肝硬化合并腎損害的危險因素分析

陸秀偉 楊娟

[關鍵詞] 肝硬化;腎損傷;危險因素;腹水;肝性腦病;高血壓;糖尿病

[中圖分類號] R657.31? ? ? ? ? [文獻標識碼] B? ? ? ? ? [文章編號] 1673-9701（2021）19-0096-04

Analysis on the risk factors of cirrhosis combined with renal damage

LU Xiuwei? ?YANG Juan

Department of Hepatology， Xixi Hospital of Hangzhou City， Hangzhou? ?310023， China

[Abstract] Objective To investigate the risk factors of cirrhosis combined with renal damage. Methods The clinical data of 100 patients with hepatic cirrhosis diagnosed and treated in our hospital from January 2017 to December 2019 were selected for the study. According to whether the patients had renal damage， they were divided into the renal damage group and the no renal damage group. The general data of the patients， complications， ascites condition， hepatic encephalopathy condition and others were recorded， and the risk factors for hepatic cirrhosis combined with renal damage were analyzed by univariate and multivariate analysis. Results Univariate analysis showed that patients with aged≥60 years， CTP grade C， complications of hypertension， diabetes， hyperuricemia， exposure history of contrast media， and hepatic encephalopathy had a higher probability of renal damage（P<0.05）. Multivariate analysis showed that patients with age≥60 years， CTP grade C， complications of hypertension， diabetes， hyperuricemia， and PVD>12.5 mm were the independent risk factors for patients with hepatic cirrhosis complicated with renal damage（P<0.05）. Conclusion Renal damage may occur in patients with hepatic cirrhosis. Age， CTP grade C， complications of hypertension， diabetes， hyperuricemia， and PVD widening are the independent risk factors for patients with hepatic cirrhosis complicated with renal damage.

[Key words] Hepatic cirrhosis; Renal damage; Risk factors; Ascites; Hepatic encephalopathy; Hypertension; Diabetes

肝硬化是由不同原因引起的慢性、進行性、彌漫性肝臟病變，主要病理變化為肝細胞廣泛壞死，在此基礎上出現纖維組織彌漫性增生。在肝失代償期，除了肝功能減退，還會出現消化道癥狀，如出血、貧血、內分泌失調、感染、肝性腦病、電解質紊亂等。而肝硬化性腎損害是常見的并發癥之一，主要表現為腎小球病變、腎小管酸中毒，嚴重者出現肝腎綜合征，此外，肝炎后肝硬化患者常可呈現乙肝或丙肝相關性腎炎的表現，如膜增殖性腎炎、膜性腎病、毛細血管內增生性腎炎、腎小球硬化等[1-2]。本研究旨在探討肝硬化患者發生腎損害的相關因素，以期為臨床值提供參考，現報道如下。

1 資料與方法

1.1 一般資料

選擇2017年1月至2019年12月我院診斷治療的肝硬化患者100例的臨床資料進行研究。納入標準：年齡≥18周歲，符合肝硬化診斷標準[3]，合并或未合并腎臟損害，臨床資料完整，患者及其家屬對本研究知情同意。排除標準[3]：急性腎臟原發性疾病或繼發于其他疾病的腎臟疾病者;合并有免疫系統疾病者;認知功能障礙者;近期應用糖皮質激素者;妊娠期或哺乳期者。患者一般資料見表1。本研究經醫院醫學倫理委員會同意。

1.2 方法

1.2.1 記錄指標? ①CTP分級[4]：根據患者白蛋白、凝血酶原時間、血清總膽紅素水平進行評分，5～6分為A級，7～9分為B級，≥10分為C級，級數越高表示患者病情越重。②腎功能評價[4]：計算患者eGFR，<60 mL/（min·1.73 m2）為存在腎損害。③記錄患者年齡、性別、既往病史（高血壓、糖尿病、泌尿系結石、高尿酸血癥）、是否應用造影劑史，記錄入院時患者病情、門靜脈主干內徑（PVD）、是否合并腹水、是否合并肝性腦病。