肾功能对冠状病毒治疗进展和结果的影响

S. Mahiiovych, T. A. Maksymets, Halyna I. Kovalchuk, N. V. Karpyshyn, Zoryana M. Kit, E. Sklyarov
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引用次数: 0

摘要

导言。冠状病毒疾病的肾脏损害表现各不相同,有的表现为无症状蛋白尿,有的则表现为急性肾脏损害,需要进行肾脏替代治疗。肾小球滤过率(GFR)下降与预后恶化和院内死亡率增加有关。目的比较冠状病毒病住院病人的临床和实验室病程特点,以及根据肾小球滤过率进行治疗的结果。材料和方法。研究对象包括 243 名中度和重度冠状病毒病住院患者,年龄在 18 至 88 岁之间,其中女性 110 名,男性 133 名。所有患者根据肾小球滤过率分为两组:第一组--132人的肾小球滤过率大于60毫升/分钟/1.73平方米,第二组--111人的肾小球滤过率小于60毫升/分钟/1.73平方米。进行了一般临床检查和实验室检查(用于检测 SARS-CoV-2 病毒的 PCR、一般血液检查、血糖、肝脏和肾脏指标、凝血检查、d-二聚体、白细胞介素-6、铁蛋白、降钙素原、测定尿液中的白蛋白和肌酐并计算其比例),以及仪器检查(胸部器官的计算机断层扫描或多位置射线照相术、脉搏血氧仪)。采用 CKD-EPI(2021 年更新版)公式计算 GFR。组间比较采用曼-惠特尼 U 检验法。分类数据以比例表示,并采用卡方检验进行分析。当 P<0.05 时,结果被认为具有统计学可靠性。结果在肾小球滤过率降低的患者中,出现咯血、血尿、高血压和明显乏力等症状的比例较高。此外,该组患者的血清 CRP、白细胞介素-6 和降钙素原水平明显较高。研究发现,第一组有 7 名患者(5.3%)死亡,而第二组有 22 名患者(19.8%)死亡,P=0.0005。结论在肾小球滤过率降低的患者中,咯血、血尿、高血压和严重全身乏力等症状明显增多。实验室指标包括较高水平的 CRP、白细胞介素-6、降钙素原和白蛋白/肌酐比值,这表明炎症过程和活动更为严重。肾小球滤过率降低患者的死亡率为 19.8%,明显高于肾小球滤过率正常组(5.3%),P=0.0005。
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THE IMPACT OF THE KIDNEY FUNCTION ON THE PROGRESSION AND OUTCOMES OF CORONAVIRUS TREATMENT
Introduction. Manifestations of kidney damage in coronavirus disease vary from asymptomatic proteinuria to acute kidney damage that requires renal replacement therapy. Decreased glomerular filtration rate (GFR) is associated with worse prognosis and increased in-hospital mortality. Aim. To compare the clinical and laboratory characteristics of the course and the results of the coronavirus disease treatment in hospitalized patients depending on the GFR. Materials and methods. The study included 243 hospitalized patients with moderate and severe coronavirus disease aged from 18 to 88 years, among them 110 females and 133 males. All patients were segregated into two groups depending on GFR: 1st group – 132 individuals with GFR > 60 mL/min per 1.73m2, 2nd group – 111 individuals with GFR <60 mL/min per 1.73m2. A general clinical examination and laboratory tests (PCR for the detection of SARS-CoV-2 virus, general blood test, glucose, liver and kidney markers, coagulation tests, d-dimer, interleukin-6, ferritin, procalcitonin, and determination of albumin and creatinine in urine with calculation of their ratio), instrumental studies (computed tomography or multi-positional radiography of the thoracic organs, pulse oximetry) were performed. The CKD-EPI (2021 update) formula was used to calculate GFR. Comparison of groups was performed by means of the Mann-Whitney U-test. Categorical data were presented as proportions and analyzed using the Chi-square test. The results were considered statistically reliable at p<0.05. Results. Among the cohort of patients with diminished GFR, there was a notable prevalence of symptoms such as hemoptysis, hematuria, hypertension, and pronounced weakness. Additionally, higher levels of serum CRP, interleukin-6, and procalcitonin were significantly more frequent in this group. It was found that 7 patients (5.3%) among the patients of the 1st group died, while 22 patients (19.8%) died in the 2nd group, p=0.0005. Conclusions. In patients with reduced GFR, such symptoms as hemoptysis, hematuria, hypertension and severe general weakness were significantly more often observed. Laboratory indicators included higher levels of CRP, interleukin-6, procalcitonin, and albumin/creatinine ratio, which indicated a more severe course and activity of the inflammatory process. The mortality rate in patients with reduced GFR was 19.8% and was significantly higher than in the group with normal GFR – 5.3%, p=0.0005.
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