58例社区获得性药物相关性肾损伤回顾性分析
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摘要
目的:了解阜阳市人民医院(以下简称"我院")收治的社区获得性药物相关性肾损伤(community-acquired drug-induced kidney injury,CA-DKI)患者的发病原因和治疗方案,为CA-DKI的预防宣教和合理用药提供参考。方法:检索2010—2018年我院收治的CA-DKI患者,回顾性分析CA-DKI与年龄、性别和药物的相关性。结果:共纳入58例CA-DKI患者。CA-DKI可发生于各年龄段人群,≥45岁患者所在比例最高,为72.4%(42/58);女性患者所占比例高于男性患者[56.9%(33/58) vs. 43.1%(25/58)];农村患者所占比例明显高于城市患者[75.9%(44/58) vs. 24.1%(14/58)];CA-DKI确诊平均需(5.6±2.2)d;<45岁患者的治愈率最高,为43.8%(7/16)。导致CA-DKI频次数排序据前3位的药物依次为抗菌药物、非甾体抗炎药和中药;存在保肾药的不合理联合应用(二联用药8例,三联用药16例,四联用药9例)。结论:CA-DKI的发病率与地区经济水平呈负相关,治愈率随着年龄增长而降低,诊断、治疗普遍存在延误。改变居民用药、保健习惯,提高医师用药水平,有助于预防和减少CA-DKI的发生。CA-DKI的治疗应遵循指南及循证医学证据,结合患者病情,合理使用保肾药、利尿剂及血液透析。
OBJECTIVE: To investigate the pathogenesis and therapeutic regimens in patients with community-acquired drug-induced kidney injury(CA-DKI) admitted into Fuyang People's Hospital, so as to provide references for the prevention propaganda and rational drug application of CA-DKI. METHODS: The CA-DKI patients admitted into our hospital from 2010 to 2018 were retrieved and retrospectively analyzed in terms of the correlation between CA-DKI and age, gender and drug. RESULTS: A total of 58 CA-DKI patients were involved. CA-DKI occurred in people of all ages, with the highest proportion of patients ≥45 years old, accounted for 72.4%(42/58); the proportion of female patients was higher than that of male [56.9%(33/58) vs. 43.1%(25/58)]; the proportion of rural patients was significantly higher than that of urban [75.9%(44/58) vs. 24.1%(14/58)]; The average time of confirmed CA-DKI diagnosis was(5.6±2.2) days; patients aged <45 had the highest cure rate of 43.8%(7/16). The top 3 drugs that induced CA-DKI ranked in the number of cases were respectively antibiotics, non-steroidal anti-inflammatory drugs and traditional Chinese medicines; there were irrational combined application of kidney-protecting drugs(8 cases of two-drug combination, 16 cases of three-drug combination and 9 cases of four-drug combination). CONCLUSIONS: The incidence of CA-DKI is negatively correlated with the regional economic level, and the cure rate decreases with age, there are widespread delays in diagnosis and treatment. Changing residents' medications and healthcare habits, improving physicians in rational medication can help to prevent and reduce the occurrence of CA-DKI. The treatment of CA-DKI should follow the guidelines and evidence-based medical evidence, in combination with patient's condition, rationally use kidney-protecting drugs, diuretics and hemodialysis.
OBJECTIVE: To investigate the pathogenesis and therapeutic regimens in patients with community-acquired drug-induced kidney injury(CA-DKI) admitted into Fuyang People's Hospital, so as to provide references for the prevention propaganda and rational drug application of CA-DKI. METHODS: The CA-DKI patients admitted into our hospital from 2010 to 2018 were retrieved and retrospectively analyzed in terms of the correlation between CA-DKI and age, gender and drug. RESULTS: A total of 58 CA-DKI patients were involved. CA-DKI occurred in people of all ages, with the highest proportion of patients ≥45 years old, accounted for 72.4%(42/58); the proportion of female patients was higher than that of male [56.9%(33/58) vs. 43.1%(25/58)]; the proportion of rural patients was significantly higher than that of urban [75.9%(44/58) vs. 24.1%(14/58)]; The average time of confirmed CA-DKI diagnosis was(5.6±2.2) days; patients aged <45 had the highest cure rate of 43.8%(7/16). The top 3 drugs that induced CA-DKI ranked in the number of cases were respectively antibiotics, non-steroidal anti-inflammatory drugs and traditional Chinese medicines; there were irrational combined application of kidney-protecting drugs(8 cases of two-drug combination, 16 cases of three-drug combination and 9 cases of four-drug combination). CONCLUSIONS: The incidence of CA-DKI is negatively correlated with the regional economic level, and the cure rate decreases with age, there are widespread delays in diagnosis and treatment. Changing residents' medications and healthcare habits, improving physicians in rational medication can help to prevent and reduce the occurrence of CA-DKI. The treatment of CA-DKI should follow the guidelines and evidence-based medical evidence, in combination with patient's condition, rationally use kidney-protecting drugs, diuretics and hemodialysis.
引文
[1] 刘刚,马序竹,邹万忠,等.肾活检患者肾脏病构成十年对比分析[J].临床内科杂志,2004,21(12):834-838.
[2] Usui J,Yamagata K,Imai E,et al.Clinical practice guideline for drug-induced kidney injury in Japan 2016:digest version[J].Clin Exp Nephrol,2016,20(6):827-831.
[3] 王亚芳,杨莉.社区获得性急性肾损伤[J].中华内科杂志,2015,54(12):1060-1062.
[4] 李颖利,熊辉.急诊室社区获得性急性肾损伤的临床分析[J].中国急救医学,2015,35(6):530-533.
[5] Wang Y,Wang J,Su T,et al.Community-acquired acute kidney injury:a nationwide survey in China[J].Am J Kidney Dis,2017,69(5):647-657.
[6] Yang L,Xing G,Wang L,et al.Acute kidney injury in China:a cross-sectional survey[J].Lancet,2015,386(10002):1465-1471.
[7] 张近波,张小乐,许国斌,等.RIFLE标准和AKIN标准诊断急性肾损伤的对比研究[J].中国全科医学,2011,14(7):734-736.
[8] 赵翠霞,王廉一,史晓虎,等.老年药物相关性急性肾衰竭临床表现及病理分析[J].中国医院用药评价与分析,2011,11(8):741-744.
[9] Kellum JA,Lameire N,Aspelin P,et al.Kidney disease:improving global outcomes(KDIGO)acute kidney injury work group.KDIGO clinical practice guideline for acute kidney injury[J].Kidney International Supplements,2012,2(1):1-138.
[10] Bagshaw SM,Uchino S,Bellomo R,et al.Timing of renal replace-ment therapy and clinical outcomes in critically ill patients with severe acute kidney injury[J].J Crit Care,2009,24(1):129-140.
[11] 胡林,李逃明,戴婷婷,等.住院患者药源性肾损伤20例临床分析[J].药物不良反应杂志,2018,20(2):91-96.
[12] 范倩倩,孔旭东,邓昂,等.药源性急性肾损伤研究进展[J].中国药物警戒,2015,12(3):164-168.
[13] 孙铁忠,李鑫宇.药物性急性肾损伤115例临床分析[J].解放军医药杂志,2012,24(9):48-50.
[14] 邱婷婷,张弨,陈丁丁.6例药源性肾损伤案例报告及临床分析[J].临床药物治疗杂志,2017,15(6):63-68.
[15] 中国老年保健医学研究会老年合理用药分会,中华医学会老年医学分会,中国药学会老年药学专业委员会,等.中国老年人潜在不适当用药判断标准(2017年版)[J].药物不良反应杂志,2018,20(1):2-8.
[16] Yildiz C,Ozsurekci Y,Gucer S,et al.Acute kidney injury due to acyclovir[J].CEN Case Rep,2013,2(1):38-40.
[17] 李钗,梁璐,李德天,等.阿昔洛韦致急性肾损伤的临床分析[J].实用药物与临床,2018,21(6):702-705.
[18] 谢雅清,梁晓美,叶伟霞.还原型谷胱甘肽的药理作用与临床应用研究进展[J].中国药业,2013,22(7):124-127.
[19] 赵瑛瑛,王建生,欧阳军,等.还原性谷胱甘肽对造影剂肾病预防作用的临床研究[J].实用医学杂志,2013,29(12):2008-2010.
[20] 宋其蔓.肾衰宁联合金水宝治疗慢性肾衰竭的疗效观察[J].中国实用医药,2014,9(35):88-89.
[2] Usui J,Yamagata K,Imai E,et al.Clinical practice guideline for drug-induced kidney injury in Japan 2016:digest version[J].Clin Exp Nephrol,2016,20(6):827-831.
[3] 王亚芳,杨莉.社区获得性急性肾损伤[J].中华内科杂志,2015,54(12):1060-1062.
[4] 李颖利,熊辉.急诊室社区获得性急性肾损伤的临床分析[J].中国急救医学,2015,35(6):530-533.
[5] Wang Y,Wang J,Su T,et al.Community-acquired acute kidney injury:a nationwide survey in China[J].Am J Kidney Dis,2017,69(5):647-657.
[6] Yang L,Xing G,Wang L,et al.Acute kidney injury in China:a cross-sectional survey[J].Lancet,2015,386(10002):1465-1471.
[7] 张近波,张小乐,许国斌,等.RIFLE标准和AKIN标准诊断急性肾损伤的对比研究[J].中国全科医学,2011,14(7):734-736.
[8] 赵翠霞,王廉一,史晓虎,等.老年药物相关性急性肾衰竭临床表现及病理分析[J].中国医院用药评价与分析,2011,11(8):741-744.
[9] Kellum JA,Lameire N,Aspelin P,et al.Kidney disease:improving global outcomes(KDIGO)acute kidney injury work group.KDIGO clinical practice guideline for acute kidney injury[J].Kidney International Supplements,2012,2(1):1-138.
[10] Bagshaw SM,Uchino S,Bellomo R,et al.Timing of renal replace-ment therapy and clinical outcomes in critically ill patients with severe acute kidney injury[J].J Crit Care,2009,24(1):129-140.
[11] 胡林,李逃明,戴婷婷,等.住院患者药源性肾损伤20例临床分析[J].药物不良反应杂志,2018,20(2):91-96.
[12] 范倩倩,孔旭东,邓昂,等.药源性急性肾损伤研究进展[J].中国药物警戒,2015,12(3):164-168.
[13] 孙铁忠,李鑫宇.药物性急性肾损伤115例临床分析[J].解放军医药杂志,2012,24(9):48-50.
[14] 邱婷婷,张弨,陈丁丁.6例药源性肾损伤案例报告及临床分析[J].临床药物治疗杂志,2017,15(6):63-68.
[15] 中国老年保健医学研究会老年合理用药分会,中华医学会老年医学分会,中国药学会老年药学专业委员会,等.中国老年人潜在不适当用药判断标准(2017年版)[J].药物不良反应杂志,2018,20(1):2-8.
[16] Yildiz C,Ozsurekci Y,Gucer S,et al.Acute kidney injury due to acyclovir[J].CEN Case Rep,2013,2(1):38-40.
[17] 李钗,梁璐,李德天,等.阿昔洛韦致急性肾损伤的临床分析[J].实用药物与临床,2018,21(6):702-705.
[18] 谢雅清,梁晓美,叶伟霞.还原型谷胱甘肽的药理作用与临床应用研究进展[J].中国药业,2013,22(7):124-127.
[19] 赵瑛瑛,王建生,欧阳军,等.还原性谷胱甘肽对造影剂肾病预防作用的临床研究[J].实用医学杂志,2013,29(12):2008-2010.
[20] 宋其蔓.肾衰宁联合金水宝治疗慢性肾衰竭的疗效观察[J].中国实用医药,2014,9(35):88-89.