老年急性肾损伤的临床特点及预后危险因素分析

摘要

目的 探讨老年急性肾损伤(acute kidney injury,AKI)的临床特点及预后危险因素.方法 选取2012年8月-2016年7月收治的AKI 206例,按年龄分为老年组(≥60岁,n=97)和非老年组(＜60岁,n=109),按照患者预后将老年组分为肾功能恢复组和肾功能未恢复组.记录年龄、性别、基础疾病(高血压病、冠心病、糖尿病)、AKI分期等资料,计算肾小球滤过率(glomerular filtration rate,GFR),观察预后及危险因素.结果 两组年龄、性别、基础疾病、AKI Ⅰ期、AKI Ⅲ期、GFR比较差异有统计学意义(P＜0.05).老年组出院时肾功能恢复51例(52.6％),末恢复46例(47.4％).与肾功能未恢复组比较,肾功能恢复组AKI Ⅰ期、AKI Ⅲ期、确诊时GFR≤60 ml/(min·1.73m2)、低蛋白血症、肾脏替代疗法(renal replacement therapy,RRT)差异有统计学意义(P＜0.05).多因素Logistic回归分析显示,低蛋白血症、AKI Ⅲ期、RRT是老年AKI患者预后的独立危险因素.结论 老年AKI患者预后与低蛋白血症、RRT和AKI Ⅲ期密切相关.%Objective To investigate the clinical characteristics and prognostic risk factors of elderly patients with acute kidney injury (AKI).Methods From August 2012 through July 2016,we enrolled 206 patients with AKI.The patients were divided into the elderly group (≥60 years old,n =97) and the non-elderly group (＜60 years old,n =109) by age,and patients in the elderly group were further assigned to renal function recovery group and renal function non-recovery group according to the prognosis of the patients.The data of age,sex,underlying diseases (hypertension,coronary heart disease and diabetes) and AKI stage were documented.The glomerular filtration rate (GFR) was calculated,and the prognosis and risk factors were observed.Results The age,sex,underlying diseases,AKI stage Ⅰ,AKI stage Ⅲ and GFR differed significantly between the two groups(P ＜0.05).In the elderly group,the number of those with and without renal function recovery was 51 (52.6％) and 46 (47.4％)respectively at discharge from hospital.Compared with renal function non-recovery group,there were significant differences in AKI stage Ⅰ,AKI stage Ⅲ,GFR ≤60 ml/ (min · 1.73m2) at diagnosis,hypoproteinemia,and renal replacement therapy (RRT) in renal function recovery group.Multivariate logistic regression analysis showed that hypoproteinemia,AKI stage Ⅲ and RRT were independent risk factors for the prognosis of elderly patients with AKI.Conclusion Hypoproteinemia,RRT and AKI stage Ⅲ were closely associated with the prognosis of elderly AKI patients.