本文選題：社區(qū)獲得性肺炎 + 急性腎損傷��； 參考：《天津醫(yī)藥》2014年10期

【摘要】：目的探討社區(qū)獲得性肺炎(CAP)患者伴發(fā)急性腎損傷(AKI)的預后危險因素。方法 456例CAP患者為無伴發(fā)AKI(N-AKI)組和伴發(fā)AKI組。AKI組又根據(jù)RIFLE的嚴重程度級別分為3個亞組:危險(Risk)、損傷(Injury)和衰竭(Failure)組。比較各組患者CAP的嚴重程度,各項臨床指標和預后評估指標的差別;多因素分析采用Logistic回歸模型,生存分析采用Kaplan-Meier法,分析影響CAP患者預后不良的危險因素及RIFLE標準在預后評估中作用。結果 456例CAP患者中有30%(135例)伴發(fā)AKI,診斷為Risk 61例(45.2%),Injury 23例(17%),Failure 51例(37.8%)。CAP患者PSI評分為Ⅰ~Ⅲ級的患者(300例)中有23.3%(70例)伴發(fā)AKI,PSI分級≥IV的患者(156例)中有41.7%(65例)伴發(fā)AKI,差異有統(tǒng)計學意義(P0.01)。伴發(fā)AKI的CAP患者30 d病死率隨AKI嚴重程度增加(N-AKI患者6.2%,Risk患者14.8%,Injury患者21.7%,Failure患者45.1%)。此外,隨著AKI嚴重程度增加,需要機械通氣、正性肌力藥物和腎臟替代治療的患者比例增加。Logistic回歸分析顯示合并AKI、75歲、合并腎外器官衰竭是住院CAP患者預后不良的危險因素。結論住院CAP患者伴發(fā)AKI的預后不良。RIFLE診斷及分級標準可有效評估CAP伴發(fā)AKI患者的預后。
[Abstract]:Objective to investigate the prognostic risk factors of acute renal injury (AKI) in patients with community-acquired pneumonia (CAP). Methods 456 patients with CAP were divided into three subgroups according to the severity of RIFLE: the group without AKIN-AKI and the group with AKI. The severity of CAP, clinical indexes and prognostic evaluation indexes were compared among the three groups. Logistic regression model was used for multivariate analysis and Kaplan-Meier method was used for survival analysis. To analyze the risk factors of poor prognosis in patients with CAP and the role of RIFLE criteria in prognosis evaluation. Results of the 456 patients with CAP, 30135 were associated with AKI, and 61 patients with Risk were diagnosed as having 45.2fibronectomies. Twenty-three of the 51patients with PSI grade 鈪，

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