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目的探讨急性肾损伤(AKI)不同国际标准确定Ⅰ型心肾综合征(CRS)的独立危险因素。方法回顾性分析2005年7月至2012年7月广东省人民医院和中山大学第一附属医院急性心力衰竭(AHF)患者的资料。以危险、损伤、衰竭、肾功能丧失、终末期肾病(RIFLE),及急性肾损伤国际组织(AKIN)、改善全球肾脏病预后组织(KDIGO)标准定义的AKI作为主要观察终点,入院前3个月内的最低血肌酐(Scr)或入院首次Scr为基线Scr。结果共入组1058例患者。KDIGO标准(52.8%)比RIFLE(37.4%)和AKIN标准(47.9%)诊断出更多的AKI患者。Logistic回归分析表明,冠心病、血浆白蛋白(ALB)<30 g/L(OR=1.437)、C反应蛋白(CRP)>29.9 mg/L(OR=2.328)、血尿酸>479μmol/L(OR=1.813)、血红蛋白(Hb)<110 g/L(OR=1.582)、入院后48 h内使用利尿剂(OR=1.499)、血管活性药物(OR=2.124)是RIFLE诊断Ⅰ型CRS的独立影响因素;ALB<30 g/L(AKIN:OR=1.490;KDIGO:OR=1.386)、Hb<110 g/L(AKIN:OR=1.963;KDIGO:OR=1.889)、CRP>29.9 mg/L(AKIN:OR=2.252;KDIGO:OR=2.681)、eGFR<60 mL/(min·1.73 m2)、尿酸>479μmol/L(AKIN:OR=3.317;KDIGO:OR=2.853)、入院后48 h内使用利尿剂(AKIN:OR=3.200;KDIGO:OR=1.556)、血管活性药物(AKIN:OR=1.907;KDIGO:OR=2.040)是AKIN、KDIGO诊断Ⅰ型CRS的独立影响因素。结论 CRP>29.9 mg/L、尿酸>479μmol/L、ALB<30 g/L、Hb<110 g/L、入院后48 h内使用利尿剂和血管活性药物可能是RIFLE、AKIN、KDIGO标准诊断Ⅰ型CRS的共同独立危险因素。
Objective To investigate the independent risk factors for determining type 1 heart-kidney syndrome (CRS) in patients with acute kidney injury (AKI) under different international standards. Methods The data of patients with acute heart failure (AHF) from July 2005 to July 2012 in Guangdong Provincial People’s Hospital and the First Affiliated Hospital of Sun Yat-sen University were retrospectively analyzed. The primary endpoint of the study was risk, injury, failure, loss of renal function, end-stage renal disease (RIFLE), and AKIN, and improvement of the global kidney disease prognosis organization (KDIGO) The lowest monthly serum creatinine (Scr) or admission to the first Scr for baseline Scr. Results A total of 1058 patients were enrolled. KDIGO criteria (52.8%) diagnosed more AKI patients than RIFLE (37.4%) and AKIN criteria (47.9%). Logistic regression analysis showed that coronary heart disease, serum albumin (ALB) <30 g / L (OR = 1.437), C reactive protein (CRP)> 29.9 mg / = 1.813), hemoglobin <110 g / L (OR = 1.582), diuretics (OR = 1.499) within 48 h after admission and vasoactive drugs (AKIN: OR = 1.386), Hb <110 g / L (AKIN: OR = 1.963; KDIGO: OR = 1.889) and CRP> 29.9 mg / L : OR = 2.252; KDIGO: OR = 2.681), eGFR <60 mL / (min · 1.73 m2) and uric acid> 479 μmol / L (AKIN: OR = 3.317; KDIGO: OR = 2.853) (AKIN: OR = 3.200; KDIGO: OR = 1.556) and vasoactive drugs (AKIN: OR = 1.907; KDIGO: OR = 2.040) were independent predictors of type I CRS by AKIN and KDIGO. Conclusions The use of diuretics and vasoactive drugs within 48 h after admission may be the standard diagnostic criteria of RIFLE, AKIN and KDIGO for CRP> 29.9 mg / L, uric acid> 479 μmol / L, ALB <30 g / L and Hb <110 g / Type CRS common independent risk factors.