本文選題：急性腎損傷 + 失代償性肝硬化　； 參考：《天津醫(yī)科大學(xué)》2014年碩士論文

【摘要】：目的： 觀察失代償性肝硬化病人伴發(fā)急性腎損傷后對預(yù)后的影響；探討失代償性肝硬化病人伴發(fā)急性腎損傷的獨立危險因素；評價INR、血肌酐、血鈉、總膽紅素、膽堿酯酶、腎小球濾過率等指標(biāo)預(yù)測失代償性肝硬化伴發(fā)急性腎損傷的診斷價值。 方法： 回顧性分析2005年1月至2012年12月期間在天津市第三中心醫(yī)院肝內(nèi)科反復(fù)住院治療的失代償性肝硬化患者126例,其中單純肝硬化組66例,肝硬化伴發(fā)急性腎損傷組60例。所有病例在初診后的第0、1、2、3、4年這5個時間點上對病例的一般情況、實驗室檢查、肝腎功能指標(biāo)和預(yù)后情況做系統(tǒng)的評估。采用SPSS17.0軟件進(jìn)行統(tǒng)計學(xué)分析。生存分析使用Kaplane Meier法,生存率比較采用log-rank檢驗。兩組間計量資料比較采用兩組獨立樣本的t檢驗,計數(shù)資料采用x2檢驗；采用Logistic回歸分析篩選失代償性肝硬化易伴發(fā)急性腎損傷的獨立危險因素。采用受試者工作特征曲線及曲線下面積評估INR、血肌酐、血鈉、總膽紅素、膽堿酯酶、腎小球濾過率的對失代償性肝硬化易伴發(fā)急性腎損傷的診斷價值。 結(jié)果： 1.本研究實際平均隨訪時間為33.79±18.13月。在整個隨訪期間,單純肝硬化組死亡12例,肝硬化伴發(fā)急性腎損傷組死亡27例。到隨訪截止時單純肝硬化組的生存率為83.33%,而肝硬化伴發(fā)急性腎損傷組的生存率為55%,兩組生存分析比較差異有統(tǒng)計學(xué)意義(x2=13.270,P=0.001)。 2. Logistic回歸分析顯示,血肌酐、總膽紅素、INR的升高以及血鈉、膽堿酯酶和腎小球濾過率的降低是失代償性肝硬化病人易伴發(fā)急性腎損傷的獨立危險因素(OR值分別為1.034、1.005、2.471、0.910、0.999、0.972,P均0.05)。 3.應(yīng)用ROC曲線評估血肌酐、總膽紅素、INR、血鈉、膽堿酯酶和腎小球濾過率這些指標(biāo)對失代償性肝硬化伴發(fā)急性腎損傷的預(yù)測能力,結(jié)果發(fā)現(xiàn)：血鈉的AUC為0.828,顯著高于INR(0.742)、膽堿酯酶(0.714)及總膽紅素(0.725),差異有統(tǒng)計學(xué)意義(Z值分別為2.332、3.091、2.911,P均0.05)；而其它指標(biāo)之間兩兩比較均未見顯著性差異(P0.05)。 結(jié)論： 1.失代償性肝硬化病人伴發(fā)急性腎損傷可以降低生存率并對預(yù)后產(chǎn)生負(fù)面影響,應(yīng)對急性腎損傷的發(fā)生提高警惕,做到早期診斷,早期治療。 2.血肌酐、總膽紅素、INR的升高以及血鈉、膽堿酯酶和腎小球濾過率的降低是失代償性肝硬化病人易伴發(fā)急性腎損傷的獨立危險因素。 3.血肌酐、總膽紅素、INR、血鈉、膽堿酯酶和腎小球濾過率等指標(biāo)的變化均可預(yù)測失代償性肝硬化病人是否易伴發(fā)急性腎損傷,其中以血鈉水平降低的診斷價值最高。
[Abstract]:Objective: To observe the influence of decompensated cirrhosis with acute renal injury on prognosis; to investigate the independent risk factors of decompensated cirrhosis with acute renal injury; to evaluate INR, serum creatinine, serum sodium, total bilirubin and cholinesterase, The value of glomerular filtration rate in the diagnosis of decompensated cirrhosis with acute renal injury. Methods: From January 2005 to December 2012, 126 cases of decompensated cirrhosis were retrospectively analyzed in the Department of Hepatology, third Central Hospital of Tianjin, including 66 cases in simple cirrhosis group and 60 cases in cirrhosis with acute renal injury group. All the cases were evaluated systematically on the 5 time points of 0 ~ 1 ~ 2 ~ 2 ~ 3 ~ (th) after first diagnosis and 4 years, including general condition, laboratory examination, liver and kidney function index and prognosis. SPSS17.0 software was used for statistical analysis. Kaplane Meier method was used for survival analysis and log-rank test was used to compare survival rate. T test of two groups of independent samples and x 2 test of counting data and Logistic regression analysis were used to screen the independent risk factors of decompensated cirrhosis with acute renal injury. The diagnostic value of INR, serum creatinine, serum sodium, total bilirubin, cholinesterase and glomerular filtration rate in decompensated cirrhosis with acute renal injury was evaluated by using the operating characteristic curve and the area under the curve. Results: 1. The actual average follow-up time was 33.79 鹵18.13 months. During the follow-up period, 12 cases died in simple cirrhosis group and 27 cases died in cirrhosis with acute renal injury group. At the end of follow-up, the survival rate of simple cirrhosis group was 83.33, while that of cirrhosis with acute renal injury group was 55. The difference of survival analysis between the two groups was statistically significant. 2. Logistic regression analysis showed that the increase of serum creatinine and total bilirubin, and the decrease of serum sodium, cholinesterase and glomerular filtration rate were the independent risk factors of acute renal injury in decompensated cirrhosis patients. The OR values were 1.034 鹵1.0052.471 鹵0.910 ~ 0.9990.972P, respectively. 3. Serum creatinine, total bilirubin, serum sodium, cholinesterase and glomerular filtration rate were evaluated by ROC curve for predicting acute renal injury associated with decompensated cirrhosis. The results showed that the AUC of blood sodium was 0.828, which was significantly higher than that of INR 0.742C, cholinesterase 0.714) and total bilirubin (0.725g). The difference was statistically significant (Z = 2.332C 3.091C 2.911C P 0.05), but there was no significant difference between other indexes (P 0.05). Conclusion: 1. The acute renal injury associated with decompensated cirrhosis can reduce the survival rate and have a negative impact on the prognosis. It is necessary to raise the vigilance for the occurrence of acute renal injury and to make early diagnosis and treatment. 2. Elevated serum creatinine total bilirubin INR and decreased serum sodium cholinesterase and glomerular filtration rate were independent risk factors for acute renal injury in patients with decompensated cirrhosis. 3. The changes of serum creatinine, total bilirubin INR, serum sodium, cholinesterase and glomerular filtration rate can predict whether decompensated cirrhosis patients are prone to acute renal injury.
【學(xué)位授予單位】：天津醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R575.2;R692.5

【參考文獻(xiàn)】

相關(guān)期刊論文 前5條

1 李西慧;肖鋒;李巖;王進(jìn);宋波;楊陽;信維強(qiáng);杜迎利;宋乃慶;張明禮;;冠狀動脈旁路移植術(shù)后急性腎損傷影響因素探討[J];北京大學(xué)學(xué)報(醫(yī)學(xué)版);2009年05期

2 凌光輝;曾妮;劉家軍;彭佑銘;段紹斌;夏運(yùn)成;劉虹;劉映紅;李軍;李瑛;孫林;劉伏友;;5100例體外循環(huán)心臟手術(shù)后急性腎損傷的圍手術(shù)期危險因素分析[J];中南大學(xué)學(xué)報(醫(yī)學(xué)版);2009年09期

3 應(yīng)楹 ,張常晶,姚定康;肝硬化病因流行病學(xué)研究進(jìn)展[J];人民軍醫(yī);2001年10期

4 侯霜;熊祖應(yīng);羅瓊;陳麗;張帆;廖瑾嵐;;277例急性腎功能衰竭患者流行病學(xué)研究[J];中國實用醫(yī)藥;2009年01期

5 Jan Lata;;Hepatorenal syndrome[J];World Journal of Gastroenterology;2012年36期

，

本文編號：1823551