【作者】 吴敏；

【导师】 廖晓辉；

【作者基本信息】 重庆医科大学 ， 临床医学（专业学位）， 2020， 硕士

【摘要】 目的:探讨重症急性胰腺炎（SAP）合并急性肾损伤（AKI）临床特点及预后,分析影响肾功能及预后的危险因素。方法:回顾性分析重庆医科大学附属第二医院2014年至2019年收治的291例重症急性胰腺炎患者,根据KDIGO指南中AKI的诊断标准分为AKI组及非AKI组,对比两组患者临床特点及AKI组的预后,并采用Logistic回归分析影响肾功能及疾病预后的危险因素。结果:（1）本研究中SAP患者总体死亡率为12.7%,且AKI组死亡率明显高于非AKI组（P<0.05）;（2）SAP最常见的病因是高脂源性,其次为胆源性;（3）AKI组与非AKI组在年龄、血压、治疗方案、疾病转归、血红蛋白（Hb）、血小板（PLT）、红细胞压积（Hct）、血钙(Ca²⁺)、C反应蛋白（CRP）、降钙素原（PCT）、血肌酐（Scr）、尿素氮（BUN）、血尿酸（UA）、天门冬氨酸氨基转移酶（AST）、γ-谷氨酰转移酶（γ-GT）、血清白蛋白（ALB）、凝血酶原活动度（PTA）、活化部分凝血活酶时间（APTT）、凝血酶原时间（PT）、血淀粉酶、动脉血PH值、MCTSI评分、Marshall评分差异有统计学意义（P<0.05）。多因素Logistic回归分析显示:PCT、CRP、UA、γ-GT、APTT是SAP发生AKI的独立危险因素,收缩压是保护性因素（P<0.05）;（4）临床转归:与好转组对比,死亡组舒张压更低,平均住院时间短,选择CRRT治疗的比例高,另外,死亡组Scr、BUN、丙氨酸氨基转移酶（ALT）、AST、APTT、Marshall评分高于好转组,而PTA、PLT、氧合指数低于好转组（P<0.05）。多因素Logistic回归分析显示APTT和Marshall评分是SAP合并AKI患者死亡的独立危险因素。结论:重症急性胰腺炎的病因以高脂源性最常见,若合并AKI死亡率增高,PCT、CRP、UA、γ-GT、APTT是SAP发生AKI的独立危险因素,收缩压是保护性因素;APTT和Marshall评分是SAP合并AKI患者死亡的独立危险因素。因此在临床上应该严格控制血脂,积极控制感染,密切监测脏器功能。更多还原

【Abstract】 Objective:To analyze the clinical characteristics and prognosis of severe acute pancreatitis（SAP）complicated with acute renal injury（AKI）,and explore the risk factors affecting renal function and prognosis.Methods:291 patients diagnosed with severe acute pancreatitis in the second affiliated Hospital of Chongqing Medical University from 2014 to2019 were divided into AKI group and non-AKI group according to the KDIGO-AKI criteria.The clinical characteristics and and the prognosis of AKI group were compared,and Logistic regression analysis was used to analyze the risk factors affecting renal function and prognosis.Results:（1）In our study,the mortality rate of SAP patients is12.7%,and SAP-induced AKI patients experienced a significantly higher mortality than those without AKI（P<0.05）.（2）The most common cause of SAP is hyperlipidemia,followed by cholelithiasis.（3）There were significant differences in age,blood pressure,treatment scheme,prognosis,hemoglobin（Hb）,platelet（PLT）,hematocrit（Hct）,Ca²⁺,C-reactive protein（CRP）,procalcitonin（PCT）,serum creatinine（Scr）,blood urea nitrogen（BUN）,serum uric acid（UA）,aspartate aminotransferase（AST）,γ-glutamyltransferase（γ-GT）,serum albumin,coagulation function,Serum amylase,artery blood pH,MCTSI scores and Marshall scores between two groups（P<0.05）.Multivariate Logistic regression analysis showed that PCT,CRP,UA,γ-GT and APTT were influencing factors of SAP complicated with AKI,while systolic blood pressure was a protective factor.（4）Compared with the survival group,the death group had lower diastolic blood pressure,shorter average hospital stay and higher proportion of CRRT.In addition,the death group had higher Scr,BUN,alanine aminotransferase（ALT）,AST,APTT and Marshall scores,while lower PTA,PLT and oxygenation（all P<0.05）.Multivariate Logistic regression analysis showed that the morality-related independent factors were APTT and Marshall scores.Conclusion:Our study suggests that hyperlipidemia is the most common cause of SAP,and the mortality will increase if it is complicated with AKI.Influencing factors of SAP complicated with AKI are PCT,CRP,UA,γ-GT and APTT,while systolic blood pressure was a protective factor.The independent risk factors related to death of SAP-induced AKI patients are APTT and Marshall scores.更多还原