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丙型肝炎相关肝硬化中与肾功能不全相关的因素及其与Child-Pugh评分的相关性。

Factors associated with renal dysfunction in hepatitis C-related cirrhosis and its correlation with Child-Pugh score.

作者信息

Bhatti Hamza Waqar, Tahir Umama, Chaudhary Noman Ahmed, Bhatti Sania, Hafeez Muhammad, Rizvi Zuhair Ali

机构信息

Medicine, Rawalpindi Medical University, Rawalpindi, Pakistan.

CMH Multan Institute of Medical Sciences, Multan, Pakistan.

出版信息

BMJ Open Gastroenterol. 2019 May 19;6(1):e000286. doi: 10.1136/bmjgast-2019-000286. eCollection 2019.

Abstract

OBJECTIVES

To assess factors associated with renal dysfunction (RD) in hepatitis C virus (HCV) cirrhosis, correlate renal parameters with Child-Pugh score (CPS) and find a cut-off value of CPS to determine RD.

MATERIALS AND METHODS

It was a cross-sectional study that included 70 cases of liver cirrhosis secondary to HCV from a period of 6 months at Combined Military Hospital, Multan. Diagnosis of HCV was confirmed by serological assay and liver cirrhosis by ultrasonography. CPS was determined and lab reports were taken. Patients were divided into two groups as not having RD (serum creatinine≤1.5 mg/dL) and having RD (serum creatinine≥1.5 mg/dL). Estimated glomerular filtration rate (eGFR) was calculated by chronic kidney disease epidemiology collaboration (CKD-EPI) formula. Data were analyzed using SPSS V.23.0. χ, Kruskal-Wallis test and Pearson coefficient of correlation were applied. ROC curve was drawn to evaluate cut-off value of CPS for the presence of RD. Level of significance was set at p<0.05.

RESULTS

Patients with CP grade B or C develop RD as compared to patients with CP grade A (p=0.000). Mean age, urea, creatinine and eGFR varies significantly among patients who develop RD and patients who do not (p=0.02, p=0.000, p=0.000 and p=0.000, respectively). eGFR negatively correlates with CPS (r=-0.359, p=0.002). Creatinine, urea and ALBI score positively correlates with CPS (r=+0.417, p=0.000; r=+0.757, p=0.000; r=+0.362, p=0.002, respectively).

CONCLUSION

Ascites and encephalopathy are associated with RD in HCV cirrhosis.

摘要

目的

评估丙型肝炎病毒(HCV)肝硬化患者肾功能不全(RD)的相关因素,将肾指标与Child-Pugh评分(CPS)进行相关性分析,并找出用于确定RD的CPS临界值。

材料与方法

这是一项横断面研究,纳入了木尔坦联合军事医院6个月期间70例HCV继发肝硬化患者。HCV诊断通过血清学检测确认,肝硬化通过超声检查确诊。确定CPS并获取实验室报告。患者分为两组,即无RD组(血清肌酐≤1.5mg/dL)和有RD组(血清肌酐≥1.5mg/dL)。采用慢性肾脏病流行病学协作组(CKD-EPI)公式计算估算肾小球滤过率(eGFR)。使用SPSS V.23.0软件进行数据分析。应用χ检验、Kruskal-Wallis检验和Pearson相关系数。绘制ROC曲线以评估存在RD时CPS的临界值。显著性水平设定为p<0.05。

结果

与CP A级患者相比,CP B级或C级患者发生RD(p=0.000)。发生RD的患者与未发生RD的患者在平均年龄、尿素、肌酐和eGFR方面差异显著(分别为p=0.02、p=0.000、p=0.000和p=0.000)。eGFR与CPS呈负相关(r=-0.359,p=0.002)。肌酐、尿素和ALBI评分与CPS呈正相关(分别为r=+0.417,p=0.000;r=+0.757,p=0.000;r=+0.362,p=0.002)。

结论

腹水和肝性脑病与HCV肝硬化患者的RD相关。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/1211/6577365/2f59ed3e03f6/bmjgast-2019-000286f01.jpg

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