经皮肾镜碎石术后尿脓毒血症发生的独立危险因素预测模型研究

doi:10.19558/j.cnki.10-1020/r.2020.05.009

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摘要 目的：研究上尿路结石患者行经皮肾镜碎石术（PCNL）后引起脓毒血症的相对独立危险因素,为围手术期提供客观依据,并建立独立危险因素的列线图预测模型。方法：回顾性分析2014年1月–2019年3月在联勤保障部队第九四〇医院行PCNL的260例患者的临床资料。依据术后是否进展为脓毒血症,分成病例组及对照组,并分别对其性别、年龄、体质量指数（BMI）、糖尿病史、结石大小、结石数量、结石位置、结石CT值、结石负荷、手术时间、既往泌尿系手术史、术前中段尿培养、术前尿亚硝酸盐、尿白细胞、血小板计数、嗜酸性粒细胞计数等影响因素进行单因素和多因素Logistic回归分析,评价PCNL术后发生脓毒血症的独立危险因素。依据多因素Logistic回归系数建立相対应的列线图预测模型。结果：根据多因素Logistic回归分析结果,与PCNL术后进展为脓毒血症的相关独立风险因素有：糖尿病史（OR=4.394,P=0.014）、结石负荷（OR=2.968,P=0.021）、手术时间（OR=2.872,P=0.008）、中段尿培养（OR=3.390,P=0.011）、尿亚硝酸盐（OR=2.961,P=0.018）。预测模型的C统计量（C-statistics）为0.915,Hosmer-Lemeshow检验提示(χ²=0.973,P=0.856）,揭示了预测模型具有良好的区分度和校准度。结论：糖尿病史、结石负荷、手术时间、中段尿培养、尿亚硝酸盐是PCNL术后发生脓毒血症的相对独立危险因素,建立的列线图预测模型有利于预测术后脓毒血症的发生率,并可促进脓毒血症的早期预防及诊治。

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	蔡高平
	杨成
	杨旭凯
	董永超
	张伟君
	谭乐明
	张大伟

关键词 ：经皮肾镜碎石术, 脓毒血症, 危险因素, 预测模型, 列线图

Abstract：Objective： To study the relative independent risk factors of sepsis caused by percutaneous nephrolithotomy （PCNL） in patients with upper urinary calculi in order to provide objective basis for perioperative period and promote the early diagnosis and treatment of urinary sepsis, and establish nomogram prediction model of independent risk factors. Methods： The clinical data （sex, age, BMI, history of diabetes, stone size, stone number, stone location, stone CT value, stone load, operation time, previous urological surgery history, preoperative urine culture, urine leukocyte, urinary nitrite, platelet count, eosinophil count） of 260 patients undergoing PCNL in our hospital from January 2014 to March 2019 were retrospectively analyzed. The independent risk factors of urinary sepsis after PCNL were evaluated by univariate and multivariate Logistic regression analysis. According to the Logistic regression coefficient, we drew the corresponding nomogram prediction model. Results： According to the results of multivariate Logistic regression analysis, the independent risk factors related to progression to urinary sepsis after PCNL included： diabetes history （OR = 4.394, P = 0.014）, stone load （OR = 2.968, P = 0.021）, operation time （OR = 2.872, P = 0.008）, preoperative urine culture （OR = 3.390, P = 0.011）, urinary nitrite （OR = 2.961, P = 0.018）.The consistency coefficient C-statistics of the prediction model is 0.915, and the Hosmer-Lemeshow test hint（χ² = 0.973, P = 0.856） revealed that the new prediction model had good discrimination and calibration. Conclusions： Diabetes history, stone load, operation time, preoperative urine culture, and urinary nitrite are relatively independent risk factors for urinary sepsis after PCNL. The nomogram prediction model established is helpful to predict the incidence of urinary sepsis after PCNL, and is also beneficial to the early prevention, treatment, and diagnosis of sepsis.

Key words： percutaneous nephrolithotomy sepsis risk factor prediction model nomogram

收稿日期: 2019-11-24

ZTFLH:

R699.2

通讯作者: 杨旭凯,yangxk125@126.com

引用本文:

蔡高平, 杨成, 杨旭凯, 董永超, 张伟君, 谭乐明, 张大伟. 经皮肾镜碎石术后尿脓毒血症发生的独立危险因素预测模型研究[J]. 微创泌尿外科杂志, 2020, 9(5): 330-336.
CAI Gaoping, YANG Cheng, YANG Xukai, DONG Yongchao, ZHANG Weijun, TAN Leming, ZHANG Dawei. Percutaneous nephrolithotomy independent risk factor prediction model related to urinary sepsis. JOURNAL OF MINIMALLY INVASIVE UROLOGY, 2020, 9(5): 330-336.

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http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/abstract/abstract1623.shtml 或 http://journal20.magtechjournal.com/Jwk_zgmnwk/CN/Y2020/V9/I5/330

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