别,统计HAARF和CAARF的流行病学、病因学和预后指标,用单因素和多因素回归分析二者预后的相关因素。结果205例确认ARF病例中,CAARF占59.5%,HAARF比率在后5年显著增加(P<0.05)。HAARF中59.0%为外科系统患者,49.4%为手术后并发症,36.1%与多病因相关;CAARF中,70.5%为内科系统患者,91.2%与单病因相关,差异均显著(P均<0.05)。HAARF和CAARF患者的病死率分别为62.7%和23.0%,肾功能恢复率分别为20.6%和67.2%,差异均显著(P均<0.01)。HAARF患者少尿和多器官功能衰竭(MOF)发生率、机械通气率、急性肾小管坏死个体严重程度指数(ATNISS)和急性生理学与慢性健康状况评分系统(APACHE)均显著高于CAARF患者(P均<0.01)。MOF和全身炎症反应综合征(SIRS)是HAARF和CAARF预后的共同危险因素,少尿和高龄分别是HAARF和CAARF预后的独立危险因素(P均<0.05)。结论CAARF占ARF比率总体高于HAARF,但后年来CAARF发病率显著上升,CAARF病因相对单一,预后较好,而HAARF病因复杂,预后很差。
Objective To investigate the differences between hospital -acquired acute renal failure （HA- ARF） and community- acquired acute renal failure （CA- ARF） in epidemiology, etiology and prognosis. Methods The diagnosis of ARF of patients diagnosed with ARF from ICD - 9 codes, who were discharged from Peking University Third Hospital from January 1994 to December 2003, was reconfirmed and categorized by two nephrologists independently. The indexes of epidemiology, etiology and prognosis were studied. Single -variable analysis and multivariate logistic regression analysis were performed to investigate the correlation between clinical features and prognosis respectively. Results Two hundred and five cases were collected and all were reconfirmed. CA- ARF had a predominance of 59.5%. HA- ARF, however, increased by 1.06 times in last 5 years （P〈0. 05）; 59.0% of HA - ARF was diagnosed in department of surgery while 70.5% of CA -ARF was in medical department （both P〈0.05）; 36.1% HA -ARF patients had two or more pathogenic causes, while 91.2% CA- ARF only had one cause （P〈0.05）; 49.4% HA-ARF developed after operation; 26.5% HA- ARF and 18.8% CA- ARF were drug- related （P〉0.05） ; 24.1% HA - ARF and 12.3% CA - ARF were infection - related （P = 0. 028）. Mortality and recovery rates were 62.7% and 20.6%, respectively, in HA - ARF while 23.0% and 67.2% in CA - ARF respectively （both P 〈 0. 01 ）. The percentage of oliguria, multiple organ failure （MOF）, systemic inflammatory response syndrome （SIRS）, and use of mechanical ventilation were significantly higher in HA-ARF than in CA- ARF （all P〈0.01）. Acute tubule necrosis -injury severity score （ATN -ISS）, acute pathological and choronic health evaluation （APACHE Ⅱ ） score were 0. 54±0. 24 and 19.6±4.9 in HA - ARF, while they were 0. 27±0.18 and 15.7±5.6 in CA - ARF （both P〈0.01）. Multiple regression analysis identified that both MOF and SIRS were common independent risk factors for HA -ARF and CA-ARF, and oliguria and advanced age were respective independent risk factor for HA-ARF and CA-ARF. Conclusion CA - ARF prevails in hospitalized Chinese patients during the last 10 years, but HA- ARF is increasing in incidence significantly during the last 5 years. The etiology is mostly simple and the prognosis is relatively good in CA- ARF, while the pathogenic cause is mostly complicated and the outcome is much poorer in HA- ARF.
出处
《中国危重病急救医学》
CAS
CSCD
北大核心
2005年第10期615-618,共4页
Chinese Critical Care Medicine
基金
北京大学"十五""211工程"重点学科建设项目循证医学学科群项目资助(93000246156118)
