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目的研究慢性丙型肝炎患者肾损伤的发病情况及其危险因素。方法收集2002年1月至2007年10月在北京大学人民医院住院治疗的慢性丙型肝炎患者213例的临床资料,采用MDRD公式计算患者的估测肾小球滤过率,并对患者肾损伤的患病率及其危险因素进行分析。结果共有213例慢性丙型肝炎患者加入本研究,其平均年龄(53.5±14.7)岁(16～86岁),其中男性127例(59.6%),女性86例(40.4%),高血压47例(22.1%),糖尿病55例(25.8%),血清HCV RNA阳性者202例(94.8%);慢性肾脏病发生率为26.3%,其中蛋白尿发生率为14.6%,血尿发生率为2.8%。经多因素Logistic回归分析发现血清HCV RNA阳性(P=0.028,OR:2.610,95%CI:1.107～6.151)是蛋白尿发生的危险因素,蛋白尿(P=0.02,OR:3.759,95%CI:1.227～11.521)、年龄(P=0.004,OR:1.058,95%CI:1.018～1.100)及血尿酸浓度(P<0.01,OR:1.011,95%CI:1.006～1.016)是其eGFR<60mL/(min.1.73m2)发生的危险因素。结论慢性丙型肝炎患者CKD的发生率较高,血清HCVRNA阳性与慢性丙型肝炎患者蛋白尿的发生密切相关。慢性丙型肝炎患者较高的CKD发生率需进一步大样本的前瞻性临床研究。
Objective To study the incidence of kidney injury and its risk factors in patients with chronic hepatitis C Methods The clinical data of 213 patients with chronic hepatitis C who were hospitalized at Peking University People’s Hospital from January 2002 to October 2007 were collected. The patients’ estimated GFR was calculated by MDRD formula and their renal injury The prevalence and risk factors were analyzed. Results A total of 213 patients with chronic hepatitis C were enrolled in this study. The mean age (53.5 ± 14.7) years (range, 16-86 years) included 127 men (59.6%), 86 women (40.4%) and 47 (22.1%), 55 cases of diabetes mellitus (25.8%) and 202 cases (94.8%) with positive serum HCV RNA. The incidence of chronic kidney disease was 26.3%. The incidence of proteinuria was 14.6% and hematuria was 2.8%. The multivariate Logistic regression analysis showed that the serum HCV RNA was positive (P = 0.028, OR: 2.610, 95% CI: 1.107-6.151), which was the risk factor for proteinuria (P = 0.02, OR: 3.759, 95% CI : 1.227-11.521), age (P = 0.004, OR: 1.058, 95% CI: 1.018-1.100) and serum uric acid concentration (P <0.01, OR: 1.011, 95% CI: 1.006-1.016) /(min.1.73m2) occurred risk factors. Conclusion The incidence of CKD in patients with chronic hepatitis C is high, and the positive serum HCVRNA is closely related to the occurrence of proteinuria in patients with chronic hepatitis C. The high incidence of CKD in patients with chronic hepatitis C requires further large prospective clinical studies.