| Purpose: The clinical features and related risk factors of patients with hepatitis B cirrhosis complicated with renal injury were retrospectively analyzed.Methods: A total of 193 hospitalized patients with hepatitis B cirrhosis who had complete case data from January 2015 to December 2018 in our hospital were enrolled.According to the estimated glomerular filtration rate(e GFR),patients were divided into two groups,including renal injury group and control group(normal renal function group).There were 52 cases in the renal dysfunction group and 141 cases in the control group.Comparative analysis of whether there were significant differences in aspartate aminotransferase(AST),alanine aminotransferase(ALT),albumin(ALB),total bilirubin(TBIL),blood urea nitrogen(BUN),serum creatinine(Scr),retinol binding protein(RBP),serum cystatin C(Cys C),hepatitis B virus DNA(HBV-DNA)content and liver function grading(Child-Pugh classification)indicators,and comparative analysis of whether there were significant differences in hepatic encephalopathy,hyponatremia,upper gastrointestinal bleeding,ascites,hyperbilirubinemia and hypoalbuminemia between the two groups.Multivariate regression analysis was performed on the indicators with significant differences between the two groups.Result: 1.The Scr of the renal injury group was 92.28±19.98umol/L,the Scr of the control group was 65.20±12.01umol/L,the difference was significant(P<0.01).The age of the renal injury group was 57.35±11.47 years old,the age of control group was 49.04±10.72 years old,the difference was significant(P<0.01).The median of BUN in the renal injury group was 6.21 mmol/L,and the median of control group was 5.50 mmol/L,which was significantly different between the two groups(P<0.01);the median of Cys C in renal dysfunction group was 1.21 mg/L,and the median of control group was 1.01 mg/L,the difference between the two groups was significant(P<0.01).The creatinine was above the normal value(female >100umol/L,male >110mmol/L)as the boundary of renal injury,the incidence of renal injury was 3.63%,and the incidence of renal injury calculated by e GFR < 90ml/min/1.73m2 was 26.94%.There was significant difference between the two groups(P < 0.01).The areas of Scr,Cys C and BUN under the Receiver Operating Characteristic curve(ROC curve)were 0.901,0.719 and 0.699,respectively,and the P values were all less than 0.01.The three indicators had predictive value.The cutoff value of Scr is 84.795umol/L,the sensitivity is 71.0%,the specificity is 98.7%;the cutoff value of Cys C is 1.035mg/L,the sensitivity is 80.6%,the specificity is 55.3%;the cutoff value of BUN is 4.245mmol/L,the sensitivity was 93.5% and the specificity was 36.8%.2.RBP,ALT,AST,TBIL,hyperbilirubinemia and HBV-DNA content were not statistically significant in the two groups(P values were 0.087,0.159,0.253,0.343,0.798,respectively).3.There was no significant difference in the incidence of renal injury between Child-Pugh grade A and Child-Pugh grade B(P>0.05).There was a significant difference in the incidence of renal injury between Child-Pugh grade B and Child-Pugh grade C(P<0.05).4.There was no significant difference in upper gastrointestinal bleeding,hypoproteinemia,hepatic encephalopathy and ascites between the two groups(P>0.05).There was significant difference in hyponatremia between the two groups(P<0.05).5.Multivariate logistic regression analysis,age was an independent risk factor for hepatitis B cirrhosis with renal injury(OR=1.073,P=0.000).The differences between the gradings of Child-Pugh grading were significant,and they were negatively correlated with renal injury.The comparison between grade A and grade C(OR=0.040,P=0.000),the difference between grade B and grade C was significant(OR=0.177,P=0.001),Child-Pugh grading is a risk factor for hepatitis B cirrhosis with renal injury.Hypoproteinemia is a risk factor for renal injury(OR=5.120,P=0.017).Hyperbilirubinemia was positively associated with renal injury and was an independent risk factor for renal injury(OR=3.865,P=0.006).Conclusion: 1.Hepatitis B cirrhosis with renal injury,calculation of e GFR is more predictive of renal injury than Scr.2.Hepatitis B cirrhosis,with the increase of Child-Pugh score,the incidence of renal injury increased,Child-Pugh grade C is more prone to renal injury;3.The incidence of hyponatremia in the renal injury group was significantly higher than that in the control group.Hepatitis B cirrhosis with hyponatremia was more prone to renal injury;4.Age,Child-Pugh classification,hypoproteinemia,and hyperbilirubinemia are independent risk factors for hepatitis B cirrhosis with renal injury. |
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