本文選題：局灶節(jié)段腎小球硬化癥 + 腎科ICU　； 參考：《南京大學(xué)》2014年碩士論文

【摘要】：目的：探討局灶節(jié)段腎小球硬化癥(FSGS)患者入住腎科重癥監(jiān)護病房(RICU)的原因及其臨床特征。方法：觀察2009年7月至2012年12月在南京軍區(qū)南京總醫(yī)院腎臟科RICU病房住院的FSGS患者,分析此類患者入住RICU原因、臨床特點和既往治療情況。結(jié)果：1)本研究共納入48例FSGS患者,其中男性36例,女性12例,占所有RICU住院患者(共1626例)的2.93%,占腎病綜合征患者(共153例)的31.37%,中位年齡23歲,中位腎臟病病程5.2月,42例(87.5%)患者尿蛋白定量3.5g/d。2)23例(47.9%)患者發(fā)生感染,以肺部感染(9例,39.1%)和皮膚軟組織感染(6例,26.1%)為主,以腎臟病病程長并且對糖皮質(zhì)激素治療不敏感(激素抵抗)患者(10例,43.8%)為主。根據(jù)患者有無感染分為感染組(23例)和非感染組(25例)。與非感染組患者相比,感染組患者中位病程較長(8月VS 1.5月,P0.05),糖皮質(zhì)激素和細胞毒藥物使用率高(糖皮質(zhì)激素：95.8%VS 63%,P0.05；細胞毒藥物：43.5%VS 16%,P0.05)。3)31例(64.4%)患者發(fā)生急性腎損傷(AKI),1期、2期和3期各10、9和12例,其中19例(61.3%)患者起病時合并低血容量,14例(45.2%)患者為初次發(fā)病并且未使用糖皮質(zhì)激素和細胞毒藥物或剛接受上述藥物治療(初發(fā)初治)。根據(jù)患者有無AKI分為AKI組(31例)和非AKI組(17例)。與非AKI組患者相比,AKI組患者中激素抵抗者比例較低(16.1%VS 52.9%,P0.05),細胞毒藥物使用率低(19.4%VS 47.1%,P0.05),而糖皮質(zhì)激素使用率無差異。4)26例(54.2%)患者發(fā)生電解質(zhì)紊亂,其中14例低鉀血癥、16例低鈉血癥。感染、AKI和電解質(zhì)紊亂常重疊存在,12例感染合并AKI,14例感染合并電解質(zhì)紊亂,16例AKI合并電解質(zhì)紊亂,7例同時存在感染、AKI和電解質(zhì)紊亂。結(jié)論：感染、AKI和電解質(zhì)紊亂等是FSGS患者入住腎科ICU的主要原因,三者常重疊存在。感染在激素抵抗患者中發(fā)生率高,以肺部感染、皮膚軟組織感染最多見,使用糖皮質(zhì)激素和細胞毒藥物是發(fā)生感染的危險因素。急性腎損傷在初發(fā)初治患者中發(fā)生率高,其中大部分患者存在腎臟血流灌注不足因素。
[Abstract]:Objective: to investigate the causes and clinical features of FSGSpatients with focal segmental glomerulosclerosis (FSGS) admitted to intensive care unit (ICU). Methods: from July 2009 to December 2012, the FSGS patients hospitalized in the RICU ward of Renal Department of Nanjing General Hospital of Nanjing military region were observed, and the causes, clinical characteristics and past treatment of RICU were analyzed. Results: a total of 48 patients with FSGS were included in the study, including 36 males and 12 females, accounting for 2.93% of all RICU inpatients (1626 cases) and 31.3737% of patients with nephrotic syndrome (153 cases), with a median age of 23 years. 42 patients with median kidney disease (n = 42) with urinary protein quantitative 3.5g/d.2)23 (n = 47.9) were infected by lung infection (n = 9) and skin and soft tissue infection (n = 6). Ten patients with long course of kidney disease and insensitive glucocorticoid therapy (hormone resistance) were mainly diagnosed. The patients were divided into infection group (n = 23) and non-infection group (n = 25). Compared with non-infected patients, In the infection group, the median course of disease was longer (August vs 1.5 months, P 0.05, glucocorticoid and cytotoxic drugs utilization rates were high (10 9 and 12 cases, respectively, 10 9 and 12 cases, respectively) with acute renal injury, stage 2, stage 2 and stage 3, respectively, were 109 and 12 cases, respectively, in 31 patients with acute renal injury. Among them, 19 cases (61.3) patients with hypovolemic syndrome (14 cases) were first onset and did not use glucocorticoid and cytotoxic drugs or just received the above drugs (initial treatment. According to the presence or absence of AKI, the patients were divided into AKI group (n = 31) and non AKI group (n = 17). Compared with the non-AKI group, the proportion of hormone resistance was lower (16.1vs 52.9V / P 0.05), and the utilization rate of cytotoxic drugs was 19.4VS 47.1P 0.05, but there was no difference in the utilization rate of glucocorticoid in 26 patients (54.2%). Among them, 14 cases had hypokalemia and 16 cases had hyponatremia. There were 12 cases of infection complicated with AKI and 14 cases of infection with electrolyte disorder. 16 cases of AKI complicated with electrolyte disorder were found in 7 cases, and the infection of AKI and electrolyte disorder were also found in 7 cases. Conclusion: infection with AKI and electrolyte disturbance are the main causes of ICU in patients with FSGS, and they often overlap. The incidence of infection was high in patients with hormone resistance, pulmonary infection and skin soft tissue infection were the most common. Glucocorticoid and cytotoxic drugs were the risk factors of infection. The incidence of acute renal injury was high in the patients with initial treatment, and most of the patients had insufficient renal perfusion.
【學(xué)位授予單位】：南京大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2014
【分類號】：R692.6

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