RIFLE标准和AKIN标准诊断儿童急性肾损伤的对比研究（附223例儿童急性肾损伤的临床分析）

Comparison of RIFLE and AKIN criteria for acute kidney injury in children（attached clinical analysis of 223 cases）

摘要:

目的：探讨RIFLE和急性肾损伤网络（acute kidney injury network，AKIN）２种分级诊断标准在儿童急性肾损伤（acute kidney injury，AKI）中的诊断意义，以期对临床AKI患儿的早期诊断及治疗有所助益。方法：回顾性分析我院223例AKI患儿的临床特征、实验室指标、治疗及转归等情况，探讨RIFLE和AKIN 2种分级诊断标准在儿童AKI中的诊断意义。结果：与RIFLE标准相比较，AKIN标准在儿童AKI的诊断方面没有明显优势（ χ2=1.000，P=0.962）。在分期诊断方面，AKIN标准1期、2期、3期与RIFLE标准对应的风险期、损伤期、衰竭期亦无明显统计学差异（ χ2=2.303，P=0.316）。无论AKIN标准或RIFLE标准，不同AKI分期的预后分布（RIFLE标准：χ2=11.526，P=0.003；AKIN标准： χ2=13.559，P=0.001）、机械通气率（RIFLE标准： χ2=12.119，P=0.002；AKIN标准： χ2=6.854，P=0.032）、血液净化率（RIFLE标准： χ2=43.569，P=0.000；AKIN标准： χ2=88.766，P=0.000）、多器官功能障碍发生率（RIFLE标准： χ2=11.896，P=0.003；AKIN标准： χ2=11.783，P=0.003）均有统计学差异。随着AKI严重程度的加重（即分期的加重），院内病死率升高，AKI衰竭期（3期）患儿的院内病死率明显高于风险期（1期）、损伤期（2期），但是这种差异在平均住院天数（RIFLE标准：F=1.540，P=0.217；AKIN标准：F=0.037，P=0.963）和治愈率（RIFLE标准： χ2=1.896，P=0.388；AKIN标准： χ2=3.646，P=0.162）方面无明显体现。结论：与RIFLE分层诊断标准相比较，AKIN标准在儿童AKI的诊断、分期诊断以及近期预后评估方面没有明显优势。然而，无论是采用RIFLE标准还是AKIN标准，AKI严重程度的加重与患儿的近期不良预后密切相关。随着AKI严重程度的加重（分期的加重），AKI患儿的机械通气率、血液净化率以及多器官功能障碍发生率升高。AKI衰竭期（3期）患儿的院内病死率明显高于风险期（1期）、损伤期（2期），但是这种差异在平均住院天数、治愈率方面无明显体现。

Abstract:

Objective：To explore the diagnostic value of RIFLE criteria and acute kidney injury network（AKIN） criteria in diagnosing child acute kidney injury（AKI） in order to help early diagnosis and treatment of children with AKI. Methods：Totally 223 hospital－ized children with AKI in our hospital were retrospectively analyzed，including clinical features，laboratory indicators，therapeutics，outcome，etc. Diagnostic value of the RIFLE criteria and AKIN criteria for children AKI was explored. Results：AKIN criteria has no obvious advantage in the diagnosis of AKI children compared with RIFLE criteria（ χ2=1.000，P=0.962）. In terms of staging diagnosis，there’s no significant statistical difference（ χ2=2.303，P=0.316） between stage 1，stage 2，stage 3 in AKIN criteria and the corresponding risk，damage，failure phase in RIFLE criteria. Regardless of AKIN criteria or RIFLE criteria，the distribution of prognosis（RI－FLE criteria： χ2=11.526，P=0.003；AKIN criteria： χ2=13.559，P=0.001），mechanical ventilation rate（RIFLE criteria： χ2=12.119，P=0.002；AKIN criteria： χ2=6.854，P=0.032），blood purification rate（RIFLE criteria： χ2=43.569，P=0.000；AKIN criteria： χ2=88.766，P=0.000） and incidence of multiple organ dysfunction（RIFLE criteria： χ2=11.896，P=0.003；AKIN criteria： χ2=11.783，P=0.003） in different AKI stages were significantly statistically different. In-hospital mortality increased with the increase of the severity of AKI（stage of AKI）. In-hospital mortality of children with AKI in failure phase（stage 3） was significantly higher than that in risk phase（stage 1） and injury phase（stage 2）. Nevertheless，there’s no statistical difference in cure rate（RIFLE criteria： χ2=1.896，P=0.388；AKIN cri－teria： χ2=3.646，P=0.162） and average hospitalization days（RIFLE criteria：F=1.540，P=0.217；AKIN criteria：F=0.037，P=0.963） among different AKI stages. Conclusion：AKIN criteria have no obvious advantage in the diagnosis，staging diagnosis and eval－uation of short-term prognosis of AKI children compared with RIFLE criteria. Regardless of AKIN criteria or RIFLE criteria，the increase of kidney injury severity in AKI children is closely related with poor short-term prognosis. As the severity of AKI（the stage of AKI） increases，mechanical ventilation rate，blood purification rate，incidence of multiple organ dysfunction increase. In-hospital mortality of children with AKI in failure phase（stage 3） is significantly higher than that in risk phase（stage 1） and injury phase（stage 2）. However，there’s no statistical difference in cure rate and average hospitalization days among different AKI stages.