發(fā)布時(shí)間：2018-01-13 23:17

  本文關(guān)鍵詞：住院慢性腎小球疾病患者感染的危險(xiǎn)因素及預(yù)后研究　出處：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文　論文類型：學(xué)位論文

  更多相關(guān)文章： 慢性腎小球疾病 感染 危險(xiǎn)因素 腎臟預(yù)后

【摘要】：研究背景在我國,由慢性腎臟病(chronic kidney disease,CKD)和終末期腎病(end stage renal disease,ESRD)帶來的治療負(fù)擔(dān)十分巨大,其發(fā)病率與患病率仍在逐年增加。感染是慢性腎臟病患者病程中重要的并發(fā)癥之一,已有許多研究證實(shí),慢性腎臟病患者感染的發(fā)病率與致死率遠(yuǎn)高于普通人群,且較差的腎功能預(yù)示著更高的感染風(fēng)險(xiǎn)與致死率。而慢性腎小球疾病(Chronic Glomerular Disease)是慢性腎臟病的重要組成部分,在我國也是導(dǎo)致終末期腎病最常見的病因。其因常需要糖皮質(zhì)激素和/或免疫抑制劑治療,而有著額外的感染的風(fēng)險(xiǎn)。但目前對(duì)于慢性腎小球疾病中感染的研究很少,且除免疫抑制治療外的其它感染危險(xiǎn)因素的研究更少。所以,本研究旨在探究慢性腎小球疾病中感染,尤其關(guān)注不同類型的腎病中感染發(fā)生的風(fēng)險(xiǎn),以及感染事件對(duì)腎臟結(jié)局的影響。研究目的1.分析2012-2016年間北京協(xié)和醫(yī)院(以下簡稱我院)住院的慢性腎小球疾病患者者中感染的基本情況,如感染例數(shù)隨時(shí)間的變化、感染部位、感染病原體等;比較常見的幾種慢性腎小球腎炎間不同類型的感染發(fā)生例數(shù)占比的差異;2.通過病例-對(duì)照研究,考察感染發(fā)生可能的危險(xiǎn)因素,尤其是不同腎小球疾病類型間感染發(fā)生的風(fēng)險(xiǎn)的差異;3.研究感染對(duì)IgA腎病尿蛋白緩解率及腎功能惡化的影響。研究方法分析2000年1月1日-2016年12月31日我院住院慢性腎小球疾病患者合并感染的例數(shù)隨時(shí)間變化的趨勢;分析2012年1月1日-2016年12月31日我院住院的慢性腎小球疾病患者中,導(dǎo)致住院的感染或院內(nèi)感染發(fā)生的概況,主要包括感染部位、病原體類型以及感染在不同腎小球疾病中的分布,并對(duì)狼瘡性腎炎、原發(fā)性膜性腎病、IgA腎病進(jìn)行組間差異性比較。采用病例-對(duì)照研究的方法,使用多因素Logistic回歸模型進(jìn)行以下分析:(1)比較不同類型腎小球疾病患者因感染住院或發(fā)生院內(nèi)感染的風(fēng)險(xiǎn);(2)研究IgA腎病治療過程中,因感染住院或發(fā)生院內(nèi)感染事件,對(duì)尿蛋白的緩解及腎功能的惡化是否有影響。研究結(jié)果1.我院2000年-2016年間因感染住院或發(fā)生院內(nèi)感染的慢性腎小球疾病病例數(shù)量具有隨年份逐漸增加的趨勢,2010年后的感染例數(shù)增加趨勢較前變快;肺部感染是占優(yōu)勢的類型。2.2012年-2016年間因感染就診于我院或于我院發(fā)生院內(nèi)感染的慢性腎小球疾病例數(shù)共955例,感染部位以肺部感染最多見(79.6%),其次為血行感染(8%)和泌尿道感染(5%);感染病原體類型以細(xì)菌感染(38.8%)最常見,其次為病毒(21.9%)、真菌(17.6%)、結(jié)核(18.1%)及PCP感染(14.2%);感染病例在不同類型的腎小球疾病中的分布則以狼瘡性腎炎最多見(32.1%),其次為原發(fā)性膜性腎病(12.1%)、IgA 腎病(5.5%)等。3.對(duì)上述研究對(duì)象中的狼瘡性腎炎、IgA腎病及原發(fā)性膜性腎病患者進(jìn)行不同類型腎小球疾病間單因素比較發(fā)現(xiàn):皮膚軟組織感染在狼瘡性腎炎的發(fā)生率明顯高于其他兩組;PCP在IgA腎病中的發(fā)生率明顯高于其他兩組。4.不同的腎病類型間因感染住院或發(fā)生院內(nèi)感染的風(fēng)險(xiǎn)不同,其中以狼瘡性腎炎患者發(fā)生感染的風(fēng)險(xiǎn)最高,為IgA腎病的4倍,其次為系統(tǒng)性小血管炎腎受累患者、紫癜性腎炎患者;原發(fā)性腎小球腎炎感染風(fēng)險(xiǎn)相對(duì)低;腎功能出現(xiàn)慢性或急性損傷的患者感染風(fēng)險(xiǎn)高于無腎功能損傷者。5.IgA腎病患者中因感染住院或發(fā)生院內(nèi)感染事件后,腎臟結(jié)局可能受到影響:單因素及性別、年齡校正后的Logistic回歸分析顯示,上述感染事件的發(fā)生是尿蛋白緩解率的降低及腎臟聯(lián)合終點(diǎn)事件發(fā)生率增加的危險(xiǎn)因素;納入混雜因素后,上述感染事件的發(fā)生對(duì)尿蛋白緩解率下降并無顯著影響;將全程治療方案做為校正因素,上述感染事件的發(fā)生將增加腎臟聯(lián)合終點(diǎn)事件發(fā)生的風(fēng)險(xiǎn),而將初始治療方案作為校正因素,則上述感染事件對(duì)腎臟聯(lián)合終點(diǎn)事件的發(fā)生無顯著性影響。結(jié)論1.我院腎小球疾病患者因感染入院或住院感染發(fā)生率呈逐年增長的趨勢;感染部位以肺部感染為主,病原體以細(xì)菌感染為主;感染在不同腎小球疾病中的分布以狼瘡性腎炎最多見,其次為原發(fā)性膜性腎病、IgA腎病。2.狼瘡性腎炎患者較其他類型的腎炎更易發(fā)生皮膚軟組織感染;IgA腎病患者較其他類型腎炎更易發(fā)生肺孢子蟲肺炎。3.常見類型的慢性腎小球疾病患者中,狼瘡性腎炎、過敏性紫癜性腎炎、系統(tǒng)性血管炎腎損害患者因感染住院或發(fā)生院內(nèi)感染的危險(xiǎn)性較IgA腎病、原發(fā)性膜性腎病、微小病變腎病更高;腎功能受損的患者更易感染;對(duì)以上患者應(yīng)積極預(yù)防感染。4.IgA腎病患者治療過程中發(fā)生需住院或院內(nèi)感染,有降低尿蛋白緩解率及降低腎功能的可能。
[Abstract]:Research background in China, from chronic kidney disease (chronic kidney, disease, CKD) and end-stage renal disease (end stage renal disease, ESRD) brought huge burden of treatment, the incidence and prevalence is increasing year by year. Infection is one of the major complications of patients with chronic kidney disease, many studies have confirmed that infection in patients with chronic kidney disease, the incidence and mortality rate is far higher than the general population, and poor renal function indicates a higher risk of infection and mortality. Chronic glomerular disease (Chronic Glomerular Disease) is an important part of chronic kidney disease, in our country is the most common cause of end-stage renal disease. It often requires glucocorticoids and / or immunosuppressive therapy, with additional risk of infection. But the infection of chronic glomerular disease rarely, and in addition to immunosuppressive therapy abroad Study on less other risk factors of infection. Therefore, the purpose of this study is to explore the infection of chronic glomerular diseases, especially the risk of infection of different types of nephropathy, and infection events on renal outcomes. Study 1. 2012-2016 from Peking Union Medical College Hospital (hereinafter referred to as the basic conditions of our hospital) in patients with chronic glomerular disease in hospital in the infection, such as the number of cases with the change of time, the site of infection, infection of pathogens; several common chronic glomerulonephritis among different types of infection accounted for the differences in number of cases; 2. by case-control study, investigation of infection risk factors, especially the difference of the risk of infection type various glomerular diseases; 3. of infection rate and alleviate the effect of deterioration of renal function in IgA nephropathy. The method of analysis of January 1, 2000 -2016 In December 31st the number of cases in our hospital with chronic glomerular diseases and infection trends over time; analysis of the January 1, 2012 -2016 year in December 31st in our hospital in patients with chronic glomerular disease, cause of infection or hospital, including infection, pathogen infection and distribution in different types of glomerular diseases. Of lupus nephritis, membranous nephropathy, IgA nephropathy, compare the difference between groups. A case-control study was conducted, using multivariate Logistic regression model was used to analyze the following: (1) comparison of different types of patients with glomerular disease due to the risk of infection or hospitalization of nosocomial infection (2); Study on IgA nephropathy in the treatment process, due to infection of hospitalized or nosocomial infection event, whether the deterioration of renal function and relieve the protein in urine. The results of 1. in our hospital in 2000 -2016 Because the number of cases from infection in hospitalized or nosocomial infection of chronic kidney disease has with the continuous increasing trend, the number of cases of infection after 2010 increased faster than before; pulmonary infection is the dominant type of.2.2012 years -2016 years due to infection in our hospital for treatment in our hospital or the number of cases of chronic glomerular disease a total of 955 cases of nosocomial infection, the infection of pulmonary infection (79.6%), followed by blood infection (8%) and urinary tract infection (5%); pathogen infection type to bacterial infection (38.8%) was the most common, followed by virus (21.9%), fungi (17.6%), tuberculosis (18.1%) and PCP infection (14.2%); the distribution of infections in different types of glomerular diseases are most common in patients with lupus nephritis (32.1%), followed by primary membranous nephropathy, IgA nephropathy (12.1%) (5.5%) of the research object in lupus nephritis.3., IgA nephropathy and primary Different types of glomerular diseases between single factor of membranous nephropathy patients: comparison of skin and soft tissue infection in lupus nephritis was significantly higher than that of the other two groups; PCP in IgA nephropathy was significantly higher than the other two groups of different types of.4. nephropathy due to the risk of infection or hospitalization of nosocomial infection, among them in patients with lupus nephritis occurred at highest risk of infection is 4 times of IgA nephropathy, followed by systemic vasculitis and renal involvement in patients with Henoch Schonlein purpura nephritis; primary glomerulonephritis infection risk is relatively low; renal injury in patients with acute or chronic infection risk than those without renal function injury in patients with.5.IgA nephropathy due to infection or hospitalization of nosocomial infection after renal outcomes may be affected by the single factor and gender, age adjusted Logistic regression analysis showed that the infection of hair thing Life is a risk factor for the rising incidence of urinary protein decreased and the remission rate of kidney combined end point events; into the confounding factors, the occurrence of infection events on urine protein remission rate decrease were not significantly affected; full treatment as a correction factor of the occurrence of the infection will increase the risk of renal events combined end point events. The initial treatment as a correction factor, the infection had no significant effects on the kidney combined end point events. Conclusion: 1. patients with glomerular disease due to infection in our hospital admission or hospital infection rate is increasing year by year; lung infection was the main pathogen, mainly to bacterial infection; the infection distribution in different glomerular the disease in lupus nephritis was the most common, followed by idiopathic membranous nephropathy, IgA nephropathy.2. in patients with lupus nephritis nephritis more easily than other types The occurrence of skin soft tissue infection; IgA nephropathy in patients with nephritis occurred more often than other types of Pneumocystis carinii pneumonia in patients with.3. common type of chronic glomerulonephritis, lupus nephritis, Henoch Schonlein purpura nephritis, systemic vasculitis with renal impairment due to risk of infection in hospitalized or nosocomial infection of primary IgA nephropathy. Membranous nephropathy, minimal change nephropathy higher; impaired renal function of the patients are more likely to require hospitalization or hospital infection; infection of.4.IgA nephropathy patients during the treatment of infection in patients above should actively prevent, reduce proteinuria and reduce the remission rate of renal function.

【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.6

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