石家庄肾病医院搜集，中华儿童肾病网摘录J6V中华儿童肾病网

【摘要】 目的 探讨严重急性呼吸综合征（SARS）并发肾脏损害的临床特征，分析其可能的原因。方法 选择北京佑安医院的SARS住院患者124例，观察了临床症状、体征、肾功能等实验室指标并对其中8例有肾损害、12例无肾损害及15例健康对照者分别检测了血清IL-1β、IL-2、IL-4、IL-6、IL-8、IL-10、TNF-α水平。2例SARS死亡患者进行了肾脏病理检查。结果 124例SARS患者中有14例（11.29%）血清Cre和BUN升高，Ccr降低。14例SARS伴肾损害的患者中12例为重症，发生率明显高于轻症，P<0.01;有糖尿病和/或高血压病史的患者8例，明显多于无基础疾病者，P<0.05;年龄>60岁的患者5例，明显多于青壮年患者，P<0.05。发病2周内出现肾损害9例。5例患者在2周内血清Cre恢复正常，8例患者死亡，1例转院。肾脏病理学检查提示非特异性炎症反应。SARS患者无论有无肾损害，7种细胞因子水平均明显高于对照组，P<0.01或P<0.05。有肾损害组的细胞因子水平明显高于无肾损害组，P<0.01或P<0.05。结论 SARS患者可以合并肾损害，其发生与病情轻重、年龄、有无慢性肾脏损害基础疾病密切相关。急性期血清细胞因子的明显升高提示SARS患者急性期存在系统性炎性反应综合征（SIRS），肾损害可能部分与SIRS有关。J6V中华儿童肾病网

关键词 严重急性呼吸综合征 肾脏损害 系统性炎性反应综合征J6V中华儿童肾病网

Clinical characteristics and preliminary analysis for pathogenesis J6V中华儿童肾病网

of kidney damage in patients of severe acute respiratory syndrome J6V中华儿童肾病网

Wen Yubing，Liu Huilan，Duan Zhongping，et al.J6V中华儿童肾病网

Department of Nephrology，Fuxing Hospital，Capital University of Medical Sciences，Beijing100038. J6V中华儿童肾病网

【Abstract】 Objective To summarize the clinical features of kidney damage in patients of severe acute respiˉratory syndrome（SARS）and provide a preliminary analysis for pathogenesis of kidney damage of SARS.Methods 124patients suffered from SARS，which were admitted to the isolation wards of Beijing You’an Hospital，were collected and analyzed about the clinical and some laboratory data，especially renal function.Among them serum interlukin-1β（IL-1β），IL-2，IL-4，IL-6，IL-8，IL-10，tumor necrosis factor（TNF）-αlevel of8cases with kidney damage，12cases without kidney damage and15healthy care workers were assayed by sandwich ELISA.Postmortem examinaˉtion of kidney in2cases were performed.Results Serum creatinine and BUN level elevated and Ccr declined in11.29percent（14cases）of124SARS patients.85.71percent of14cases with kidney injurywas fatal SARS and sigˉnificantly more than slight SARS，P<0.01.57.14%of14cases had suffered from diabetes mellitus and/or primary hypertension and statistically more than the patients without accompanying diseases，P<0.05.35.71%of14cases was over60years old and significantly more than youth and middle-aged，P<0.05.Kidney injury in9cases ocˉcurred within two weeks from disease development.Renal function of5cases turned to normal gradually in two weeks，8cases died and1case was admitted to other hospital.Pathological observation showed a non-specific inflammatory reaction.SARS with or without kidney damage had significantly higher serum IL-1β，IL-2，IL-4，IL-6，IL-8，IL-10，TNF-αlevel than control in the acute phrase，P<0.01or0.05.Serum levels of the seven cytokines in paˉtients with kidney damage were statistically higher than in patients without kidney damage，P<0.01or0.05.Concluˉsion SARS with kidney damage is not fewer.Kidney injury of SARS is closely associated with disease severity，age，basic primary or secondary kidney diseases.It is also shown that there is a early-response of cytokines，such as interˉleukins and tumor necrosis factors.The results suggest strongly that there maybe a systemic inflammat oryresponse synˉdrome（SIRS）in SARS patients in early stage，and the kidney damage maybe partially correlate with SIRS.J6V中华儿童肾病网

Key words severe acute respiratory syndrome kidney damage systemic inflammatory response syndrome J6V中华儿童肾病网

严重急性呼吸综合征（severe acute respiratory syndrome，SARS）是由新型冠状病毒引起的以呼吸系统（主要是肺泡与肺间质）的急性炎症性损伤为突出表现的新型烈性传染病。WHO的资料表明，截止到2003年7月11日，全球SARS患者为8437例，死亡率高达9.64% ［1］ 。SARS冠状病毒感染人体后，会在肺组织细胞增殖表达并使宿主发生强烈的免疫反应，引起弥漫性肺泡和间质炎性渗出、水肿、透明膜形成，进而导致肺泡气体交换障碍 ［2］ 。SARS出现的呼吸衰竭，并发心、肝、肾等其它脏器损害已经成为病情重症化及死亡的主要原因。本文重点分析了SARS并发肾脏损害的特点，并对其原因进行了初步探讨。