Arrhythmia is a common and clinically relevant complication among patients with chronic kidney disease (CKD) undergoing hemodialysis (HD), contributing to adverse cardiovascular outcomes. We hypothesized that wearable electrocardiogram (ECG) monitors, being more patient-acceptable than standard ECG devices, could facilitate the detection of arrhythmias, including asymptomatic cases, in HD patients. This two-phase real-world observational study enrolled CKD patients undergoing maintenance HD. In Phase I, we assessed the wearable single-lead ECG monitors with comparison to standard 12-lead Holter monitoring for detecting arrhythmias and measuring heart rate variability (HRV). In Phase II, we used the wearable ECG monitors to investigate the prevalence of arrhythmias during HD. Additionally, LASSO logistic regression was conducted to identify subgroups of patients most likely to benefit from wearable devices. This study enrolled 538 patients from five hospitals. In Phase I (n = 185), we found that the wearable ECG enabled continuous monitoring of arrhythmias and HRV in patients undergoing HD. Linear regression revealed a significant correlation of parameters of HRV, including SDNN, SDANN, and pNN50 between the wearable ECG and the standard Holter monitoring (p < 0.001). LASSO logistic regression model identified the older patients (age ≥ 50) would benefit more from the usage of wearable devices than the younger. In Phase II, arrhythmias were detected in 34.0

目的:探讨影响腹膜透析(PD)患者发生导管感染的危险因素并建立列线图预测模型.方法:收集于本院行PD的213例慢性肾衰竭患者资料,将患者按6:4分为建模组(128例)及验证组(85例).建模组患者根据是否发生导管感染分为导管感染组和无导管感染组,并行单因素及多因素Logistic回归分析,建立列线图预测模型并绘制校准曲线及ROC曲线评估模型的有效性及区分度.结果:导管感染组和无导管感染组患者的体质指数、透析时间、合并糖尿病、合并高血压、机体抵抗力、心功能不全、防护不规范、出口处机械性压迫、透析充分、管道固定不良、血尿酸、血钾等比较差异有统计学意义(P＜0.05);多因素Logistic回归分析显示,透析时间(OR=17.642)、合并糖尿病(OR=3.467)、合并高血压(OR=3.705)、体质指数(OR=3.637)、防护不规范(OR=3.758)、出口处机械性压迫(OR=7.389)、管道固定不良(OR=10.158)为导管感染发生的危险因素(P＜0.05).建模组和验证组校准曲线斜率均接近1oH-L检验建模组x2=7.284,P=0.506;验证组x2=6.365,P=0.498.ROC曲线结果显示,建模组曲线下面积为0.899(95％CI 0.833～0.946),敏感度为84.72％,特异度为80.00％;验证组曲线下面积为0.879(95％CI 0.809～0.930),敏感度为94.44％,特异度为69.09％.结论:透析时间、合并糖尿病、合并高血压、体质指数、防护不规范、出口处机械性压迫、管道固定不良为影响慢性肾衰竭行PD患者发生导管感染的危险因素,建立的列线图预测模型有效性及区分度较好,能够作为早期个体化预测慢性肾衰竭行PD患者导管感染发生风险的工具.

Objective To evaluate the effect of roxadustat on iron metabolism in initial hemodialysis patients with renal anemia. Methods From January 2021 to June 2022, 120 patients with renal anemia who initially underwent hemodialysis in Jianyang People’s Hospital were retrospectively analyzed. They were divided into observation group with 54 cases and control group with 66 cases according to different anemia correction drugs, the observation group was treated with roxadustat combined with iron polysaccharide complex capsule, and the control group was treated with recombinant human erythropoietin combined with iron polysaccharide complex capsule. The observation period was 3 months. The indices of iron metabolism [serum iron, serum ferritin（SF）, transferrin saturation（TSAT）],anemia indicators [haematocrit（Hct）, red blood cell count（RBC）, hemoglobin], and the levels of inflammatory factors [tumor necrosis factor-α（TNF-α）, C-reactive protein（CRP）, and interleukin-6（IL-6）], as well as adverse reactions such as headaches, nausea and vomiting, elevated blood pressure, diarrhea and abdominal pain before and after treatment were compared between the two groups. Results After treatment, the levels of serum iron, SF, TSAT, Hct, RBC and hemoglobin in the two groups were higher than before treatment, the levels of serum iron, SF and TSAT in the observation group were（16.79±6.22） μmol/L,（298.27±115.35） ng/mL,（30.26±15.32）%, respectively, which were higher than those in the control group [（12.49±6.41） μmol/L,（214.05±96.92） ng/mL,（24.53±13.70）%], the differences were statistically significant（P＜0.05）. After 3 months of treatment, the levels of Hct, RBC and hemoglobin in the two groups were significantly higher than those before treatmen, the levels of Hct, RBC and hemoglobin in the observation group were（39.33±12.17）%,（3.48±0.80）×10 12 /L,（105.49±23.77） g/L, respectively, which were higher than those in the control group[（34.87±10.74）%,（3.21±0.73）×10 12 /L,（97.54±21.62） g/L], the differences were statistically significant（P＜0.05）. The levels of TNF-α, CRP and IL-6 in the observation group were significantly lower than after treatment, and the differences were statistically significant（P＜0.05）, while the levels of TNF-α, CRP and IL-6 in the control group were not statistically significant（P＞0.05）. The levels of TNF-α, CRP and IL-6 in the observation group were（5.66±2.43） ng/L,（9.63±7.46） mg/L,（18.06±8.25） pg/mL, respectively, which were significantly lower than those in the control group [（10.49±4.61） ng/L,（21.52±5.33） mg/L,（46.51±17.39） pg/mL], the differences were statistically significant（P＜0.05）. There was no statistically significant difference in the incidence of headache, nausea and vomiting, elevated blood pressure, diarrhea and abdominal pain between 2 groups（P＞0.05）. Conclusion Roxadustat can improve iron metabolism status in initial hemodialysis patients with renal anemia, reduce microinflammatory status, and effectively correct anemia with high safety.

Objective: To establish and validate a model to predict acute kidney injury (AKI) following wasp stings. Methods: In this multicentre prospective study, 508 patients with wasp stings from July 2015 to December 2019 were randomly divided into a training set (n = 381) and a validation set (n = 127) for internal and external validation. Risk factors were identified, and a model was established to predict the probability of AKI following multiple wasp stings using an individual nomogram and a predictive formula. The performances of the model were assessed by using the area under the curve (AUC), accuracy (ACC) of the receiver operating characteristic curve and decision curve analysis. Results: The number of stings, aspartate aminotransferase >147 U/L, lactate dehydrogenase >477 U/L, time from stings to admission >12 h and activated partial thromboplastin time >49 s were demonstrated to be independent risk factors for AKI following wasp stings (all P value < 0.05) and were incorporated into the model. The performances of the model were validated (AUC = 0.950 [95% CI: 0.923 to 0.969], ACC = 0.916 and AUC = 0.953 [95% CI: 0.900 to 0.982], ACC = 0.906 in the training set and validation set, respectively). The predictive formula and the nomogram of the model could be utilized to predict AKI following wasp stings, which have sufficient accuracies, good predictive capabilities and good net benefits. Conclusion: The predictive formula and the individual nomogram of the model might serve as promising predictive tools to assess the probability of AKI following wasp stings.

目的 探讨不同剂量尿激酶对维持性血液透析(MHD)患者动静脉内瘘血栓的溶栓效果及凝血功能的影响.方法 收集2017年6月至2021年6月简阳市人民医院收治的72例MHD发生动静脉内瘘血栓患者的临床资料,根据尿激酶剂量的不同将患者分为观察组(n=40,采用50万U尿激酶治疗)和对照组(n=32,采用25万U尿激酶治疗).比较两组患者的溶栓治疗相关情况(48 h溶栓成功率、溶栓时间)、凝血功能指标[活化部分凝血活酶时间(APTT)、凝血酶时间(TT)、组织型纤溶酶原激活物(tPA)、纤溶酶原激活物抑制物(PAI)、纤维蛋白降解产物(FDP)和D-二聚体(D-D)水平]、氧化应激反应指标[一氧化氮(NO)、过氧化氢酶(CAT)、超氧化物歧化酶(SOD)水平]和溶栓治疗后并发症发生情况.结果 观察组患者48 h溶栓成功率高于对照组患者,溶栓时间短于对照组患者,差异均有统计学意义(P<0.05).溶栓后24 h、7 d,两组患者的tPA、FDP水平均高于本组溶栓治疗前,APTT、TT均长于本组溶栓治疗前,PAI、D-D水平均低于本组溶栓治疗前,且观察组患者的tPA、FDP水平均高于对照组患者,APTT、TT均长于对照组患者,PAI、D-D水平均低于对照组患者,差异均有统计学意义(P<0.05).溶栓治疗后7 d,观察组患者的NO、SOD、CAT水平均明显高于对照组患者,差异均有统计学意义(P<0.01).结论 不同剂量尿激酶对MHD患者动静脉内瘘血栓均具有较好的治疗效果,但高剂量尿激酶起效更快,效果更优,不但能够减少氧化应激反应,改善凝血功能,而且不增加溶栓治疗后并发症.

Safe and effective anticoagulation is essential for hemodialysis patients who are at high risk of bleeding. The purpose of this trial is to evaluate the effectiveness and safety of two-stage regional citrate anticoagulation (RCA) combined with sequential anticoagulation and standard calcium-containing dialysate in intermittent hemodialysis (IHD) treatment.Patients at high risk of bleeding who underwent IHD from September 2019 to May 2021 were prospectively enrolled in 13 blood purification centers of nephrology departments, and were randomly divided into RCA group and saline flushing group. In the RCA group, 0.04 g/mL sodium citrate was infused from the start of the dialysis line during blood draining and at the venous expansion chamber. The sodium citrate was stopped after 3 h of dialysis, which was changed to sequential dialysis without anticoagulant. The hazard ratios for coagulation were according to baseline.A total of 159 patients and 208 sessions were enrolled, including RCA group (80 patients, 110 sessions) and saline flushing group (79 patients, 98 sessions). The incidence of severe coagulation events of extracorporeal circulation in the RCA group was significantly lower than that in the saline flushing group (3.64% vs. 20.41%, P<0.001). The survival time of the filter pipeline in the RCA group was significantly longer than that in the saline flushing group ((238.34±9.33) min vs. (221.73±34.10) min, P<0.001). The urea clearance index (Kt/V) in the RCA group was similar to that in the saline flushing group with no statistically significant difference (1.12±0.34 vs. 1.08±0.34, P=0.41).Compared with saline flushing, the two-stage RCA combined with a sequential anticoagulation strategy significantly reduced extracorporeal circulation clotting events and prolonged the dialysis time without serious adverse events.

Objective To evaluate the clinical significance of the changes in mean platelet volume（MPV）,platelet-large cell ratio（P-LCR）,platelet distribution width（PDW）,neutrophil-lymphocyte ratio（NLR）,platelet-lymphocyte ratio（PLR）and monocyte-lymphocyte ratio（MLR）in early diabetic nephropathy（DN）.Methods Complete blood count（CBC）of 117 DN patients and 87 healthy controls（HC）were measured.Also PLR,NLR and MLR were compared among two groups.Results MPV,P-LCR,NLR,PLR and MLR were significantly higher in DN patients than those in HC group.Conclusion The levels of MPV,P-LCR,PDW,NLR,PLR and MLR become elevated in early DN patients.All these parameters have certain clinical reference values.

近年来，局部枸橼酸抗凝（regional citrate anticoagulation，RCA）在血液净化领域得到广泛应用，对于存在出血高危风险及活动性出血的患者有其独特优势。本文回顾分析近年来国内外RCA在临床血液净化领域中的应用，其抗凝安全、有效，与全身性抗凝相比RCA可以延长滤器寿命、减少出血并发症，适宜在临床广泛开展。

Background Acute kidney injury (AKI) following wasp stings is a serious and common health hazard, however the early prediction remains challenging. The study aimed to establish a model to predict AKI following wasp stings and validate it. Methods In the multicenter prospective cohort study, 508 patients with wasp stings from Jul 2015 to Dec 2019 were randomly divided into the training set (n = 381) and validation set (n = 127) for internal and external validation. A model that based on the multivariable logistic regression analysis was utilized to predict the probability of AKI following wasp stings by a predictive formula and a nomogram. The performances of the model were assessed by using the area under the curve (AUC) and accuracy (ACC) of the receiver operating characteristic curve. The calibration curves were utilized for estimating the consistency between the actual observed outcome and the nomogram predicted AKI probability. Decision curve analysis (DCA) demonstrated the net benefit associated with the use of the nomogram-derived probability for the prediction of AKI following wasp stings. Results Number of stings, hemoglobin (HB) < 110 g/dl, total bilirubin (TBI) > 34 mg/dl, alanine transaminase (ALT) > 40 U/L and activated partial thromboplastin time (APTT) > 47 s were demonstrated as the independent risk factors for AKI following wasp stings (all P value < 0.05) and were incorporated into the model. The performances of the model were validated (AUC = 0.912, ACC = 0.869 and AUC = 0.936, ACC = 0.898 in the training set and validation set respectively). The predictive formula and nomogram of the model could be utilized to predict the AKI following wasp stings, which having sufficient accuracies, good predictive capabilities and good net benefits. Conclusion In conclusion, we proved that number of stings, HB < 110 g/dl, TBI > 34 mg/dl, ALT > 40 U/L and APTT > 47 s were independence risk factors for AKI following wasp stings. The predictive formula and the individual nomogram of the model might serve as promising predictive tools to assess the probability of the AKI following wasp stings.

目的 探讨蜂蜇伤后患者白细胞介素(IL)-2、IL-4、IL-6、IL-10、肿瘤坏死因子-α(TNF-α)、γ 干扰素(IFN-γ)的变化以及与多器官功能衰竭综合征(MODS)的相关性.方法 选取61例蜂蜇伤患者作为蜂蜇伤组,并根据是否发生M ODS分为M ODS组和非M ODS组;另选取21例健康人作为对照组.采用流式细胞术检测血清IL-2、IL-4、IL-6、IL-10、T N F-α、IFN-γ的水平.比较蜂蜇伤患者和对照组、M ODS组和非M ODS组之间细胞因子水平的差异.结果 蜂蜇伤患者血清IL-2、IL-6、IL-10、IFN-γ 的水平明显高于对照组(P<0.05),两组间IL-4、TNF-α水平比较差异无统计学意义(P>0.05);蜂蜇伤后发生MODS的患者血清IL-2、IL-10、IFN-γ水平明显高于非M ODS组(P<0.05),两组的IL-4、IL-6、T N F-α水平比较的差异无统计学意义(P>0.05).结论 蜂蜇伤后患者的部分细胞因子水平发生明显改变,细胞因子水平的改变可能参与到蜂蜇伤导致M ODS发生的机制中.

目的 探讨肾小球内补体C4d沉积对免疫球蛋白A(immunoglobulin A,IgA)肾病预后的影响.方法 选取2010年2月至2016年5月四川省简阳市人民医院肾内科收治的IgA肾病患者146例.根据补体C4d在肾小球内沉积情况将患者分为阳性组(75例)和阴性组(71例),比较两组临床及随访资料.采用Kaplan-Meier法对两组患者终点事件的发生时间进行分析;采用Cox比例风险回归模型分析发生终点事件的独立危险因素.结果 阳性组血肌酐、血尿酸、24h尿蛋白、血清IgA、血清C4d高于阴性组,估算滤过率低于阴性组(P<0.05);两组牛津分型(M、S、T分级)比较差异有显著性(P<0.05);阳性组终点事件发生率高于阴性组(P<0.05);Kaplan-Meier分析结果显示,阳性组终点事件发生时间短于阴性组(P<0.05);多因素Cox回归分析显示,肾小球内补体C4d沉积阳性是影响IgA肾病预后的独立危险因素(P<0.05).结论 肾小球内补体C4d沉积与IgA肾病患者预后较差相关,可作为判断患者预后不良的标志物.

Purpose: The results from randomized controlled trials (RCTs) concerning the timing of initiation of renal replacement therapy (RRT) for patients with acute kidney injury (AKI) are still inconsistent. Materials and methods: We searched for RCTs, as well as relevant references, focusing on the timing of RRT for AKI patients in the Medline, Embase, Cochrane Library, Google Scholar and Chinese databases from their inception to December 2018. Results: We included 18 RCTs from 1997 to 2018 involving 2856 patients. Pooled analyses of all RCTs showed no significant difference in mortality between early initiation and delayed initiation of RRT (RR 0.98, 95% CI: 0.89 to 1.08, p = .7) (I-2 = 2%), and similar results were found in critically ill and community-acquired AKI patients, as well as in a subgroup of patients with sepsis and in cardiac surgery recipients. There was also no difference in the incidence of dialysis independence (RR 0.75, 95% CI: 0.47 to 1.2, p = .2) (I-2 = 0). However, an early RRT strategy was associated with a significantly higher incidence of the need for RRT for AKI patients (RR 1.24, 95% CI: 1.13 to 1.36, p < .01) (I-2 = 34%). Conclusions: As no life-threatening complications occurred, there was no evidence to show any benefit of an early RRT strategy for critically ill or community-acquired AKI patients; in contrast, a delayed strategy might avert the need for RRT.

The aim of this study was to explore the effect of sex on the clinicopathological features and long-term outcomes of IgAN patients. A total of 1096 adult IgAN patients were divided into male and female groups. Clinicopathological features and risk factors of IgAN patients of different genders were contrasted. The primary endpoint was the combined endpoint of a 50% reduction in estimated glomerular filtration rate (eGFR) and/or end stage renal disease (ESRD: eGFR < 15 mL/min/1.73 m2 or dialysis). The effect of gender on prognosis of IgAN was assessed using Kaplan–Meier and Cox proportional hazards models. In total, 475 male patients and 621 female patients were included in this study. At baseline, male patients had higher values for blood pressure, serum creatinine, urine protein and serum uric acid, as well as lower levels of eGFR. Further analysis indicated that tubular atrophy/interstitial fibrosis (T) lesions and vascular lesions were more frequent in male patients. During the follow-up period of 40.9 ± 24.2 months, kidney survival rates of male IgAN patients were remarkably lower than those of female patients. Using multivariate Cox regression analysis, male gender was identified as an independent risk factor for poor outcomes (β = 0.384, Wald = 4.290, Exp (β) = 1.47, p = 0.038), including hypertension, low eGFR, IgM deposition, arteriosclerosis lesions and T1–T2 lesions. However, male and female patients were characterized by different risk factors. Male patients presented with more severe clinical and pathological changes than female patients. Renal survival rates of male patients were remarkably lower than those of female patients, and male gender was identified as an independent risk factor for poor outcomes.

目的 目前国内报道非典型抗肾小球基底膜(抗GBM)肾炎病例较少,本文将结合病例对非典型抗GBM肾炎的诊断、治疗及预后进行分析、探讨.方法 回顾性分析四川大学华西医院肾内科1例非典型抗GBM肾炎患者的临床表现、诊治思路、治疗结局,并进行相关文献复习.结果 患者经过血浆置换联合糖皮质激素及免疫抑制剂治疗后,尿蛋白、血尿转阴,血肌酐正常,肾功能完全恢复病情平稳.结论 抗GBM肾炎患者的临床和病理表现复杂多样,存在个体差异及特殊类型,如临床上疑似该病,应行抗GBM抗体检测及肾穿刺活检明确诊断,及早的诊断和充分有效地治疗,可明显改善肾脏的预后.

Objective To explore the relationship of serum ferritin(SF) level with prognosis in maintenance hemodialysis patients.Methods From June 2011 to December 2012, 180 patients with end-stage renal diseases(ESRD) who underwent maintenance hemodialysis in the Department of Nephrology of Jianyang People’s Hospital were selected as the subjects. These patients were followed up until December 31, 2017. Dialysis related indicators and outcome indicators were recorded. The main endpoint event was death. Cumulative survival rate was calculated with a non-parametric product estimation method, the Kaplan-Meier method. Single-variate and multivariate COX proportional hazard models were adopted to analyze the independent hazard factors influencing prognosis of maintenance hemodialysis patients. Results The one-year, two-year, three-year and five-year cumulative survival rates of the high SF group and low SF group were 78.57%, 69.05%, 57.14%, 42.86% and 89.86%, 82.61%, 73.91% and 60.15%, respectively. There was a significant difference in survival rate between the two groups by Log-rank test showed difference of statistical significance in the survival rate between two groups(P<0.05). Multivariate COX regression analysis indicated that high SF level was an independent hazard factor for mortality in maintenance hemodialysis patients(P<0.05). The mortality rates of cardiovascular disease and infection in the high SF group was higher than that those in the low SF group(P<0.05). Conclusions The survival rate of hemodialysis patients with high SF level is relatively low. High SF level is an independent hazard factor for mortality in maintenance hemodialysis patients.

蜂蛰伤后蜂毒对心肌的损伤主要是直接毒性作用和过敏反应引起的间接损伤,其临床表现多样,包括Kounis综合征、心动过缓伴或不伴心肌梗死、Kounis综合征合并应激性心肌病、药物洗脱支架内血栓形成、心房颤动、心房扑动、房室传导阻滞、预激综合征等.该文通过临床案例介绍蜂蛰伤后心肌损伤的临床表现及其发病机制.

IgA肾病是世界范围内发病率最高的原发性肾小球疾病,但由于其临床和病理表现多样,个体预后差异极大.影响IgA肾病预后的因素很多,尿蛋白、肾小球滤过率、血压、尿酸等临床检验指标,半乳糖缺乏型IgA1分子、氧化蛋白产物、血清免疫球蛋白G等生物标志物,系膜细胞增殖、内皮细胞增殖、节段性硬化或黏连、肾小管萎缩/肾间质纤维化、新月体病变等病理变化标志物,都可作为IgA肾病预后预测标志物.

目的 探究老年尿毒症皮肤瘙痒患者在使用不同血液净化模式后的治疗效果.方法 研究对象为2015年6月-2016年6月收入的老年尿毒症皮肤瘙痒患者80例,分为血液透析组(HD组),血液透析滤过组(HDF组),血液透析+血液灌流组(HD+HP组).采用视觉模拟评分法(VAS)评价3组患者的皮肤瘙痒程度,并对比观察3组患者的生化指标.结果 治疗前,3组患者VAS评分比较差异无统计学意义(P>0.05);治疗后3组VAS评分均较治疗前降低,HDF组与HD+HP组均低于HD组,HD+HP组低于HDF组,差异均有统计学意义(P<0.05).治疗前,3组患者各生化指标比较差异无统计学意义(P>0.05);治疗后相对于HD组和HDF组,HD+HP组患者的生化指标改善较为明显,差异有统计学意义(P<0.05).结论 采用HD+HP治疗老年尿毒症患者,不仅能够改善生化指标,还能减轻皮肤瘙痒症状,值得临床应用与推广.

目的:探讨血液透析患者予以吲哚布芬治疗以降低其动静脉内瘘术后血栓的临床效果.方法:本次200例肾衰血液透析患者均为我院2014年1月—2016年1月期间收治,根据用药的不同将其分为两组,其中100例患者给予阿司匹林药物治疗作为对照组,另100例患者给予吲哚布芬药物治疗作为观察组,观察两组患者用药后动静脉内瘘术后血栓发生情况.结果:给药前两组患者各凝血功能指标对比均无统计学意义(P＞0.05),给药12周后,观察组与给药前相比FIB水平下降,APTT增加(P＜0.05),而对照组用药前后各指标对比均无统计学意义(P＞0.05);两组间给药后各指标对比差异亦无统计学意义(P＞0.05);两组患者用药后,观察组内瘘1年通畅率96.0％(96/100)明显优于对照组89.0％(89/100),差异具有显著性(P＜0.05).内瘘闭塞者均经B超检查,行局部溶栓或取栓术治疗.结论:血液透析患者实施吲哚布芬治疗,可有效降低其动静脉内瘘术后血栓发生率,效果显著,同时具有一定的预防血栓形成作用.

目的 分析连续性肾脏替代治疗(continuous renal replacement therapy,CRRT)在蜂蜇伤致横纹肌溶解症合并急性肾损伤(acute kidney injury,AKI)中的应用.方法 前瞻性分析简阳市人民医院、四川大学华西医院及安岳县人民医院2013年1月-2016年12月收治的132例蜂蜇伤致横纹肌溶解症患者,其中62例合并AKI,均接受CRRT治疗,采用连续性静脉-静脉血液滤过(continuous veno-venous hemofiltration,CVVH)的模式.CVVH机型为金宝Prismaflex,滤器选择M100-AN69,血流量180～ 200mL/min,置换液速度2 000～2 500mL/h[30～ 35 mL/(kg.h)],应用普通肝素或低分子肝素抗凝,碳酸氢盐置换液采用前稀释方法输入,治疗时间至少48 h;患者病情稳定后使用间断血液透析.对比患者治疗前后生化指标变化、住院时间、生存率及肾功能恢复情况,使用SPSS 19.0软件进行统计学分析.结果 51例患者符合入选标准,其中4例(7.8％)在住院期间死亡,其余47例完成治疗及随访.经治疗3、7、14d后患者肌酸激酶、肌红蛋白、乳酸脱氢酶均明显下降,并逐渐恢复至正常水平.45例(95.7％)患者肾脏功能在3个月内恢复,2例患者发展为慢性肾脏病.患者血红蛋白于(30.5±11.3)d后恢复至正常水平.结论 蜂蜇伤致横纹肌溶解合并AKI是蜂蜇伤的严重并发症,早期积极的CRRT干预能获得满意疗效.