肝硬化的肾脏病理

E. G. Malaeva
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摘要

目的根据切面分析法分析肝硬化患者肾脏病变的结构和频率,并研究急性肾损伤与尿路感染之间的关系。研究设计为混合型:描述性和分析性,包括根据国家医疗机构 "戈梅利地区临床病理解剖学局 "2022 年 1 月至 2023 年 7 月期间病理解剖学尸检方案的结果,以及肝硬化患者的临床、实验室、仪器、细胞学、微生物学数据,对肾脏病理进行回顾性病例对照研究。研究包括 98 名死亡患者,其中男性 70 人(占 71.4%),女性 28 人(占 28.6%)。平均年龄为 53.9 岁,大多数患者为工作年龄段的人--男性占 72.9%,女性占 60.7%,年轻人占 21.4%。根据切面分析,肝硬化患者最常见的肾脏病变是急性肾损伤(57.1%)。肾脓肿(3%)、肾小管间质性肾炎(2%)和肾盂肾炎(4%)的诊断率较低。尽管大多数肝硬化患者都没有肾脏疾病史,但 100%的病例在尸检时都发现了典型的肾脏组织损伤的临床、实验室和仪器征象,以及肾脏的宏观和微观变化。在 84.7% 的病例中,急性肾小管坏死的形态学诊断从局灶性(51%)到完全性(19.4%)不等,并不总是伴随着血清肌酐水平的升高。急性肾损伤与尿路感染之间存在中度关系(OR = 14;95 % CI 11.13-16.61)。肝硬化最常见的预后不良并发症是急性肾损伤,这与尿路感染有关。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Kidney pathology in liver cirrhosis
Objective. To analyze the structure and frequency of kidney pathology in liver cirrhosis according to sectional analysis and to study the relationship between acute renal injury and urinary tract infection.Materials and methods. The design of the study is mixed: descriptive and analytical, which included conducting a retrospective case–control study of kidney pathology based on the results of the protocols of pathoanatomical autopsies on the basis of the state healthcare institution “Gomel Regional Clinical Pathoanatomical Bureau” for the period of January 2022 – July 2023 and clinical, laboratory, instrumental, cytological, microbiological data of patients with liver cirrhosis. The study included 98 deceased patients, including 70 (71.4%) men, 28 (28.6%) women. The average age was 53.9 years, the majority of patients were persons of working age — 72.9% of men and 60.7% of women, 21.4% were young people.Results. The most common kidney pathology in liver cirrhosis according to sectional analysis is acute renal injury (57.1%). Kidney abscesses (3%), tubulointerstitial nephritis (2%) and pyelonephritis (4%) were less frequently diagnosed. Despite the absence of a history of kidney diseases in most patients with cirrhosis, classical clinical, laboratory and instrumental signs of renal tissue damage, macroscopic and microscopic changes of the kidneys were revealed in 100% of cases at autopsy. In 84.7% of cases, acute tubular necrosis was morphologically diagnosed from focal (51%) to total (19.4%), which was not always accompanied by an increase in serum creatinine levels. A moderate relationship was established between acute kidney injury and urinary tract infection (OR = 14; 95 % CI 11.13–16.61).Conclusion. The most common complication of liver cirrhosis associated with an unfavorable prognosis is acute renal injury, which is associated with the presence of urinary tract infection.
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