重度蜂蜇伤致急性肾损伤患者的临床特征及危险因素分析

黄加力 俞东容 胡日红 姚国明 王利峰

[摘要] 目的 探讨重度蜂蛰伤致急性肾损伤（AKI）患者的临床特征及危险因素，为临床提供依据。方法 回顾性分析杭州市中医院2018年1月至2020年12月收治的重度蜂蜇伤患者资料，根据是否合并AKI分为AKI组26例和非AKI组54例，比较两组一般情况、实验室指标、住院时间及费用，对AKI患者进行亚组分析，通过多因素Logistic回归分析影响预后的危险因素。 结果 符合纳入标准的患者有80例，其中男女比例为5∶3，平均年龄（58.1±11.9）岁。蜂蜇伤多发生于7～11月，其中4例（5.0%）死亡，2例（2.5%）进入终末期肾脏病。与非AKI组相比，AKI组患者住院时间更长，日平均费用更高，差异有统计学意义（P<0.01）;兩组入院24 h内实验室指标比较，差异有统计学意义（P<0.05）。AKI亚组：多因素Logistic回归分析显示，患者年龄>60岁、血乳酸>4 mmol/L是蜂蜇伤致AKI患者疾病进展的独立危险因素（P<0.05）。 结论 蜂蛰伤所致AKI患者病情凶险，经济负担重，蜇伤后应密切监测血常规、肝肾功能等指标，若合并高龄及血乳酸高者应警惕疾病恶化。

[关键词] 蜂蜇伤;急性肾损伤;危险因素;预后

[中图分类号] R646          [文献标识码] B          [文章编号] 1673-9701（2021）33-0109-04

[Abstract] Objective To explore the clinical characteristics and risk factors in patients with acute kidney injury （AKI） caused by severe bee sting injury， and to provide clinical evidence. Methods A retrospective analysis was conducted on patients with severe bee stings admitted to the Hangzhou Chinese Medical Hospital from January 2018 to December 2020. According to whether the bee stings were complicated with AKI， they were divided into the AKI group（n=26） and the non-AKI group（n=54）. The general conditions， laboratory indicators， hospital stay， and cost were compared between the two groups. Subgroup analysis was conducted in AKI patients. Multivariate Logistic regression analysis was conducted to investigate the risk factors for prognosis. Results A total of 80 patients met the inclusion criteria. The male to female ratio was 5∶3， and average age was（58.1±11.9）years old. Bee stings mostly occurred from July to November， among which 4 patients （5.0%） died， and 2 patients （2.5%） got end-stage renal disease. Compared with the non-AKI group， the AKI group had a longer hospital stay and a higher average daily cost， with statistically significant differences （P<0.01）. There were statistically significant differences in laboratory indicators within 24 hours after hospitalization between the two groups（P<0.05）. In the AKI subgroup， multivariate logistic regression analysis showed that age>60 years old and blood lactate>4 mmol/L were independent risk factors for disease progression in patients with AKI caused by bee stings（P<0.05）. Conclusion Patients with AKI caused by bee stings have a dangerous condition and a heavy economic burden. After sting， blood count， liver function， renal function and other indicators should be closely monitored. Patients with advanced age and high blood lactic acid should be alert to the deterioration of disease.

[Key words] Bee sting injury; Acute kidney injury; Risk factors; Prognosis

蜂蛰伤多见于夏秋两季，近年来发病率呈上升趋势，其起病急、进展快，严重威胁患者生命健康，加重社会经济负担。蜂蜇伤可引起多个脏器功能损伤，而急性肾损伤（Acute kidney injury，AKI）较为常见，发生率为20%～50%[1]，其可能加重其他脏器负担，甚至引起死亡。早期识别危重患者尤为重要，尽早临床干预有助于AKI逆转，改善患者预后。目前，国内外尚缺乏蜂蜇伤合并AKI的大样本临床研究，蜇伤后出现AKI及病情恶化的危险因素也有待进一步明确。因此，收集本院近3年蜂蜇伤患者的资料，分析重度蜂蜇伤合并AKI的危险因素，为早发现、早干预提供依据，以期优化诊疗方案，减轻患者负担，现报道如下。

1 资料与方法

1.1 一般资料