经皮肾镜碎石术后并发全身炎症反应综合征的危险因素分析及预测模型的建立
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摘要
目的:分析经皮肾镜碎石术(PCNL)后全身炎症反应综合征(SIRS)的相关危险因素,并建立Logistic回归预测模型。方法:回归性分析2017年1月-2018年3月期间在新疆医科大学第一附属医院泌尿中心结石病区行PCNL治疗上尿路结石的414例患者的临床资料。采用单因素及多因素Logistic回归分析筛选PCNL术后SIRS发生的危险因素,建立Logistic回归预测模型,最终用Hosmer and Lemeshow检验来对所建立的预测模型的拟合优度进行测验,用ROC曲线下面积来对该预测模型的效能进行评定。结果:414例PCNL患者当中术后发生SIRS的人数为62例,SIRS的发生率为15%,其中有3例患者发生感染性休克,占总数的0.72%。单因素Logistic回归分析的结果表明:性别、手术时间、通道数目、结石最大直径、术前尿培养阳性,术前尿白细胞阳性,术前尿亚硝酸盐阳性,结石成分等因素和PCNL术后SIRS的发生有着一定关系(P<0.05);多因素Logistic回归分析结果显示性别(OR=2.537,P<0.05)、手术时间(OR=5.025,P<0.05)、术前尿培养阳性(OR=4.524,P<0.05)、术前尿亚硝酸盐阳性(OR=2.247,P<0.05)是PCNL术后SIRS发生的独立危险因素(P<0.05);根据多因素Logistic回归分析有统计学意义的变量进入回归方程,获得的预测模型为P=1/1+EXP(-3.982+0.931×X1+1.614×X7+1.509×X14+0.810×X17)。Hosmer and Lemeshow检验提示预测模型拟合度为(χ2=5.724,P>0.05);ROC曲线下面积为0.857,95%CI(0.809～0.904)。结论:性别、手术时间、术前尿培养阳性、术前尿亚硝酸盐阳性是PCNL术后SIRS发生的独立危险因素,所建立的预测模型有一定的风险评估价值。
Objective:To analyze the risk factors of systemic inflammatory response syndrome(SIRS)after per?cutaneous nephrolithotomy(PCNL),and to establish a logistic regression-based prediction model.Methods:Regres?sion analysis was conducted on 414 patients with upper urinary tract calculi treated by PCNL in the Department of Urology of our hospital from January 2017 to March 2018. Univariate and multivariate logistic regression analyses were used to screen the risk factors of SIRS after PCNL,and to establish a logistic regression-based prediction mod?el. Finally,the Hosmer-Lemeshow test was used to assess the goodness of fit of the prediction model and the area un?der the ROC curve was used to evaluate its effectiveness.Results:Among 414 PCNL patients,62(15%)developed SIRS post-surgery and 3 patients had septic shock(0.72% of the total). Univariate logistic regression analysis showed that factors such as gender,operation time,number of channels,maximum diameter of stones,positive pre?operative urinary culture,positive preoperative urinary leukocytes,positive preoperative urinary nitrite and stone com?position were related to the occurrence of SIRS after PCNL(P<0.05). Multivariate logistic regression analysis showed that the gender(OR=2.537,P<0.05),operation time(OR=5.025,P<0.05),preoperative positive urine culture(OR=4.524,P<0.05),and preoperative positive urine nitrite(OR=2.247,P<0.05) were independent risk factors for SIRS after PCNL(P<0.05). According to the multivariate logistic regression analysis,statistically significant variables were added to a regression equation,and the resulting predictive model was P=1/1+ EXP(-3.982+0.931×X1+1.614×X7+1.509×X14+0.810×X17). The Hosmer-Lemeshow test indicated that the fit?ting degree of the prediction model was χ2=5.724(P>0.05),and the area under the ROC curve was 0.857 with95% CI[0,904].Conclusions:Patient gender,operation time,preoperative positive urine culture,and preopera?tive positive urine nitrite are independent risk factors for SIRS after PCNL,and the established predictive model has certain value in risk assessment.
Objective:To analyze the risk factors of systemic inflammatory response syndrome(SIRS)after per?cutaneous nephrolithotomy(PCNL),and to establish a logistic regression-based prediction model.Methods:Regres?sion analysis was conducted on 414 patients with upper urinary tract calculi treated by PCNL in the Department of Urology of our hospital from January 2017 to March 2018. Univariate and multivariate logistic regression analyses were used to screen the risk factors of SIRS after PCNL,and to establish a logistic regression-based prediction mod?el. Finally,the Hosmer-Lemeshow test was used to assess the goodness of fit of the prediction model and the area un?der the ROC curve was used to evaluate its effectiveness.Results:Among 414 PCNL patients,62(15%)developed SIRS post-surgery and 3 patients had septic shock(0.72% of the total). Univariate logistic regression analysis showed that factors such as gender,operation time,number of channels,maximum diameter of stones,positive pre?operative urinary culture,positive preoperative urinary leukocytes,positive preoperative urinary nitrite and stone com?position were related to the occurrence of SIRS after PCNL(P<0.05). Multivariate logistic regression analysis showed that the gender(OR=2.537,P<0.05),operation time(OR=5.025,P<0.05),preoperative positive urine culture(OR=4.524,P<0.05),and preoperative positive urine nitrite(OR=2.247,P<0.05) were independent risk factors for SIRS after PCNL(P<0.05). According to the multivariate logistic regression analysis,statistically significant variables were added to a regression equation,and the resulting predictive model was P=1/1+ EXP(-3.982+0.931×X1+1.614×X7+1.509×X14+0.810×X17). The Hosmer-Lemeshow test indicated that the fit?ting degree of the prediction model was χ2=5.724(P>0.05),and the area under the ROC curve was 0.857 with95% CI[0,904].Conclusions:Patient gender,operation time,preoperative positive urine culture,and preopera?tive positive urine nitrite are independent risk factors for SIRS after PCNL,and the established predictive model has certain value in risk assessment.
引文
[1]何英剑,吴小候.经皮肾镜碎石术后发生全身炎症反应综合征的相关因素.重庆医学,2012,41(10):1014-1016.
[2]范钧泓,吴文起,朱玮,等.经皮肾镜取石术后全身炎症反应综合征的相关危险因素分析.中华泌尿外科杂志,2017,38(11):857-861.
[3] RIVERA M,VIERS B,COCKERILL P,et al.Pre-and postoperative predictors of infection-Relatedcomplications in patients undergoing percutaneousnephrolithotomy. J Endourol,2016,30(9):982-986.
[4] ERDIL T,BOSTANCI Y,OZDEN E,et al. Riskfactors for systemic inflammatory response syndromefollowing percutaneous nephrolithotomy. Urolithia?sis,2013,41(5):395-401.
[5]周少丽,邓颖青,谭芳,等.经皮肾镜碎石取石术后全身炎症反应综合征的风险因素回顾性分析.中山大学学报(医学科学版),2016,37(2):295-299.
[6]安立哲,黄晓波,许清泉,等.经皮肾镜碎石取石术后发生全身炎症反应综合征的多因素分析.中国微创外科杂志,2017,17(11):965-969.
[7] MOSES R,AGARWAL D,RAFFIN E,et al.Response Syndrome Is Not Associated With Unplanned Readmission. Urology. 2017,100:33-37.
[8]魏世平,李辉明,陶维雄,等.经皮肾镜碎石术后并发全身炎症反应综合征的危险因素分析.中国内镜杂志,2015,21(8):878-880.
[9]中华医学会重症医学分会.成人严重感染与感染性休克血流动力学监测与支持指南.中华医学信息导报,2007,22(16):21-22.
[10] KORAS O,BOZKURT IH,YONGUC T,et al.Risk factors for postoperative infectious complications following percutaneous nephrolithotomy:a prospective clinical study. Urolithiasis,2015,43(1):55-60.
[11] YANG T,LIU SH,HU JM,et al. The evaluation of risk factors for postoperative infectious complications after percutaneous nephrolithotomy. Biomed Res Int,2017,19(1):48-55.
[12]董圣芳,杨建勋.上尿路结石患者经皮肾镜术后全身炎性反应综合征发生情况及危险因素分析.解放军预防医学杂志,2017,35(2):149-152.
[13]姜道彬,邱明,龙平华,等.经皮肾镜取石术治疗肾结石的研究进展.海南医学,2012,23(1):113-115.
[14] SINGH P,YADAV S,SINGH A,et al. Systemic inflammatory response syndrome following percutaneous nephrolithotomy:assessment of risk factors and their impact on patient outcomes. Urol Int,2016,96(2):207-211.
[15]谷明利,诸禹平.腔镜治疗上尿路结石术后全身炎症反应综合征的危险因素分析.中国内镜杂志,2015,21(9):952-955.
[16]牛强,沈明康,翁超,等.上尿路结石围手术期尿细菌检测的临床意义.中华泌尿外科杂志,2011,32(3):196-198.
[17] KUMAR S,BAG S,GANESAMONI R,et al.Risk factors for urosepsis following percutaneous nephrolithotomy:role of 1 week of nitrofurantoin in reducing the risk of urosepsis. Urol Res,2012,40(1):79-86.
[18] MARIAPPAN P,SMITH G,BARIOL SV,et al.Re:stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy:a prospective clinical study. J Urol,2005,174(5):2069-2070.
[19]梁敏,郑立民,马志明,等.经皮肾镜取石术前术中尿及结石细菌培养对照研究.现代医药卫生,2017,33(1):25-26.
[20]史建国,王领军,陈宇东,等.上尿路结石经皮肾镜术后全身炎症反应综合征的危险因素分析.解放军医学院学报,2016,37(9):964-966+983.
[21]李东升,杨彦峰,李亚飞,等.经皮肾镜取石术后全身炎症反应综合征的危险因素分析.临床泌尿外科杂志,2015,22(4):335-338.
[22]朱文波,戴蕾,张葵.尿白细胞、细菌及亚硝酸盐的联合检测在诊断尿路感染中的应用.医疗卫生装备,2016,37(5):78-80.
[23]王静.细菌性尿路感染中尿液亚硝酸盐的检测价值分析.世界最新医学信息文摘,2016,42(7):154,165.
[24]李玉芳.尿亚硝酸盐对泌尿系感染的诊断价值.中国误诊学杂志,2002,2(12):1838.
[25]刘小宁.尿常规亚硝酸盐检测对细菌性尿路感染的诊断价值研究.中国医药指南,2018,9(7):97.
[26]黄海,周建辉,黄文胜,等.经皮肾镜取石术后全身炎症反应综合征的危险因素.中国内镜杂志,2012,18(4):373-375.
[27] RAMARAJU K,PARANJOTHI AK,NAMPERUMALSAMY DB,et al. Predictors of systemic inflammatory response syndrome following percutaneous nephrolithotomy. Urol Ann,2016,8(4):449-453.
[28] TAN F,GAN XL,DENG YQ,et al. Intraoperative dexmedetomidine attenuates postoperative systemic inflammatory response syndrome in patients who underwent percutaneous nephrolithotomy:a retrospective cohort study. Ther Clin Risk Manag,2018,14(5):287-293.
[2]范钧泓,吴文起,朱玮,等.经皮肾镜取石术后全身炎症反应综合征的相关危险因素分析.中华泌尿外科杂志,2017,38(11):857-861.
[3] RIVERA M,VIERS B,COCKERILL P,et al.Pre-and postoperative predictors of infection-Relatedcomplications in patients undergoing percutaneousnephrolithotomy. J Endourol,2016,30(9):982-986.
[4] ERDIL T,BOSTANCI Y,OZDEN E,et al. Riskfactors for systemic inflammatory response syndromefollowing percutaneous nephrolithotomy. Urolithia?sis,2013,41(5):395-401.
[5]周少丽,邓颖青,谭芳,等.经皮肾镜碎石取石术后全身炎症反应综合征的风险因素回顾性分析.中山大学学报(医学科学版),2016,37(2):295-299.
[6]安立哲,黄晓波,许清泉,等.经皮肾镜碎石取石术后发生全身炎症反应综合征的多因素分析.中国微创外科杂志,2017,17(11):965-969.
[7] MOSES R,AGARWAL D,RAFFIN E,et al.Response Syndrome Is Not Associated With Unplanned Readmission. Urology. 2017,100:33-37.
[8]魏世平,李辉明,陶维雄,等.经皮肾镜碎石术后并发全身炎症反应综合征的危险因素分析.中国内镜杂志,2015,21(8):878-880.
[9]中华医学会重症医学分会.成人严重感染与感染性休克血流动力学监测与支持指南.中华医学信息导报,2007,22(16):21-22.
[10] KORAS O,BOZKURT IH,YONGUC T,et al.Risk factors for postoperative infectious complications following percutaneous nephrolithotomy:a prospective clinical study. Urolithiasis,2015,43(1):55-60.
[11] YANG T,LIU SH,HU JM,et al. The evaluation of risk factors for postoperative infectious complications after percutaneous nephrolithotomy. Biomed Res Int,2017,19(1):48-55.
[12]董圣芳,杨建勋.上尿路结石患者经皮肾镜术后全身炎性反应综合征发生情况及危险因素分析.解放军预防医学杂志,2017,35(2):149-152.
[13]姜道彬,邱明,龙平华,等.经皮肾镜取石术治疗肾结石的研究进展.海南医学,2012,23(1):113-115.
[14] SINGH P,YADAV S,SINGH A,et al. Systemic inflammatory response syndrome following percutaneous nephrolithotomy:assessment of risk factors and their impact on patient outcomes. Urol Int,2016,96(2):207-211.
[15]谷明利,诸禹平.腔镜治疗上尿路结石术后全身炎症反应综合征的危险因素分析.中国内镜杂志,2015,21(9):952-955.
[16]牛强,沈明康,翁超,等.上尿路结石围手术期尿细菌检测的临床意义.中华泌尿外科杂志,2011,32(3):196-198.
[17] KUMAR S,BAG S,GANESAMONI R,et al.Risk factors for urosepsis following percutaneous nephrolithotomy:role of 1 week of nitrofurantoin in reducing the risk of urosepsis. Urol Res,2012,40(1):79-86.
[18] MARIAPPAN P,SMITH G,BARIOL SV,et al.Re:stone and pelvic urine culture and sensitivity are better than bladder urine as predictors of urosepsis following percutaneous nephrolithotomy:a prospective clinical study. J Urol,2005,174(5):2069-2070.
[19]梁敏,郑立民,马志明,等.经皮肾镜取石术前术中尿及结石细菌培养对照研究.现代医药卫生,2017,33(1):25-26.
[20]史建国,王领军,陈宇东,等.上尿路结石经皮肾镜术后全身炎症反应综合征的危险因素分析.解放军医学院学报,2016,37(9):964-966+983.
[21]李东升,杨彦峰,李亚飞,等.经皮肾镜取石术后全身炎症反应综合征的危险因素分析.临床泌尿外科杂志,2015,22(4):335-338.
[22]朱文波,戴蕾,张葵.尿白细胞、细菌及亚硝酸盐的联合检测在诊断尿路感染中的应用.医疗卫生装备,2016,37(5):78-80.
[23]王静.细菌性尿路感染中尿液亚硝酸盐的检测价值分析.世界最新医学信息文摘,2016,42(7):154,165.
[24]李玉芳.尿亚硝酸盐对泌尿系感染的诊断价值.中国误诊学杂志,2002,2(12):1838.
[25]刘小宁.尿常规亚硝酸盐检测对细菌性尿路感染的诊断价值研究.中国医药指南,2018,9(7):97.
[26]黄海,周建辉,黄文胜,等.经皮肾镜取石术后全身炎症反应综合征的危险因素.中国内镜杂志,2012,18(4):373-375.
[27] RAMARAJU K,PARANJOTHI AK,NAMPERUMALSAMY DB,et al. Predictors of systemic inflammatory response syndrome following percutaneous nephrolithotomy. Urol Ann,2016,8(4):449-453.
[28] TAN F,GAN XL,DENG YQ,et al. Intraoperative dexmedetomidine attenuates postoperative systemic inflammatory response syndrome in patients who underwent percutaneous nephrolithotomy:a retrospective cohort study. Ther Clin Risk Manag,2018,14(5):287-293.