广西某医院2014-2018年恙虫病致急性肾损伤临床对照分析

李柏成; 朱洁云; 王霄玲; 张剑锋

doi:10.16462/j.cnki.zhjbkz.2019.09.022

广西某医院2014-2018年恙虫病致急性肾损伤临床对照分析

doi: 10.16462/j.cnki.zhjbkz.2019.09.022

1.
530021 南宁, 广西医科大学研究生院
2.
530007 南宁, 广西医科大学第二附属医院急诊科

基金项目:

2017广西重点研发计划：广西重大突发事件卫生应急救援体系建设及应用示范 Guike AB17195002

详细信息

通讯作者:
张剑锋, E-mail: zhangjianfeng930@163.com

中图分类号: R183.5;R513.2
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出版历程
- 收稿日期: 2019-04-14
- 修回日期: 2019-06-30
- 刊出日期: 2019-09-10

Clinical comparative analysis of acute kidney injury caused by scrub typhus in Guangxi from 2014 to 2018

1.
Graduate School of Guangxi Medical University, Nanning 530021, China
2.
Emergency Department of The Second Affiliated Hospital of Guangxi Medical University, Nanning 5300007, China

Funds:

Key Research and Development Plan of Guangxi in 2017: Construction and Application Demonstration of Health Emergency Rescue System for Major Emergencies in Guangxi Guike AB17195002

More Information

Corresponding author: ZHANG Jian-feng, E-mail: zhangjianfeng930@163.com

摘要

摘要: 目的回顾性分析广西某医院恙虫病发生急性肾损伤（acute kidney injury，AKI）的临床资料，评估AKI发病率，寻找预测AKI指标。方法收集广西医科大学第一附属医院2014-2018年211例患者病例资料，分为AKI组（58例）和非急性肾损伤（non-acute kidney injury，NAKI）组（153例）。对照研究两组辅助检查、治疗措施、并发症等差异情况；回归分析发生AKI相关危险因素。结果 211例发生AKI 58例（27.49%，95%CI：1.66~1.76，P < 0.001），外斐试验166例均为阴性。两组治疗措施和并发症频数比较，AKI组需要率和发生率比NAKI组高（均有P < 0.05）。多因素Logistic回归分析模型显示出现血液系统损害（OR=4.536，95%CI：1.262~16.308），需要使用激素（OR=3.261，95%CI：1.259~8.446）和利尿剂（OR=3.870，95%CI：1.186~12.633）治疗是AKI发生危险因素；直接胆红素低（OR=0.952，95%CI：0.915~0.991）是保护因素。结论广西某医院恙虫病致AKI发生率位于国内外中等水平，近年外斐试验敏感性和特异性不高。恙虫病患者有血液系统损害并发症、需要用激素和利尿剂治疗是发生AKI的危险因素。
- 恙虫病 /
- 急性肾损伤 /
- 流行特征 /
- 危险因素 /
- 外斐试验
Abstract: Objective To retrospectively analyze the clinical data of patients with acute kidney injury (AKI) caused by scrub typhus in Guangxi, to evaluate the incidence of AKI, and to search for the prediction indicators of AKI. Methods Data of 211 patients from The First Affiliated Hospital of Guangxi Medical University from 2014 to 2018 were collected and divided into AKI group (58 cases) and non-acute kidney injury (NAKI) group (153 cases). The auxiliary examination, treatment measures and complications of the two groups were compared. Regression analysis was used to analyze the risk factors associated with AKI. Results There were 58 cases (27.49%, 95% CI: 1.66-1.76, P < 0.001) with AKI and 166 cases were all negative in the field test. Compared with the NAKI group, the incidence and need rate of AKI were higher than NAKI group, and the differences were statistically significant (all P < 0.05). Multivariate Logistic regression analysis showed that blood system damage (OR=4.536, 95% CI: 1.262-16.308), the use of hormones (OR=3.261, 95% CI: 1.259-8.446) and diuretics (OR=3.870, 95% CI: 1.186-12.633) were risk factors for AKI. Low direct bilirubin (OR=0.952, 95% CI: 0.915-0.991) was a protective factor. Conclusion The incidence of scrub typhus induced AKI in Guangxi is in the middle level at domestic and abroad. Patients with scrub typhus who have complications of blood system damage and have to be treated with hormones and diuretics are risk factors for AKI.
- Scrub typhus /
- Acute kidney injury /
- Epidemic characteristics /
- Risk factors /
- Field test

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表 1 2014-2018年211例恙虫病患者一般情况[n(%)]

Table 1. General situation of 211 cases of scrub typhus in 2014-2018 [n(%)]

年份	性别		年龄(岁)		t值	P值	AKI人数 [n(%)]	AKI发生率 95% CI(%)
年份	男	女	NAKI组	AKI组	t值	P值	AKI人数 [n(%)]	AKI发生率 95% CI(%)
2014	24	22	51.06±13.80	57.93±15.67	1.490	0.143	14(30.43)	1.56~1.83
2015	23	21	55.87±12.45	61.86±12.33	1.491	0.143	14(31.82)	1.54~1.83
2016	17	17	53.38±13.55	59.50±11.36	1.253	0.219	10(29.41)	1.54~1.87
2017	24	21	58.09±13.06	61.40±10.37	0.737	0.465	10(22.22)	1.65~1.90
2018	18	24	55.09±14.37	60.30±8.74	1.079	0.287	10(23.81)	1.63~1.90
合计	106	105	54.82±13.51	60.16±11.93	2.643	0.009	58(27.49)	1.66~1.79

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表 2 2014-2018年211例恙虫病患者两组主要生化指标比较

Table 2. Comparison of main biochemical indexes of 211 cases of scrub typhus between two groups from 2014 to 2018

生化指标	NAKI组(n=153)	AKI组(n=58)	t值	P值
白细胞(×10⁹/L)	10.11±5.68	10.64±4.44	0.637	0.525
血红蛋白(×10⁹/L)	116.13±24.84	109.52±24.84	-1.992	0.048
血小板(×10⁹/L)	167.76±110.96	103.28±84.29	-4.002	＜0.001
直接胆红素(μmol/L)	7.42±9.13	29.51±43.86	5.888	＜0.001
间接胆红素(μmol/L)	8.45±9.87	14.00±17.32	2.906	0.004
白蛋白(g/L)	32.36±5.73	27.92±4.74	-5.264	＜0.001
天门冬氨酸转移酶(U/L)	86.44±68.14	125.47±96.30	3.284	0.001
肌酸肌同工酶(U/L)	16.03±8.62	20.33±11.67	2.916	0.004
乳酸脱氢酶(U/L)	461.13±183.61	592.50±273.72	4.006	＜0.001
乳酸脱氢酶同工酶1(U/L)	116.96±70.59	148.45±92.43	2.639	0.009
凝血酶原时间(s)	11.91±1.19	13.55±5.15	3.662	＜0.001

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表 3 2014-2018年211例恙虫病患者两组治疗措施比较[n(%)]

Table 3. Comparison of treatment measures 211 cases of scrub typhus between two groups from 2014 to 2018 [n(%)]

治疗措施	NAKI组(N=153)	AKI组(N=58)	[n(%)]	χ²值	P值
重症监护	15	25	40(18.96)	30.354	＜0.001
呼吸机支持	7	13	20(9.48)	15.598	＜0.001
输红细胞	4	19	23(10.90)	39.348	＜0.001
输血浆制品	0	13	13(6.16)	36.545	＜0.001
输血小板	4	14	18(8.53)	24.969	＜0.001
血液透析	0	8	8(3.79)	21.935	＜0.001
血管活性药	8	15	23(10.90)	18.435	＜0.001
激素	34	32	65(30.81)	21.243	＜0.001
白蛋白	32	33	65(30.81)	25.544	＜0.001
利尿剂	21	33	54(25.59)	41.162	＜0.001
镇静药	8	15	23(10.90)	18.435	＜0.001

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表 4 2014-2018年211例恙虫病患者两组并发症比较[n(%)]

Table 4. Comparison of complications 211 cases of scrub typhus between two groups from 2014 to 2018 [n(%)]

并发症	NAKI组(N=153)	AKI组(N=58)	[n(%)]	χ²值	P值
肺损害	118	58	176(83.41)	15.906	＜0.001
肝损害	58	37	95(45.02)	11.384	0.001
血液损害	37	42	79(37.44)	41.769	＜0.001
心脏损害	19	16	35(16.59)	6.993	0.008
MODS	29	36	65(30.81)	36.676	＜0.001
休克	11	12	23(10.90)	7.892	0.005
脑损害	6	7	13(6.16)	4.829	0.028

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表 5 2014-2018年211例恙虫病致急性肾损伤单因素回归分析

Table 5. Single-factor regression analysis of 211 cases of acute renal injury caused by scrub typhus from 2014 to 2018

因素	β值	S_x值	Wald值	P值	OR值(95%CI)
年龄(岁)	-0.032	0.013	6.612	0.010	0.968(0.945~0.992)
血红蛋白(g/L)	0.014	0.007	3.922	0.048	1.014(1.000~1.029)
血小板(10⁹/L)	0.007	0.002	13.685	＜0.001	1.008(1.004~1.012)
直接胆红素(μmol/L)	-0.049	0.012	16.318	＜0.001	0.952(0.929~0.975)
间接胆红素(μmol/L)	-0.033	0.013	6.376	0.012	0.968(0.944~0.993)
白蛋白(g/L)	0.165	0.035	21.844	＜0.001	1.179(1.100~1.264)
天门冬氨酸转移酶(U/L)	-0.006	0.002	9.277	0.002	0.994(0.990~0.998)
肝损害	1.060	0.320	10.968	0.001	2.886(1.541~5.404)
血液损害	2.108	0.349	36.428	＜0.001	8.230(4.151~16.317)
心脏损害	0.988	0.383	6.672	0.010	2.687(1.269~5.687)
MODS	1.945	0.340	32.690	＜0.001	6.997(3.591~13.631)
休克	1.214	0.451	7.262	0.007	3.368(1.392~8.144)
脑损害	1.213	0.580	4.378	0.036	3.363(1.080~10.472)
重症监护	1.942	0.380	26.139	＜0.001	6.970(3.311~14.671)
呼吸机支持	1.796	0.499	12.962	＜0.001	6.025(2.267~16.018)
血管活性药	1.844	0.471	15.332	＜0.001	6.323(2.512~15.915)
激素	1.460	0.328	19.835	＜0.001	4.308(2.265~8.192)
白蛋白	1.608	0.331	23.536	＜0.001	4.991(2.607~9.556)
利尿剂	2.116	0.354	35.675	＜0.001	8.297(4.144~16.614)

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表 6 2014-2018年211例恙虫病致急性肾损伤多因素回归分析

Table 6. Multi-factor regression analysis of 211 cases of acute renal injury caused by scrub typhus from 2014 to 2018

因素	β值	s_x	Wald值	OR(95% CI)值	P值
直接胆红素(μmol/L)	-0.049	0.020	5.854	0.952(0.915~0.991)	0.016
血液损害	1.512	0.653	5.362	4.536(1.261~16.308)	0.021
激素治疗	1.182	0.486	5.925	3.261(1.259~8.446)	0.015
利尿剂治疗	1.353	0.604	5.028	3.870(1.186~12.633)	0.025

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