潘坤明 陈灿 江莹 吴薇 许青 李晓宇 吕迁洲

中图分类号 R969.3 文献标志码 A 文章编号 1001-0408（2021）09-1100-08

DOI 10.6039/j.issn.1001-0408.2021.09.13

摘 要 目的：研究我国药物致急性肾损伤（DIAKI）的临床现状和预后影响因素，为DIAKI的早期发现、早期干预和改善预后提供参考。方法：计算机检索PubMed、Embase、Cochrane Library、中国知网、万方数据库和维普网，检索DIAKI相关的临床研究，检索时限均为从各库建库起至2020年4月16日。对纳入研究进行资料提取和质量评价后，对结果进行描述性分析，并采用Rev Man 5.3软件进行Meta分析。结果：共纳入29项研究，合计1 870例患者。DIAKI例数占同期发生急性肾损伤（AKI）总例数的32.2%（877/2 721）。涉及药物以抗菌药物为主，占47.5%（773/1 629）;例数排名前5位的药物类别分别为氨基糖苷类抗生素、利尿剂或脱水剂、头孢菌素类抗生素、非甾体抗炎药和中药。DIAKI病理类型以急性间质性肾炎为主，占51.9%（70/135）。DIAKI患者病死率为14.4%（240/1 677）;共有70.4%（1 176/1 670） 的患者肾功能痊愈。与保守治疗比较，接受透析治疗的患者病死率显著更低[OR=0.30，95%CI（0.10，0.91），P=0.003];与无贫血的患者比较，合并贫血状态的患者肾功能恢复显著延迟[OR=0.25，95%CI（0.09，0.65），P=0.004];而更低的视黄醇结合蛋白水平與肾功能快速恢复显著相关[MD=-15.84，95%CI（-22.34，-9.34），P<0.01]。结论：医务人员需要不断加强抗菌药物管理，谨慎使用致AKI药物;对于发生DIAKI的患者，尽早给予透析治疗可能有助于降低其病死率;及时纠正DIAKI患者的基础贫血状态，有助于患者肾功能的快速恢复;更低的视黄醇结合蛋白水平可能是预测患者肾功能快速恢复的潜在生物标志物。

关键词 中国;药物致急性肾损伤;系统评价;抗菌药物;预后;影响因素

Systematic Review of Drug-induced Acute Kidney Injury in Chinese Population

PAN Kunming，CHEN Can，JIANG Ying，WU Wei，XU Qing，LI Xiaoyu，LYU Qianzhou（Dept. of Pharmacy， Zhongshan Hospital， Fudan University， Shanghai 200032， China）

ABSTRACT   OBJECTIVE： To study clinical situation and influential factors for prognosis of drug-induced acute kidney injury （DIAKI） in Chinese population， and to provide reference for early detection， early intervention and prognosis improvement of DIAKI. METHODS： Retrieved from PubMed， Embase， Cochrane Library， CNKI， Wanfang database and VIP， clinical studies related to DIAKI were collected during the inception to Apr. 16th， 2020. After the data extraction and quality evaluation of included studies， the results were analyzed descriptively， and Meta-analysis was carried out by Rev Man 5.3 software. RESULTS： A total of 29 studies were included， including 1 870 patients. The results showed that DIAKI accounted for 32.2% （877/2 721） of the patients developed AKI in the same period. Antibacterial drugs were the main cause of DIAKI， accounting for 47.5% （773/1 629）. The top five drugs by case number were classified as aminoglycoside antibiotics， diuretics or dehydrating agents， cephalosporin antibiotics， non-steroidal anti-inflammatory drugs and traditional Chinese medicine. The pathological type of DIAKI was mainly acute interstitial nephritis， accounting for 51.9% （70/135）. The mortality of DIAKI patients was 14.4% （240/1 677）. A total of 70.4% （1 176/1 670） of patients had renal recovery. Compared with conservative treatment， the mortality of patients receiving dialysis treatment was significantly lower [OR=0.30， 95%CI （0.10， 0.91）， P=0.003]. Compared with patients without anemia， patients with anemia had a significantly delayed renal recovery [OR=0.25， 95%CI （0.09， 0.65）， P=0.004]. Lower levels of retinol binding protein was significantly related to rapid renal recovery [MD=-15.84， 95%CI （-22.34， -9.34）， P<0.01]. CONCLUSIONS： Clinicians need to continuously strengthen antibiotic management and use drugs that induce AKI with caution. For patients with DIAKI， receiving dialysis treatment as soon as possible may help reduce mortality. Timely correction of the basic anemia status of patients with DIAKI will help patients with rapid renal recovery， and lower retinol binding protein levels may be a potential biomarker for predicting patients rapid renal recovery.

KEYWORDS   China; Drug-induced acute kidney injury; Systematic review; Antibiotics; Prognosis; Influential factor

急性肾损伤（AKI）是一种常见的临床重症，具有高病死率和进展为慢性肾脏病（CKD）的风险[1]。近年来，随着抗菌药物、抗肿瘤药物及造影剂等在临床的广泛运用，肾毒性药物越来越多地成为AKI的重要诱因[2-3]。药物致急性肾损伤（DIAKI）是指由于药物使用导致患者新出现的AKI，目前依然缺乏统一的定义[4]。由于DIAKI临床表现各异，加之肾脏本身具有很强的代偿能力，因此容易被漏诊。……