老年横纹肌溶解症的临床特征及预后分析

doi:10.3969/j.issn.1003-9198.2025.05.019

摘要/Abstract

摘要： 目的探讨老年横纹肌溶解症(rhabdomyolysis, RM)的病因、临床表现及预后情况。方法回顾性分析江苏省人民医院2016年7月至2023年10月收治的RM病人的临床资料,依据病人年龄分为老年组(≥60岁,54例)和非老年组(＜60岁,160例),比较2组病人基线特征、病因分布情况、临床表现特点、并发急性肾损伤(acute kidney injury,AKI)及30 d预后情况。结果 2组间性别、尿酸及钾离子水平差异无统计学意义(P＞0.05),肌酸激酶、血红蛋白、血尿素、血肌酐、磷离子水平差异有统计学意义(P＜0.01或P＜0.05)。2组首要危险因素有所不同,老年组前三位病因分别是感染(42.59%)、其他物理损伤(22.22%)和中毒(12.96%),而非老年组主要是剧烈运动(49.37%)、感染(16.25%)和中毒(10.62%)。老年组出现三联征中至少一种表现的病人有32例(59.26%),低于非老年组的120例(75.00%),差异具有统计学意义(P=0.042)。老年组表现为发热的比例显著高于非老年组(25.93%比7.50%,P＜0.001)。老年组AKI发生率显著高于非老年组(59.26%比24.38%,P＜0.001)。入组病人住院30 d后死亡共11例,其中老年组并发AKI死亡8例,非老年组并发AKI死亡1例,提示RM病人并发AKI与预后不良有显著的相关性(χ²=0.024,P＜0.001),且老年RM并发AKI病人的30 d死亡率显著高于非老年人(χ²=7.993,P=0.005)。结论老年RM病人与非老年RM病人的病因和临床表现各不相同,老年病人较少表现为典型三联征,但更易并发AKI,预后更差。

关键词: 老年人, 横纹肌溶解症, 急性肾损伤, 预后, 临床特征

Abstract: Objective To investigate the etiology, clinical manifestations and prognosis of rhabdomyolysis (RM)in the elderly. Methods The clinical data of RM patients admitted to Jiangsu Province Hospital from July 2016 to October 2023 were retrospectively analyzed, and the patients were divided into the elderly group (≥60 years old, 54 cases) and the non-elderly group (<60 years old, 160 cases).The baseline characteristics, etiological distribution, clinical manifestations, incidence of acute kidney injury (AKI), and 30-day prognosis were compared between the two groups. Results There were no signicant differences in gender, and the levels of uric acid and potassium between the two groups (P>0.05), while the differences in the levels of creatine kinase, hemoglobin, blood urea, serum creatinine, and phosphorus were statistically significant (P<0.01 or P<0.05). The primary risk factors were different between the two groups. In the elderly group, the top three etiologic factors were infection (42.59%), other physical injuries (22.22%) and poisoning (12.96%), while in the non-elderly group, they were strenuous exercise (49.37%), infection (16.25%) and poisoning (10.62%), respectively. There were 32 patients (59.26%) presenting with at least one manifestation of the triad in the elderly group, which was lower than that in the non-elderly group (120 cases, 75.00%), and the difference was statistically significant (P=0.042). The proportion of patients presenting with fever in the elderly group was significantly higher than that in the non-elderly group (25.93% vs 7.50%, P<0.001). The incidence rate of AKI in the elderly group was significantly higher than that in the non-elderly group (59.26% vs 24.38%,P<0.001). A total of 11 patients died within 30 days of hospitalization, including 8 cases of AKI-related death in the elderly group and 1 case in the non-elderly group.Patients with RM and a poor prognosis were significantly associated with concomitant AKI (χ²=0.024,P<0.001), and the 30-day mortality rate of elderly patients with RM complicated with AKI was significantly higher than that of non-elderly patients (χ²=7.993, P=0.005). Conclusions Elderly RM patients differ from non-elderly RM patients in terms of etiology and clinical presentation, and elderly patients are less likely to present with the classic triad, but are more likely to have concomitant AKI and have a worse prognosis.

Key words: aged, rhabdomyolysis, acute kidney injury, prognosis, clinical feature

中图分类号:

R 59

张梦, 蒋知凡, 沈淳, 谢而付, 郭露露, 张涛. 老年横纹肌溶解症的临床特征及预后分析[J]. 实用老年医学, 2025, 39(5): 530-533.

ZHANG Meng, JIANG Zhifan, SHEN Chun, XIE Erfu, GUO Lulu, ZHANG Tao. Clinical characteristics and prognosis of rhabdomyolysis in the elderly[J]. Practical Geriatrics, 2025, 39(5): 530-533.

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