摘要
目的应用急性肾损伤（AKI）的临床诊断及分期标准，分析儿童AKI各分期级别间的临床及病理特点，探讨其对临床的指导意义。方法按照2005年阿姆斯特丹会议关于AKI的诊断标准及临床分期标准，将2004年10月至2011年10月在湖南省儿童医院肾内科住院的AKI患儿分为1期、2期、3期，比较不同分期级别间AKI患儿年龄、病因、病理及转归等临床特点。结果（1）165例患儿（男109例、女56例）进入本研究，年龄（6．26±4．43）岁。1期AKI患儿69例，2期AKI患儿19例，3期AKI患儿77例。（2）1期、2期、3期AKI患儿的年龄分别为（9．09±3．69）岁、（4．34±3．90）岁、（4．22±3．78）岁，3组比较差异有统计学意义（P〈0．01）。（3）病因以药物性原因（24．8％）、急性肾小球。肾炎（22．4％），脓毒症（15．2％）为主。3组患儿间的病因构成差异较大（P〈0．01）。（4）140例AKI患儿完成肾脏病理检查，以急性小管间质性肾炎56例（40．0％）、毛细血管内增生性肾小球肾炎33例（23．6％）、系膜增生性肾小球肾炎18例（12．9％）为主。3组患儿问病理损害类型差异较大，1期AKI患儿以肾小球疾病为主（84．4％），2期AKI患儿肾小球疾病及小管间质病变均为38．5％，3期AKI以肾小管问质病变为主（73．0％）（P〈0．01）。（5）1期、2期、3期患儿血肌酐值回复至基线水平的中位时间分别为9d（3—41d）、11d（3～25d）、16d（3d—oc）（P〈0．05）。（6）165例AKI患儿中，124例患儿出现不同程度的血尿，126例患儿表现有不同程度的蛋白尿。3组患儿间血尿的发生率及持续时间差异有统计学意义（P〈0．01）；而3组患儿问蛋白尿的发生率差异无统计学意义（P〉0．05），但1期AKI患儿蛋白尿持续的时间较长（P〈0．01）。结论儿童AKI以1期和3期多见。l期AKI患儿以学龄期儿童多见，急性肾小球肾炎是学龄期AKI患儿的常见病因；3期AKI患儿以婴幼儿多见，药物性及脓毒症导致的肾损害为主要原因，。肾脏病理以急性小管间质性肾炎为主，肾功能恢复较慢。
Objective To analyze the clinical and pathological characteristics of children in different stages and to investigate the clinical significance based on clinical diagnosis and staging criteria of acute kidney injury （AK1）. Methods Based on the clinical diagnosis and staging criteria of AKI, 165 AKI children admitted to the Department of Nephrology of Hunan Children＇s Hospital ,between Oct. 2004 and Oct. 2011 were divided into 3 groups：stage 1 ,stage 2 and stage 3. Clinical characteristics, age, etiology, pathology and prognosis were compared among 3 groups of children with AKI. Results （ l ） A total of 165 patients （ 109 males and 56 females） were included in this study, average age of （6.26 _＋4.43） years, including 69 patients in stage 1,19 patients in stage 2, and 77 patients in stage 3. （2）The 3 groups of patients had an average age of（9.09 _＋ 3.69 ） years, （4.34 _＋ 3.90） years, and（4.22 _＋ 3.78 ） years, respec- tively, which showed significant differences （P 〈 0.01 ）. （3）Three most frequent causes of AKI were drugs （24.8%） , a- cute glomerulonephritis （ AGN ） （ 22.4% ） and septicemia （ 15.2 % ）, which showed significant differences （ P 〈 0.01 ）. （4） Renal histopathological examination was performed on 140 AKI children,3 most main types of pathology were acute tubular interstitial nephritis 56 cases （40.0%） , endoeapillary proliferative glomerulonephritis 33 cases （23.6%） and mesangial proliferative glomerulonephritis 18 cases （12.9%）. In the stage 1 patients, glomerular disease was predomi- nant（ 84.4% ）. In the stage 2 patients, glomerular disease （38.5%） and tnbulointerstitial lesions （38.5%） were the major pathological types. In the stage 3 patients, tubulointerstitial damage （ 73.0% ） was the major pathological type （P 〈 0.01 ）. The patients in 3 different groups showed significant differences in the ratio of tubulointerstitial disease and glomerular disease（P 〈0.01 ）. （5）The median recovery time of serum creatinine to the baseline was 9 days（3 -41 days） for stage 1 patients, 11 days（ 3 -25 days） for stage 2 patients, and 16 days （3 - ~ days ） for stage 3 patients, which showed a significant difference （ P 〈 0.05 ）. （6） Of the 165 AKI patients, 124 cases had hematuria, 126 cases had varying degrees of proteinuria. There were significant differences in the hematuria incidence and the duration among the 3 groups （P 〈 0.01 ）. There was no difference in the proteinuria incidence among the 3 groups （ P 〉 0.05 ）, while the stage 1 patients showed significant differences from the other 2 groups （ P 〈 0.01 ）. Conclusions The patients are mostly seen in stage 1 and stage 3. The stage 1 AKI children are largely school-age children and acute glomerulone phri- tis is the main etiology. The stage 3 AKI children are mainly infants and the etiology of AKI is mainly drugs and septiee-mia, the pathological type is mainly acute tubulointerstitial nephritis, and the renal functional recovery is slow.
出处
《中华实用儿科临床杂志》
CAS
CSCD
北大核心
2013年第23期1808-1811,共4页
Chinese Journal of Applied Clinical Pediatrics
基金
湖南省自然科学基金项目资助（11JJ3101）
湖南省科技厅科研基金项目资助（2011TT2003）
湖南省卫生厅科研基金资助项目（132013-103）
关键词
急性肾损伤
临床
病理
预后
儿童
Acute kidney injury
Clinic
Pathology
Prognosis
Child
