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RÉSUMÉ
Objectif. Décrire les aspects cliniques, biologiques et évolutifs des patients hospitalisés pour Insuffisance rénale aigue (IRA) et ayant été mis en hémodialyse. Méthodes. Il s’agissait d’une étude de cohorte de patients hospitalisés au service de Néphrologie- Médecine Interne D du CHU de Treichville; réalisée sur une période de 02 ans d’Octobre 2016 à Septembre 2018. Résultats. Nous avons colligé 84 cas d’IRA hémodialysée durant la période d’étude. L’âge moyen était de 42,6±15,5 ans avec une prédominance masculine (sex-ratio=2,23). Les patients étaient majoritairement référés pour altération de la fonction rénale (38%). Ils étaient admis pour perte de connaissance(23,8%), diarrhée-vomissements (14,3%). Les facteurs de risque tels que l’hypertension artérielle(23,8%), le VIH (11,9%) et le diabète(7,1%) ont été retrouvés. L’atteinte rénale était parenchymateuse (92,9%) et obstructive(7,1%). Les principales étiologies étaient infectieuses (42,8%) et toxiques (38%). La dialyse a été indiquée devant une urémie sévère(73,7%) et une anurie de plus de 24h (36,8%). Le nombre moyen de séance était de 3. L’évolution était favorable dans 73,8% des cas avec une récupération totale de la fonction rénale dans 40,5%. La présence de diabète était associée au risque de décès chez nos patients (OR=2,30; IC95%=1,73-7,20; p=0,03). Les facteurs tels que l’obstruction des voies urinaires(OR=1,77; IC95%=1,45-2,15; p=0,03), et la présence de diabète (OR=0,56; IC95%=0,46-0,68; p=0,03) étaient associés à la non-récupération de la fonction rénale. Conclusion. La mortalité chez les hémodialysés pour IRA reste élevée. Les étiologies sont dominées par les infections et les causes toxiques. La présence de diabète impacte le pronostic des patients.
ABSTRACT
Aim. To describe the clinical, biological and evolutionary aspects of patients hospitalized for acute kidney injury (AKI) and having undergone hemodialysis sessions. Methods. This was a cohort study of hospitalized patients in the Department of Nephrology-Internal Medicine D of the Teaching Hospital of Treichville carried over a period of 02 years from October 2016 to September 2018. Results. We collected 84 cases of hemodialysis AKI during the study period. The mean age was 42.6 ± 15.5 years with a male predominance (sex ratio = 2.23). The majority of patients were referred for impaired kidney function (38%). They were admitted for loss of consciousness (23.8%), diarrhea and vomiting (14.3%). Risk factors such as high blood pressure (23.8%), HIV (11.9%) and diabetes (7.1%) were found. Kidney damage was parenchymal (92.9%) and obstructive (7.1%). The main diseases were infectious (42.8%) and toxic (38%). Dialysis was performed for severe uremia (73.7%) and anuria of more than 24 hours (36.8%). The average number of sessions was 3. The evolution was favorable in 73.8% of the cases with a total recovery of the renal function in 40.5%. Being diabetic was associated with the risk of death in our patients (OR = 2.30, 95% CI = 1.73-7.20, p = 0.03). Factors such as urinary tract obstruction (OR = 1.77, 95% CI = 1.45-2.15, p = 0.03), and presence of diabetes (OR = 0.56, 95% CI) 0.46-0.68, p = 0.03) were associated with recovery of renal function. Conclusion. Mortality in hemodialysis for AKI remains high. The main causes were dominated by infections and toxic causes. The presence of diabetes impacts the prognosis of patients.
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References
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- doi: 10.1016/s0140-6736(95)92057-9.
- -Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol2005; 16: 3365-70. DOI: 10.1681/ASN.2004090740
- -Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet 2005; 365: 417-30. DOI: 10.1016/S0140-6736(05)17831-3
- -Lameire N, Van Biesen W, Vanholder R. The changing epidemiology of acute renal failure. Nature Clin Prat Nephrol2006; 2: 362-77. DOI: 10.1038/ncpneph0218
- -Van Biesen W, Vanholder R, Lameire N. Defining acute renal failure: RIFLE and beyond. Clin J Am Soc Nephrol2006; 1314-9. DOI: 10.2215/CJN.02070606
- -Waiker SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol 2006; 17: 1143-50. DOI: 10.1681/ASN.2005091017
- -Yao KH, Konan SD, Tia WM, Diopoh SP, Moh R, Sanogo S. Outcomes of acute kidney injury in a department of internal medicine in Abidjan (Côte d’Ivoire). Nephrology 2018; 23(7): 653-60. https://doi.org/10.1111/nep.13064
- -Clec'h C, Gonzalez F, Lautrette A, Nguile-Makao M, Garrouste-Orgeas M, Jamali S, et al. Multiple-center evaluation of mortality associated with acute kidney injury in critically ill patients: a competing risks analysis. Crit Care. 2011; 15(3): R128. doi: 10.1186/cc10241
- -Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational Aki-epistudy. Intensive Care Med. 2015;41(8):1411-23. doi: 10.1007/s00134-015-3934-7
- -Vinsonneau C, Allain-Launay E, Blayau C, Darmon M, Ducheyron D, Gaillot T, et al. Renal replacement therapy in adult and pediatric intensive care:recommendations by an expert panel from the French Intensive Care Society (Srlf) with the French society of anesthesia intensive care (Sfar) French group for pediatric intensive care emergencies (Gfrup) the French dialysis society (Sfd). Ann Intensive Care. 2015;5(1):58. doi: 10.1186/s13613-015-0093-5
- -Yang X, Tu G, Gao J, Wang C, Zhu D, Shen B, et al. A comparison of preemptive versus standard renal replacement therapy for acute kidney injury after cardiac surgery. J SurgRes. 2016; 204(1):205-12. DOI:10.1016/j.jss.2016.04.073
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- -Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med. 2016; 375(2): 122-33. doi: 10.1056/NEJMoa1603017
- -Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care Med 2007; 11(2):31. DOI: 10.1186/cc5713
- -American Diabetes Association. Part2. Classification and Diagnosis of Diabetes. Diabetes Care 2015; 38(1): S8-S16. https://doi.org/10.2337/dc15-S005
- -Abel N, Contino K, Jain N, Grewal N, Grand E, Hagans I, et al. Eighth Joint National Committee (JNC-8) Guidelines and the Outpatient Management of Hypertension in the African-American Population. N Am J Med Sci2015; 7 (10): 438–45. DOI: 10.4103/1947-2714.168669
- -Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250-6. DOI: 10.1097/01.CCM.0000050454.01978.3B
- -Haukoos JS, Hopkins E, Conroy AA, Silverman M, Byyny RL, Eisert S, et al. Routine Opt-Out Rapid HIV Screening and Detection of HIV Infection in Emergency Department Patients. JAMA 2010; 304 (3): 284-92. DOI: 10.1001/jama.2010.953
- -Lengani A, Kargougou D, Fogazzi GB, Laville M.Acute renalfailure in Burkina Faso. Nephrol Ther 2010; 6: 28-34. Doi : 10.1016/j.nephro.2009.07.013
- -Kaballo BG, Khogali MS, Khalifa EH, Khaiii EH, Ei-Hassan AM, Abu-Aisha H. Patterns of “severe acute renalfailure” in a referral center in Sudan:excluding intensive care and major surgery patients. Saudi J Kidney Dis Transpl 2007; 18: 220-5.
- -Arogundade FA, Sanusi AA, Okunola OO, Soyinka FO, Ojo OE, Akinsola A. Acute renalfailure (ARF) in developing countries:which factors actually influence survival. Cent Afr J Med 2007; 53: 34-9. DOI: 10.4314/cajm.v53i5-8.62614
- -Fagugli RM, Patera F, Battistoni S, Tripepi G. Outcome in noncriticallyill patients with acute kidney injury requiring dialysis: Effects of differing medical staffs and organizations. Medicine 2016; 95(30): e4277. doi: 10.1097/MD.0000000000004277
- -Bensalem M, Frih A, Ghali M, Elhmidi K, Gazouini N, Hamouda H, et al. Hémodialyse en situation d’urgence : à propos de 114 cas. Nephrol Ther 2015 ; 11 : 297. https://doi.org/10.1016/j.nephro.2015.07.093
- -Chou YH, Huang TM, Wu VC, Wang CY, Shiao CC, Lai CF et al. Impact of timing of renal replacement therapy initiation on outcome of septic acute kidneyinjury. Crit Care 2011; 15(3): R134. doi: 10.1186/cc10252
- -Chijioke A, Makusidi AM, Rafiu MO. Factors influencing hemodialysis and outcome in severe acute renal failure from Ilorin, Nigeria. Saudi J Kidney Dis Transpl 2012; 23: 391-6.
- -Dembélé S.Prévalence hospitalière de l’insuffisance rénale aigue obstructive dans le service de néphrologie et d’hémodialyse du chu de point G [Thèse Med]. Bamako, 2008: N°603. http://www.keneya.net/fmpos/theses/2008/med/pdf/08M603.pdf (consulté le 15 juin 2021)
- -Ait Elhaj L, Aladlouni A, Fadili W, Laouad I. Insuffisance rénale aiguë dialysée en néphrologie : de quelle origine ? Et pour quel pronostic. Nephrol Ther 2012 ;8 : 344.
- -Haffane L, Bezzaz A, Elouazzani H, Benamer L, Ezaitouni F, Alhamany, et al. Insuffisance rénale aiguë : épidémiologie et facteurs pronostiques. Nephrol Ther 2012 ; 8 : 340-1.
- -Hamzic-Mehmedbasic A, Rasic S, Rebic D, Durak-Nalbantic A, Muslimovic A, Dzemidzic J. Renal Function Outcome Prognosis in Septic and Non-septic Acute Kidney Injury Patients. Med Arch 2015; 69(2): 77-80. doi: 10.5455/medarh.2015.69.77-80
- -Tia WM, Yao H, Coulibaly PA, Delorg DC, Gnionsahé DH, Ouattara B. Evolution des étiologies de l’insuffisance rénale aigue de 1982 à 2011 au CHU de Yopougon à Abidjan. RISM 2018; 20(1) : 51-5. http://www.revues-ufhb-ci.org/fichiers/FICHIR_ARTICLE_2141.pdf (consulté le 15 juin 2021)
- -Krishna ChV, Rao PV, Das GC, Kumar VS. Acute renal failure in falciparum malaria:Clinical characteristics, demonstration of oxidative stress, and prognostication, Saudi J Kidney Dis Transpl 2012; 23(2): 296-300.
- -Maheshwari A, Singh AK, Sinha DK, Tripathi D, Prakash J. Spectrum of renaldisease in malaria. J Indian Med Assoc 2004; 102(3): 143.
- -Luyckx VA, Ballantine R, Claeys M, Cuyckens F, Van den Heuvel H,Cimanga RK, et al. Herbal remedy-associated acute renal failure secondary to Cape aloes. Am J Kidney Dis 2002; 39: 13. DOI: 10.1053/ajkd.2002.31424
- -Jha V, Rathi M. Natural medicines causing acute kidney injury. Semin Nephrol 2008; 28(4): 416-28. DOI: 10.1016/j.semnephrol.2008.04.010
- -Igiraneza G, Ndayishimiye B, Nkeshimana M, Dusabejambo V, Ogbuagu O. Clinical Profile and Outcome of Patients with Acute Kidney Injury Requiring Hemodialysis:TwoYears’ Experience at a Tertiary Hospital in Rwanda. BiomedRes Int [Internet] 2018 [Consulté le 13 Mars 2019]; 2018: Article ID 1716420. Disponible sur : https://www.hindawi.com/journals/bmri/2018/1716420/. (consulté le 20 juin 2021)
- -Bourial M, El Khayat S, Zamd M, Medkouri G, Benghanem, Ramdani B. Indications de la dialyse aiguë au Maroc. Nephrol Ther 2017; 13: 365-6.
- -Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstadt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the Elain randomized clinical trial. JAMA. 2016; 315(20):2190-9. DOI: 10.1001/jama.2016.5828
- -Yang X-M, Tu G-W, Zheng J-L, Shen B, Ma GG, Hao G-W, et al. A comparison of early versus late initiation of renal replacement therapy for acute kidney injury in critically ill patients: an updated systematic review and meta analysis of randomized controlled trials. BMC Nephrology 2017; 18:264. DOI: 10.1186/s12882-017-0667-6
- -Hu SL, Said FR, Epstein D, Lokeshwari M. The impact of anemia on renal recovery and survival in acute kidney injury. Clin Nephrol 2013; 79(3): 221-8. DOI: 10.5414/cn107471
References
-Brady HR, Singer GG. Acute renal failure. Lancet 1995; 346: 1533-40.
doi: 10.1016/s0140-6736(95)92057-9.
-Chertow GM, Burdick E, Honour M, Bonventre JV, Bates DW. Acute kidney injury, mortality, length of stay, and costs in hospitalized patients. J Am Soc Nephrol2005; 16: 3365-70. DOI: 10.1681/ASN.2004090740
-Lameire N, Van Biesen W, Vanholder R. Acute renal failure. Lancet 2005; 365: 417-30. DOI: 10.1016/S0140-6736(05)17831-3
-Lameire N, Van Biesen W, Vanholder R. The changing epidemiology of acute renal failure. Nature Clin Prat Nephrol2006; 2: 362-77. DOI: 10.1038/ncpneph0218
-Van Biesen W, Vanholder R, Lameire N. Defining acute renal failure: RIFLE and beyond. Clin J Am Soc Nephrol2006; 1314-9. DOI: 10.2215/CJN.02070606
-Waiker SS, Curhan GC, Wald R, McCarthy EP, Chertow GM. Declining mortality in patients with acute renal failure, 1988 to 2002. J Am Soc Nephrol 2006; 17: 1143-50. DOI: 10.1681/ASN.2005091017
-Yao KH, Konan SD, Tia WM, Diopoh SP, Moh R, Sanogo S. Outcomes of acute kidney injury in a department of internal medicine in Abidjan (Côte d’Ivoire). Nephrology 2018; 23(7): 653-60. https://doi.org/10.1111/nep.13064
-Clec'h C, Gonzalez F, Lautrette A, Nguile-Makao M, Garrouste-Orgeas M, Jamali S, et al. Multiple-center evaluation of mortality associated with acute kidney injury in critically ill patients: a competing risks analysis. Crit Care. 2011; 15(3): R128. doi: 10.1186/cc10241
-Hoste EAJ, Bagshaw SM, Bellomo R, Cely CM, Colman R, Cruz DN, et al. Epidemiology of acute kidney injury in critically ill patients: the multinational Aki-epistudy. Intensive Care Med. 2015;41(8):1411-23. doi: 10.1007/s00134-015-3934-7
-Vinsonneau C, Allain-Launay E, Blayau C, Darmon M, Ducheyron D, Gaillot T, et al. Renal replacement therapy in adult and pediatric intensive care:recommendations by an expert panel from the French Intensive Care Society (Srlf) with the French society of anesthesia intensive care (Sfar) French group for pediatric intensive care emergencies (Gfrup) the French dialysis society (Sfd). Ann Intensive Care. 2015;5(1):58. doi: 10.1186/s13613-015-0093-5
-Yang X, Tu G, Gao J, Wang C, Zhu D, Shen B, et al. A comparison of preemptive versus standard renal replacement therapy for acute kidney injury after cardiac surgery. J SurgRes. 2016; 204(1):205-12. DOI:10.1016/j.jss.2016.04.073
-Bagshaw SM, Uchino S, Bellomo R, Morimatsu H, Morgera S, Schetz M, et al. Timing of renal replacement therapy and clinical outcomes in critically ill patients with severe acute kidney injury. J Crit Care. 2009;24(1):129–40. doi: 10.1016/j.jcrc.2007.12.017
-Gaudry S, Hajage D, Schortgen F, Martin-Lefevre L, Pons B, Boulet E, et al. Initiation strategies for renal-replacement therapy in the intensive care unit. N Engl J Med. 2016; 375(2): 122-33. doi: 10.1056/NEJMoa1603017
-Mehta RL, Kellum JA, Shah SV, Molitoris BA, Ronco C, Warnock DG, et al. Acute Kidney Injury network: report of an initiative to improve outcomes in acute kidney injury. Crit Care Med 2007; 11(2):31. DOI: 10.1186/cc5713
-American Diabetes Association. Part2. Classification and Diagnosis of Diabetes. Diabetes Care 2015; 38(1): S8-S16. https://doi.org/10.2337/dc15-S005
-Abel N, Contino K, Jain N, Grewal N, Grand E, Hagans I, et al. Eighth Joint National Committee (JNC-8) Guidelines and the Outpatient Management of Hypertension in the African-American Population. N Am J Med Sci2015; 7 (10): 438–45. DOI: 10.4103/1947-2714.168669
-Levy MM, Fink MP, Marshall JC, Abraham E, Angus D, Cook D, et al. 2001 SCCM/ESICM/ACCP/ ATS/SIS International Sepsis Definitions Conference. Crit Care Med 2003; 31: 1250-6. DOI: 10.1097/01.CCM.0000050454.01978.3B
-Haukoos JS, Hopkins E, Conroy AA, Silverman M, Byyny RL, Eisert S, et al. Routine Opt-Out Rapid HIV Screening and Detection of HIV Infection in Emergency Department Patients. JAMA 2010; 304 (3): 284-92. DOI: 10.1001/jama.2010.953
-Lengani A, Kargougou D, Fogazzi GB, Laville M.Acute renalfailure in Burkina Faso. Nephrol Ther 2010; 6: 28-34. Doi : 10.1016/j.nephro.2009.07.013
-Kaballo BG, Khogali MS, Khalifa EH, Khaiii EH, Ei-Hassan AM, Abu-Aisha H. Patterns of “severe acute renalfailure” in a referral center in Sudan:excluding intensive care and major surgery patients. Saudi J Kidney Dis Transpl 2007; 18: 220-5.
-Arogundade FA, Sanusi AA, Okunola OO, Soyinka FO, Ojo OE, Akinsola A. Acute renalfailure (ARF) in developing countries:which factors actually influence survival. Cent Afr J Med 2007; 53: 34-9. DOI: 10.4314/cajm.v53i5-8.62614
-Fagugli RM, Patera F, Battistoni S, Tripepi G. Outcome in noncriticallyill patients with acute kidney injury requiring dialysis: Effects of differing medical staffs and organizations. Medicine 2016; 95(30): e4277. doi: 10.1097/MD.0000000000004277
-Bensalem M, Frih A, Ghali M, Elhmidi K, Gazouini N, Hamouda H, et al. Hémodialyse en situation d’urgence : à propos de 114 cas. Nephrol Ther 2015 ; 11 : 297. https://doi.org/10.1016/j.nephro.2015.07.093
-Chou YH, Huang TM, Wu VC, Wang CY, Shiao CC, Lai CF et al. Impact of timing of renal replacement therapy initiation on outcome of septic acute kidneyinjury. Crit Care 2011; 15(3): R134. doi: 10.1186/cc10252
-Chijioke A, Makusidi AM, Rafiu MO. Factors influencing hemodialysis and outcome in severe acute renal failure from Ilorin, Nigeria. Saudi J Kidney Dis Transpl 2012; 23: 391-6.
-Dembélé S.Prévalence hospitalière de l’insuffisance rénale aigue obstructive dans le service de néphrologie et d’hémodialyse du chu de point G [Thèse Med]. Bamako, 2008: N°603. http://www.keneya.net/fmpos/theses/2008/med/pdf/08M603.pdf (consulté le 15 juin 2021)
-Ait Elhaj L, Aladlouni A, Fadili W, Laouad I. Insuffisance rénale aiguë dialysée en néphrologie : de quelle origine ? Et pour quel pronostic. Nephrol Ther 2012 ;8 : 344.
-Haffane L, Bezzaz A, Elouazzani H, Benamer L, Ezaitouni F, Alhamany, et al. Insuffisance rénale aiguë : épidémiologie et facteurs pronostiques. Nephrol Ther 2012 ; 8 : 340-1.
-Hamzic-Mehmedbasic A, Rasic S, Rebic D, Durak-Nalbantic A, Muslimovic A, Dzemidzic J. Renal Function Outcome Prognosis in Septic and Non-septic Acute Kidney Injury Patients. Med Arch 2015; 69(2): 77-80. doi: 10.5455/medarh.2015.69.77-80
-Tia WM, Yao H, Coulibaly PA, Delorg DC, Gnionsahé DH, Ouattara B. Evolution des étiologies de l’insuffisance rénale aigue de 1982 à 2011 au CHU de Yopougon à Abidjan. RISM 2018; 20(1) : 51-5. http://www.revues-ufhb-ci.org/fichiers/FICHIR_ARTICLE_2141.pdf (consulté le 15 juin 2021)
-Krishna ChV, Rao PV, Das GC, Kumar VS. Acute renal failure in falciparum malaria:Clinical characteristics, demonstration of oxidative stress, and prognostication, Saudi J Kidney Dis Transpl 2012; 23(2): 296-300.
-Maheshwari A, Singh AK, Sinha DK, Tripathi D, Prakash J. Spectrum of renaldisease in malaria. J Indian Med Assoc 2004; 102(3): 143.
-Luyckx VA, Ballantine R, Claeys M, Cuyckens F, Van den Heuvel H,Cimanga RK, et al. Herbal remedy-associated acute renal failure secondary to Cape aloes. Am J Kidney Dis 2002; 39: 13. DOI: 10.1053/ajkd.2002.31424
-Jha V, Rathi M. Natural medicines causing acute kidney injury. Semin Nephrol 2008; 28(4): 416-28. DOI: 10.1016/j.semnephrol.2008.04.010
-Igiraneza G, Ndayishimiye B, Nkeshimana M, Dusabejambo V, Ogbuagu O. Clinical Profile and Outcome of Patients with Acute Kidney Injury Requiring Hemodialysis:TwoYears’ Experience at a Tertiary Hospital in Rwanda. BiomedRes Int [Internet] 2018 [Consulté le 13 Mars 2019]; 2018: Article ID 1716420. Disponible sur : https://www.hindawi.com/journals/bmri/2018/1716420/. (consulté le 20 juin 2021)
-Bourial M, El Khayat S, Zamd M, Medkouri G, Benghanem, Ramdani B. Indications de la dialyse aiguë au Maroc. Nephrol Ther 2017; 13: 365-6.
-Zarbock A, Kellum JA, Schmidt C, Van Aken H, Wempe C, Pavenstadt H, et al. Effect of early vs delayed initiation of renal replacement therapy on mortality in critically ill patients with acute kidney injury: the Elain randomized clinical trial. JAMA. 2016; 315(20):2190-9. DOI: 10.1001/jama.2016.5828
-Yang X-M, Tu G-W, Zheng J-L, Shen B, Ma GG, Hao G-W, et al. A comparison of early versus late initiation of renal replacement therapy for acute kidney injury in critically ill patients: an updated systematic review and meta analysis of randomized controlled trials. BMC Nephrology 2017; 18:264. DOI: 10.1186/s12882-017-0667-6
-Hu SL, Said FR, Epstein D, Lokeshwari M. The impact of anemia on renal recovery and survival in acute kidney injury. Clin Nephrol 2013; 79(3): 221-8. DOI: 10.5414/cn107471