支气管扩张症急性加重增加不良肾脏结局风险——一项大型全区域队列研究的结果
Bronchiectasis Exacerbation Increases the Risk of Adverse Renal Outcomes-Results From a Large Territory-Wide Cohort Study.
作者信息
Kwok Wang Chun, Tsui Chung Ki, Sze Him Isaac Leung, Wong Chun Ka Emmanuel, Tam Terence Chi Chun, Ho James Chung Man, Yap Desmond Yat Hin
机构信息
Division of Respiratory Medicine and Critical Care Medicine, Department of Medicine, Queen Mary Hospital, The University of Hong Kong, Pok Fu Lam, Hong Kong SAR, China.
Department of Statistics, The Chinese University of Hong Kong, Sha Tin, Hong Kong SAR, China.
出版信息
Clin Respir J. 2025 Jan;19(1):e70029. doi: 10.1111/crj.70029.
INTRODUCTION
Bronchiectasis exacerbation (BE) is associated with unfavorable sequelae in other organs such as the cardiovascular system; data regarding its impact on adverse term renal outcomes, however, is lacking.
METHODS
A territory-wide retrospective cohort study was conducted in Hong Kong between 1/1/1993 and 31/12/2017. All patients with bronchiectasis followed in the public healthcare system in 2017 were classified as "Exacerbators" or "Non-Exacerbators," and their adverse renal outcomes (renal progression [decrease in eGFR by 30 mL/min lasted for more than 12 months during follow up], acute kidney injury [AKI], and annual rate of eGFR decline) in the ensuing 7 years were compared. Results were also analyzed in the 1:1 propensity score matched (PSM) cohort.
RESULTS
A total of 7929 patients (1074 "Exacerbators" group and 6855 "Non-exacerbators") were followed for 6.2 ± 1.6 years. A total of 1570 patients (19.8%) had renal progression, and 935 (11.8%) patients developed AKI. "Exacerbators" showed significantly increased risk of renal progression (adjusted odds ratio [aOR] 1. 27 [95% CI 1.08-1.50, p = 0.003]), more rapid eGFR decline (-3.67 [-1.74 to -6.54] vs. -3.03 [-1.56 to -5.12] mL/min/1.73 m/year, p = 0.004) and AKI (aOR 1.99; 95% CI 1.44-2.73, p < 0.001) than the "Non-exacerbators." Annual number of BE was associated with renal progression (aOR 1.45; 95% CI 1.22-1.72, p < 0.001) and AKI (aOR 2.00; 95% CI 1.38-2.91, p < 0.001). Results were consistent in the analysis with the PSM cohort.
CONCLUSIONS
Renal progression and AKI are common among patients with bronchiectasis, and BE is an independent risk factor for adverse renal outcomes.
引言
支气管扩张症急性加重（BE）与心血管系统等其他器官的不良后果相关；然而，关于其对远期肾脏不良结局影响的数据尚缺乏。
方法
1993年1月1日至2017年12月31日期间在香港进行了一项全地区的回顾性队列研究。将2017年在公共医疗系统中接受随访的所有支气管扩张症患者分为“急性加重组”或“非急性加重组”，并比较他们在随后7年中的肾脏不良结局（肾脏进展[随访期间估算肾小球滤过率（eGFR）下降30 mL/min持续超过12个月]、急性肾损伤[AKI]和eGFR年下降率）。还在1:1倾向评分匹配（PSM）队列中分析了结果。
结果
共7929例患者（“急性加重组”1074例，“非急性加重组”6855例）接受了6.2±1.6年的随访。共有1570例患者（19.8%）出现肾脏进展，935例（11.8%）患者发生AKI。“急性加重组”患者出现肾脏进展的风险显著增加（调整后的优势比[aOR]为1.27[95%可信区间（CI）1.08 - 1.50，p = 0.003]），eGFR下降更快（-3.67[-1.74至-6.54] vs. -3.03[-1.56至-5.12] mL/min/1.73 m²/年，p = 0.004），发生AKI的风险也更高（aOR 1.99；95% CI 1.44 - 2.73，p < 0.001）。与“非急性加重组”相比。BE的年发作次数与肾脏进展（aOR 1.45；95% CI 1.22 - 1.72，p < 0.001）和AKI（aOR 2.00；95% CI 1.38 - 2.91，p < 0.001）相关。在PSM队列分析中结果一致。
结论
肾脏进展和AKI在支气管扩张症患者中很常见，BE是肾脏不良结局的独立危险因素。
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