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目的比较急性生理和慢性健康评分(APACHEⅡ)与急性肾小管坏死-个体严重程度指数(ATN-ISI)两种评分系统对儿童急性肾损伤(AKI)患儿的预后及肾脏损伤转归的预判效果。方法回顾性分析2004年1月至2010年4月在湖南省儿童医院住院的167例AKI患儿临床资料,将患儿分为原发组和继发组,比较APACHE Ⅱ、ATN-ISI评分系统对患儿病死率及肾脏损伤转归的预判效果。结果对原发组患儿的病死率,ATN-ISI有判定价值,而APACHE Ⅱ不能做出有效判断;对继发组患儿的病死率,两种评分系统均有判定价值。在出现AKI的第15天进行肾脏转归评价,两种评分系统均不能对继发组做出有效判断,而对原发组均有判定价值。结论两种评分系统对继发性肾脏损害所致AKI患儿的病死率均有较好预判效果,但ATN-ISI评分系统对肾脏原发性疾病所致AKI患儿的病死率判断优于APACHE Ⅱ且更适用于儿童患者,两种评分系统在肾脏损伤转归的预判效果上无明显差别。
Objective To compare the predictive value of acute physiology and chronic health score (APACHEⅡ) and acute tubular necrosis - ATN-ISI score in children with acute kidney injury (AKI) and prognosis of kidney injury effect. Methods The clinical data of 167 children with AKI who were hospitalized in Children’s Hospital of Hunan Province from January 2004 to April 2010 were retrospectively analyzed. The children were divided into primary group and secondary group. APACHE Ⅱ and ATN-ISI scoring system were compared The prognosis of children with mortality and kidney injury outcome. Results The mortality rate of ATN-ISI in children with primary hepatic fibrosis was determined, while APACHE Ⅱ was unable to make a valid judgment. The mortality of the secondary children was assessed by both scoring systems. Renal outcomes were evaluated on the 15th day when AKI occurred, and neither of the two scoring systems could make a valid judgment on the secondary group, but both of them were of value in the primary group. Conclusion Both scoring systems have a good predictive value for the mortality of children with AKI secondary to renal damage. However, the ATN-ISI scoring system is superior to the case-fatality rate of children with AKI due to primary kidney disease APACHE Ⅱ and more suitable for pediatric patients, the two scoring system in predicting outcome of kidney injury no significant difference.