摘要
目的:上消化道出血(upper gastrointestinal bleeding UGIB)是临床常见的危重症,本研究观察UGIB发生急性肾损伤(acute kidney injury AKI)和死亡的危险因素。方法:回顾性统计山西医科大学附属人民医院2010年04月～2018年04月内科疾病UGIB的住院患者2 168例,从中选择纤维内镜检查确定出血原因作为研究对象。根据KDIGO2012年AKI肌酐标准确定UGIB后AKI及分期,比较无AKI患者与AKI不同分期患者相关危险因素以及对预测UGIB死亡多因素进行Cox多元回归分析。结果:纳入患者491例。男性250例、女性241例。年龄18岁～89岁(58±29)。其中AKI 201例(9. 3%),年龄(77. 3±13. 5)岁,无AKI患者290例(13. 4%)年龄(67±15. 8)岁。两组年龄比较有明细差异(P值<0. 001),AKI发生与胃部疾病的性质(如肿瘤)尤其消化性溃疡Forrest的分级有关。491例UGIB中死亡27例(5. 5%),AKI患者中死亡21例(10. 4%),无AKI患者死亡6例(2. 1%) P值<0. 001。AKI 3期患者死亡风险HR值为3. 593(95%CI1. 305～9. 892),P=0. 013,充血性心衰、恶性肿瘤、慢性肾脏病存在也与UGIB患者的死亡密切相关。结论:UGIB患者AKI的发生率较高,而且AKI使UGIB患者死亡的风险明显增加。
Objective: Upper gastrointestinal bleeding( UGIB) is a common clinical critical disease. This study assessed the risk factor for acute kidney injury( AKI) and mortality from UGIB. Methods: Retrospective statistics were preformed on hospitalized2168 adult patients with UGIB in people’s hospital affiliated to Shanxi medical university from April 2010 to April 2018. The patients were bleeding etiology determined by gastroscopy were also included in the study. After AKI and AKI staging were determined according to KDIGO 2012 AKI creatinine standard,the risk factors related to AKI in patients without AKI and those with different AKI stages were compared,and the multivariate Cox regression analysis was performed to predict the mortality of UGIB. Results: 491 patients with UGIB were included. There were 250 males and 241 females. Age: 18 ~ 89( 58 ± 29). Among them,the age of AKI was 77. 3± 13. 5 in 201 cases( 9. 3%) and that of non-aki patients was 67 ± 15. 8 in 290 cases( 13. 4%). There were significant differences in age between the two groups( P < 0. 001). The occurrence of AKI is related to the nature of gastric diseases( such as tumors),especially Forrest classification of peptic ulcer. There were 27 deaths( 5. 5%) in 491 patients with UGIB,21 deaths( 10. 4%) in patients with AKI,and 6 deaths( 2. 1%) in patients without AKI. The risk of death of AKI patients was significantly increased by HR value of 3. 593( 95% CI 1. 305 ~ 9. 892) P = 0. 013,and the presence of congestive heart failure,malignant tumor and chronic kidney disease was also closely related to the death of patients with upper gastrointestinal bleeding. Conclusion: The incidence of AKI with upper gastrointestinal hemorrhage is relatively high,and the risk of death of UGIB patients was obviously increased because of AKI.
作者
李辰飞
刘高虹
渠风琴
汪嵘
师东武
LI Chenfei;LIU Gaohong;QU Fengqin(Endoscopic Center of People's Hospital Affiliated to Shanxi Medical University,Taiyuan,030001)
出处
《中国中西医结合肾病杂志》
2019年第3期219-223,共5页
Chinese Journal of Integrated Traditional and Western Nephrology
基金
山西省卫生厅科研计划项目(No.201301030)
