乙型肝炎病毒相关慢加急性肝衰竭患者合并肾损害的临床特点分析

    Clinical features of renal injury in patients with HBV-related acute-on-chronic liver failure

    • 摘要: 目的 探讨乙型肝炎病毒相关慢加急性肝衰竭(HBV-ACLF)患者合并肾损害的临床特点。方法 收集华中科技大学附属同济医院感染科2014年10月至2017年5月住院期间诊断为HBV-ACLF的539例患者的临床资料,对其肾损害情况进行回顾性分析。结果 有19.67%(106/539)的患者出现肾损害,≥51岁组患者肾损害的发生率最高,为34.52%;合并感染、肝硬化、长期卧床及使用利尿剂的患者更容易出现肾损害,其比率分别为25.86%、27.08%、26.07%和22.51%。有肾损害组患者的白蛋白、总胆固醇、三酰甘油、凝血酶原活动度、血红蛋白和血小板计数均低于无肾损害组患者,而白细胞计数则高于无肾损害组。结论 肾损害在HBV-ACLF患者中较为常见,发病率高,临床上应重点关注年龄大、长期卧床、使用利尿剂和合并感染、肝硬化的患者,且应及时纠正低白蛋白血症、低脂血症、贫血、感染、凝血异常等情况,避免肝衰竭进一步加重。

       

      Abstract: Objective To explore the clinical features of renal injury in patients with HBV-related acute-on-chronic liver failure (ACLF). Methods The clinical data of 539 patients who were diagnosed as HBV-ACLF during the hospitalization were collected in Wuhan Tongji Hospital from October 2014 to May 2017. The features of renal injury were analyzed retrospectively. Results The renal injury occurred in 19.67% (106/539) patients with HBV-ACLF. The incidence was highest in ≥ 51-year-old group, 34.52%. Patients with infection, cirrhosis, long-time bed and diuretics were more susceptible to renal injury, with the ratio of 25.86%, 27.08%, 26.07% and 22.51% respectively. Albumin, total cholesterol, triglyceride, prothrombin activity, hemoglobin and platelet count were reduced in patients with renal injury, but the white blood cell count was increased as compared with those in patients without renal injury. Conclusions Renal injury is common in patients with HBV-ACLF, with a high incidence. The patients with older age, long-time bed, diuretics, infection and cirrhosis should be focused. Hypoalbuminemia, hypolipidemia, anemia, infection and coagulation abnormalities also should be treated immediately to avoid further aggravation of liver failure.

       

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