实体瘤患者发生肾功能损害的危险因素分析
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摘要
目的分析实体瘤患者发生肾功能损害的危险因素,为临床预防和治疗提供参考。方法采用自制调查问卷调查296例实体瘤患者(其中38例患者合并肾功能损害)的年龄、性别、肿瘤类别、肿瘤性质、合并基础疾病情况、肾功能指标情况和感染情况等。实体瘤患者发生肾功能损害的影响因素采用多因素Logistic回归分析。结果单因素分析结果显示,不同疼痛情况、合并基础疾病情况、肿瘤类别、肿瘤性质、治疗方法、肾功能指标情况实体瘤患者的肾功能损害情况比较,差异均有统计学意义(P﹤0.05)。不同年龄、性别、文化程度、医疗费用来源、情绪状况、睡眠状况和感染情况实体瘤患者的肾功能损害情况比较,差异均无统计学意义(P﹥0.05)。多因素Logistic回归分析结果显示,合并基础疾病、肿瘤类别为肾脏肿瘤、肿瘤性质为恶性、肾功能指标较差是实体瘤患者发生肾功能损害的独立危险因素。结论临床应重点关注合并基础疾病、肿瘤类别是肾脏肿瘤、肿瘤性质为恶性、肾功能指标较差的实体瘤患者的肾功能,早发现、早治疗,降低患者肾功能损害的发生率。
Objective To analyze the risk factors of renal impairment in patients with solid tumors and to discuss the possible solution for clinical prevention and treatment. Method A total of 296 patients with solid tumors were enrolled in the study and had completed the survey for age, gender, tumor type, malignancy of tumor, comorbidity, renal function and infections, among them, 38 patients developed renal impairment. Multivariate Logistic regression models were used to analyze the factors influencing the occurrence of renal impairment in these patients with solid tumors. Result Univariate analysis showed that, different degree of pain, comorbidities, tumor type, malignancy of tumor, therapies, and renal function were of significant influence on the incidence of renal impairment in solid tumor patients, and the differences were statistically significant(P<0.05). Age, gender, education background, payment of medical expenses, emotional status, sleep status and infections were less likely related to the occurrence of renal damage(P>0.05). Multivariate Logistic regression analysis indicated that, comorbidities, renal cancer, malignant tumor, poor renal function were independent risk factors for developing renal impairment in patients with solid tumors. Conclusion In clinical practice, patients with solid tumors, including comorbidities, renal cancer, malignant tumors, and poor renal function, should be monitored closely for renal function, in order to realize early diagnosis and early treatment, lowering the incidence of renal damage.
Objective To analyze the risk factors of renal impairment in patients with solid tumors and to discuss the possible solution for clinical prevention and treatment. Method A total of 296 patients with solid tumors were enrolled in the study and had completed the survey for age, gender, tumor type, malignancy of tumor, comorbidity, renal function and infections, among them, 38 patients developed renal impairment. Multivariate Logistic regression models were used to analyze the factors influencing the occurrence of renal impairment in these patients with solid tumors. Result Univariate analysis showed that, different degree of pain, comorbidities, tumor type, malignancy of tumor, therapies, and renal function were of significant influence on the incidence of renal impairment in solid tumor patients, and the differences were statistically significant(P<0.05). Age, gender, education background, payment of medical expenses, emotional status, sleep status and infections were less likely related to the occurrence of renal damage(P>0.05). Multivariate Logistic regression analysis indicated that, comorbidities, renal cancer, malignant tumor, poor renal function were independent risk factors for developing renal impairment in patients with solid tumors. Conclusion In clinical practice, patients with solid tumors, including comorbidities, renal cancer, malignant tumors, and poor renal function, should be monitored closely for renal function, in order to realize early diagnosis and early treatment, lowering the incidence of renal damage.
引文
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[18]陈静,刘丽.常用肾功能检测指标在透析治疗效果评价上的应用价值[J].检验医学与临床, 2017, 14(8):1173-1176.
[19]张兴宗,林云,邹映东,等. 4项肾小球滤过功能检测指标在肾功能不全中的临床应用分析[J].国际检验医学杂志, 2016, 37(10):1395-1396.
[2] Wijeratne PA, Vavourakis V, Hipwell JH, et al. Multiscale modelling of solid tumour growth:the effect of collagen micromechanics[J]. Biomech Model Mechanobiol, 2016, 15(5):1079-1090.
[3]徐爱兵,龚振夏.恶性肿瘤与肾功能损害(附34例报告)[J].河南肿瘤学杂志, 2000, 13(5):367-368.
[4]高丹,景三辉,吴歌.血清Cys C和NGAL及U-m Alb/Cr在恶性肿瘤患者化疗肾损害早期诊断中的价值[J].肿瘤基础与临床, 2017, 30(3):189-191.
[5]刘芳,付平.恶性肿瘤肾损害[J].中国实用内科杂志,2011, 31(2):100-102.
[6]沈明静,曹金安.恶性肿瘤引起肾损害91例临床分析[J].中国民政医学杂志, 1997, 9(4):207-208.
[7]沈政洁,程海波,沈卫星,等.肿瘤炎性微环境与“癌毒”病机相关性探讨[J].北京中医药大学学报, 2015, 38(1):14-17.
[8] Minchinton AI, Tannock IF. Drug penetration in solid tumours[J]. Nat Rev Cancer, 2006, 6(8):583-592.
[9]巴应贵.恶性肿瘤与肾损害临床分析[J].现代预防医学,2013, 40(8):1600.
[10]任玉卿,姜振华,史官茂,等.肿瘤合并肾损害35例临床分析[J].基层医学论坛, 2012, 16(32):4228-4230.
[11]陈浩,宓穗卿,赵威.药物引起肾功能损伤的研究进展[J].现代生物医学进展, 2012, 12(7):1380-1383.
[12]潘罅,尹友生.药源性肾损伤研究进展[J].大家健康(学术版), 2015, 9(22):284-286.
[13] MulèG, Calcaterra I, Costanzo M, et al. Relationship between short-term blood pressure variability and subclinical renal damage in essential hypertensive patients[J]. J Clin Hypertens(Greenwich), 2015, 17(6):473-480.
[14] Mennuni S, Rubattu S, Pierelli G, et al. Hypertension and kidneys:unraveling complex molecular mechanisms underlying hypertensive renal damage[J]. J Hum Hypertens,2014, 28(2):74-79.
[15] Carmines PK. Mechanisms of renal microvascular dysfunction in type 1 diabetes:potential contribution to end organ damage[J]. Curr Vasc Pharmacol, 2014, 12(6):781-787.
[16] Tatsugami K, Tanaka S, Ohtsubo S, et al. Causes of diminished renal function in the affected kidney after partial nephrectomy[J]. BJU Int, 2012, 110(8 Pt B):E357-E361.
[17] K?st S, D?rr W, Keinert K, et al. Effect of dose and dosedistribution in damage to the kidney following abdominal radiotherapy[J]. Int J Radiat Biol, 2002, 78(8):695-702.
[18]陈静,刘丽.常用肾功能检测指标在透析治疗效果评价上的应用价值[J].检验医学与临床, 2017, 14(8):1173-1176.
[19]张兴宗,林云,邹映东,等. 4项肾小球滤过功能检测指标在肾功能不全中的临床应用分析[J].国际检验医学杂志, 2016, 37(10):1395-1396.