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目的:观察局灶节段性肾小球硬化(FSGS)患者急性肾损伤(AKI)、感染及血栓栓塞的发生率,探讨并发症发生的危险因素。方法:观察70例经临床及肾脏病理确诊的特发性FSGS患者的AKI、感染及血栓栓塞的发生率,分析并发症的临床特征及高危因素。结果:(1)70例特发性FSGS中,34例(48.6%)并发AKI、14例(20.0%)合并感染、11例(15.7%)出现血栓栓塞。(2)AKI以男性多见,其尿蛋白水平较高,血白蛋白水平较低,小管间质损伤更重,小管急性损伤的程度与AKI的分期有关;随访过程中AKI患者完全缓解率及有效率显著低于未合并AKI者。(3)感染以呼吸道感染多见,院内感染占50%;与非感染组相比,感染组患者的尿蛋白水平更高,血白蛋白、球蛋白、IgG水平则较低;随住院时间延长,感染发生率升高,院内感染所占比例增加;Logistic回归分析显示白蛋白低于20g/L和住院时间延长是感染的独立危险因素。(4)血栓栓塞包括颅内静脉窦血栓2例、颈内静脉血栓1例、右肾静脉血栓1例、股静脉血栓2例、腘静脉血栓2例和肺栓塞3例;血栓栓塞患者的循环内皮细胞计数(CECs)、血管性血友病因子(vWF)高于未合并血栓栓塞者,Logistic回归分析显示CECs和血红蛋白水平升高与血栓栓塞独立相关。结论:FSGS患者肾小管损伤、低白蛋白血症和住院时间延长、血管内皮细胞损伤和血液浓缩分别在AKI、感染、血栓栓塞的发生中起重要作用。
Objective: To observe the incidence of acute kidney injury (AKI), infection and thromboembolism in patients with focal segmental glomerulosclerosis (FSGS) and to explore the risk factors for the complications. Methods: The incidence of AKI, infection and thromboembolism in 70 patients with idiopathic FSGS diagnosed by clinical and renal pathology were observed. The clinical features and risk factors of complications were analyzed. Results: (1) In 70 idiopathic FSGS cases, 34 cases (48.6%) were complicated with AKI and 14 cases (20.0%) were infected with infection. Thromboembolism occurred in 11 cases (15.7%). (2) AKI is more common in men, with higher levels of urinary protein, lower serum albumin levels, heavier tubulointerstitial lesions and acute tubular injury related to the stage of AKI. The complete remission rate of AKI in follow-up and The efficiency was significantly lower than those without AKI. (3) Infection was more common in respiratory tract infection, nosocomial infection accounted for 50%; Compared with non-infected group, the patients in the infected group had higher urinary protein level and lower albumin, globulin and IgG levels; , The incidence of infection increased, the proportion of nosocomial infections increased; Logistic regression analysis showed that albumin less than 20g / L and hospital stay is an independent risk factor for infection. (4) Thromboembolism includes 2 cases of intracranial venous sinus thrombosis, 1 case of internal jugular vein thrombosis, 1 case of right renal vein thrombosis, 2 cases of femoral vein thrombosis, 2 cases of popliteal vein thrombosis and 3 cases of pulmonary embolism. Circulation of thromboembolism CECs and vWF were higher than those without thromboembolism. Logistic regression analysis showed that CECs and hemoglobin levels were independently associated with thromboembolism. CONCLUSIONS: Tubular injury, hypoalbuminemia and length of hospital stay are prolonged in FSGS patients. Vascular endothelial cell injury and blood concentration play an important role in the pathogenesis of AKI, infection and thromboembolism, respectively.