Kosmadakis George, Michail Otho, Filiopoulos Vasileios, Papadopoulou Panoraia, Michail Spiridon
Gregorios Vosnides Department of Nephrology, Laiko General Hospital, Athens, Greece.
Int J Artif Organs. 2011 Jul;34(7):584-8. doi: 10.5301/IJAO.2011.8509.
Regular or illegal drugs and toxins are the most frequent non-physical causes of rhabdomyolysis (RM) in peacetime. Acute kidney injury (AKI) is a serious and, sometimes, fatal complication of RM. It occurs in 8-20% of RM incidents.
In this prospective study we evaluated the severity of RM and AKI in narcotic drug users. From January 2001 to December 2007, 21 patients (17 males, mean age 27.8±4.8 years) with RM associated with AKI were classified into two groups: 11 heroin users (HU) and 10 non-heroin users (NHU). The severity of RM was evaluated by estimation, on admission, of serum creatine phosphokinase (CPK), serum glutamic oxaloacetic transaminase (SGOT), lactate dehydrogenase (LDH), phosphate (PO4 ) and calcium (Ca) and by the presence of paraplegia (PPL). The severity of AKI during hospitalization was evaluated by estimation of serum creatinine (CR), the presence of oligoanuria (OA), the days of hospitalization (DH), the total of hemodialysis treatments (THD) and the number of patients who received blood transfusions (BT).
RM was much more severe in HU than in NHU. Mean SGOT, CPK, LDH, and P values on admission were higher in HU. Hypocalcemia was statistically more severe in HU. Nine HU were admitted with PPL vs. 1 NHU. Serum CR levels were higher and oligoanuria was much more common in HU. HU had a longer hospitalization period and underwent a bigger number of HT. More HU took BT.
The results of this study suggest that both RM and ARF are more severe in HU than in NHU possibly due to an additional myotoxic effect of heroin.
在和平时期，常规或非法药物及毒素是横纹肌溶解症（RM）最常见的非物理性病因。急性肾损伤（AKI）是RM的一种严重且有时致命的并发症。它在8%-20%的RM病例中出现。
在这项前瞻性研究中，我们评估了吸毒者中RM和AKI的严重程度。2001年1月至2007年12月，21例伴有AKI的RM患者（17例男性，平均年龄27.8±4.8岁）被分为两组：11例海洛因使用者（HU）和10例非海洛因使用者（NHU）。通过入院时血清肌酸磷酸激酶（CPK）、血清谷氨酸草酰乙酸转氨酶（SGOT）、乳酸脱氢酶（LDH）、磷酸盐（PO4）和钙（Ca）的测定以及截瘫（PPL）的存在情况评估RM的严重程度。通过血清肌酐（CR）的测定、少尿无尿（OA）的存在情况、住院天数（DH）、血液透析治疗总数（THD）以及接受输血（BT）的患者数量评估住院期间AKI的严重程度。
HU的RM比NHU严重得多。HU入院时的平均SGOT、CPK、LDH和P值更高。HU的低钙血症在统计学上更严重。9例HU因截瘫入院，而NHU为1例。HU的血清CR水平更高，少尿无尿更常见。HU的住院时间更长，接受血液透析的次数更多。更多的HU接受了输血。
本研究结果表明，HU的RM和急性肾衰竭（ARF）比NHU更严重，可能是由于海洛因额外的肌毒性作用。
