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摘要：
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摘要：目的 探讨肝硬化并发急性肾损伤（acute kidney injury，AKI）患者的临床预后及影响因素。方
法 选取2012年1月至2018年11月解放军第928医院收治的55例肝硬化并发AKI患者为研究对象，收集患
者的年龄、性别、体重指数（body mass index，BMI）、肝硬化病因、Child-Pugh分级、AKI分期、
并发症（高血压、糖尿病、食管静脉曲张、上消化道出血、腹水、感染及肝性脑病）发生率、HBV
DNA载量、丙氨酸氨基转移酶（alanine aminotransferase，ALT）、天门冬氨酸氨基转移酶（aspartate
aminotransferase，AST）、血氨、血钠、凝血酶原活动度（prothrombin activity，PTA）及门静脉内径
等资料，记录是否使用腹水引流及血管活性药物（如特利加压素）等。统计患者的临床预后。住院
期间或出院后2个月内病死的患者为病死组（22例），其他患者为存活组（33例），比较两组患者的
上述资料，采用多因素Logistic回归分析患者病死的独立影响因素。结果 55例肝硬化并发AKI患者入
院后平均住院时间为（19.2 ± 8.9）d，其中27例（49.1%）AKI恢复，2例（3.6%）AKI无变化，26例
（47.3%）AKI进展，AKI进展者中22例（40.0%）住院期间或出院后2个月内病死。病死组患者的年
龄[（61.93 ± 6.63）岁vs（57.38 ± 8.26）岁]、上消化道出血发生率[31.8%（7/22）vs 9.1%（3/33）]、
感染发生率[77.3%（17/22）vs 45.5%（15/33）]、肝性脑病发生率[40.9%（9/22）vs 15.2%（5/33）]、
ALT [（105.39 ± 35.59）U/L vs（83.25 ± 28.96）U/L]、AST [（99.52 ± 33.13）U/L vs（82.03 ± 25.58）U/L]、
血氨水平[（69.95 ± 20.21）μmol/L vs（58.98 ± 18.26）μmol/L]等均显著高于存活组，PTA显著低于存活
组[（55.01 ± 8.58）% vs（65.25 ± 10.63）%]，差异均有统计学意义（P ＜ 0.05）。两组Child-Pugh分级（A
级/B级/C级：6例/5例/11例 vs 9例/13例/11例）及AKI分期（1期/2期/3期：6例/5例/11例 vs 15例/10例/8例），
差异均有统计学意义（P ＜ 0.05）。多因素Logistic回归分析表明，Child-Pugh C级（OR = 3.568，95%CI：
1.082～11.771，P = 0.037）、AKI 3期（OR = 5.058，95%CI：1.398～18.296，P = 0.013）和感染（OR = 3.239，
95%CI：1.141～9.189，P = 0.027）是肝硬化并发AKI患者病死的独立危险因素，PTA升高是独立保护因素
（OR = 0.813，95%CI：0.670～0.987，P = 0.037）。结论 肝硬化并发AKI患者的临床预后较差，Child-Pugh C
级、AKI 3期及感染是患者病死的独立危险因素，PTA升高是独立保护因素。
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Abstract: Objective To investigate the clinical prognosis and affecting factors of patients with liver cirrhosis
complicated with acute renal injury (AKI). Methods Total of 55 liver cirrhosis patients complicated with
AKI in NO. 928 Hospital of PLA from January 2012 to November 2018 were enrolled. The age, gender,
body mass index (BMI), reason of liver cirrhosis, Child-Pugh grade, AKI stage, incidence of complications
(hypertension, diabetes mellitus, esophageal varices, upper gastrointestinal bleeding, ascites, infection and
hepatic encephalopathy), HBV DNA, alanine aminotransferase (ALT), aspartate aminotransferase (AST), serum
ammonia, serum sodium, prothrombin activity (PTA) and internal diameter of portal vein of the patients were
collected. Treatment methods including ascites drainage and vascular active drugs (terlipressin) were recorded.
Patients who died during hospitalization or within two months after discharge were classified as death group
(22 cases), and the other patients were classified as survival group (33 cases). The above data of patients in
the two groups were compared. Multivariate Logistic regression analysis was used to analyze the independent
influencing factors of death. Results The average hospitalization time of patients was (19.2 ± 8.9) days after
admission. In terms of clinical prognosis, 27 cases (49.1%) recovered from AKI, 2 cases (3.6%) remained
unchanged from AKI, and 26 cases (47.3%) had progression of AKI, including 22 patients (40.0%) died during
hospitalization or within 2 months after discharge. Age [(61.93 ± 6.63) years old vs (57.38 ± 8.26) years old],
incidence of upper gastrointestinal bleeding [31.8% (7/22) vs 9.1% (3/33) ], incidence of infection [77.3% (17/22) vs
45.5% (15/33)], incidence of hepatic encephalopathy [40.9% (9/22) vs 15.2% (5/33)], ALT [(105.39 ± 35.59) U/L vs
(83.25 ± 28.96) U/L], AST [(99.52 ± 33.13) U/L vs (82.03 ± 25.58) U/L] and serum ammonia [(69.95 ± 20.21) μmol/L vs
(58.98 ± 18.26) μmol/L] of patients in death group were significantly higher than those in survival group and PTA [(55.01 ±
8.58)% vs (65.25 ± 10.63)%] of patients in death group was significantly lower than that in survival group
(all P ＜ 0.05). There were statistically significant differences of Child-Pugh grade (grade A/grade B/grade C:
6 cases/5 cases/11 cases vs 9 cases/13 cases/11 cases) and AKI stage (stage 1/stage 2/stage 3: 6 cases/5 cases/11
cases vs 15 cases/10 cases/8 cases) between death group and survival group (P ＜ 0.05). Multivariate Logistic
regression analysis result showed that Child-Pugh grade C (OR = 3.568, 95%CI: 1.082～11.771, P = 0.037), AKI
stage 3 (OR = 5.058, 95%CI: 1.398～18.296, P = 0.013) and infection (OR = 3.239, 95%CI: 1.141～9.189, P =
0.027) were independent risk factors for death of liver cirrhosis patients complicated with AKI, while elevated
PTA was an independent protective factor (OR = 0.813, 95%CI: 0.670～0.987, P = 0.037). Conclusions The
clinical prognosis of liver cirrhosis patients complicated with AKI is poor. Child-Pugh grade C, AKI stage 3 and
infection were independent risk factors for death, while elevated PTA was an independent protective factor.
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