国内经皮肾镜取石术后发生全身炎症反应综合征相关因素的Meta分析  

Risk factors associated with systemic inflammatory response syndrome after percutaneous nephrolithotomy in China: A Meta-analysis

作　　者：翁湘涛 曹家栋 何君伟 王树声[2] 向松涛[2] 古炽明[2] 甘澍[2] 

机构地区：[1]广州中医药大学,广东广州510403 [2]广东省中医院泌尿外科,广东广州510120

出　　处：《中国内镜杂志》2017年第9期11-19,共9页China Journal of Endoscopy

基　　金：广东省中医院朝阳人才专项基金(No:2014KT1324)

摘　　要：目的探讨国内经皮肾镜取石术(PCNL)后发生全身炎症反应综合征(SIRS)的危险因素。方法计算机检索国内有关PCNL术后发生SIRS的相关研究,时间截止至2016年10月,采用Rev Man5.3进行Meta分析。结果共纳入18个研究,5 323例患者,Meta分析结果显示:(1)单因素分析结果 :肾功能不全[OR=2.78,95%CI(1.96,3.95),P=0.000]、术前尿培养细菌阳性[OR=3.41,95%CI(1.89,6.15),P=0.000]、术前尿常规白细胞异常[OR=3.78,95%CI(3.02,4.72),P=0.000]、糖尿病[OR=2.14,95%CI(1.33,3.45),P=0.002]、结石细菌培养阳性[OR=5.14,95%CI(2.46,10.73),P=0.000]和手术时间≥120 min[OR=2.31,95%CI(1.40,3.82),P=0.001]是PCNL术后发生SIRS的危险因素;(2)多因素分析显示:术前尿培养细菌阳性[OR=6.83,95%CI(2.82,16.57),P=0.000]、术前尿常规白细胞异常[OR=5.43,95%CI(3.51,8.41),P=0.000]、糖尿病[OR=2.85,95%CI(1.45,5.58),P=0.002]、结石细菌培养阳性[OR=4.30,95%CI(1.30,14.21),P=0.020]和手术时间≥120 min[OR=2.72,95%CI(1.62,4.59),P=0.000]是PCNL术后发生SIRS的独立危险因素。结论糖尿病、术前尿培养细菌阳性、术前尿常规白细胞异常、结石细菌培养阳性和手术时间是PCNL术后发生SIRS的独立危险因素,受纳入研究数量和质量影响,需开展更多高质量研究证实上述结论。Objective To explore the risk factors of systemic inflammatory response syndrome crisis （SIRS） after percutaneous nephrolithotomy （PCNL） in China. Methods Databases of CNKI, CBM, WanFan and VIP were searched to retrieve studies about systemic inflammatory response syndrome after percutaneous nephrolithotomy to October, 2016. Results 18 studies involving 5,323 patients were included. The results of meta-analysis showed that： a） univariate analysis indicated that renal insufficiency [OR=2.78, 95%CI （1.96 to 3.95）, P = 0.000], preoperative positive urine culture [OR = 3.41, 95%CI （1.89 to 6.15）, P = 0.000], preoperative routine urine leucocyte positive [OR = 3.78, 95%CI （3.02 to 4.72）, P = 0.000], diabetes mellitus [OR = 2.14, 95%CI （1.33 to 3.45）, P = 0.002], pelvic positive urine culture [OIL = 5.14, 95%CI （2.46 to 10.73）, P = 0.000] and operation time 〉120 min [OR = 2.31, 95%CI （1.40 to 3.82）, P = 0.001] were the risk factors of SIRS; b） multivariate analysis showed that, preoperative positive urine culture [OR = 6.83, 95%CI （2.82 to 16.57）, P = 0.000], preoperative routine urine leucocyte positive [OR = 5.43, 95%CI （3.51 to 8.41）, P = 0.000], diabetes mellitus [OR = 2.85, 95%CI （1.45 to 5.58）, P = 0.002], pelvic positive urine culture [OR = 4.30, 95%CI （1.30 to 14.21）, P = 0.020] and operation time 〉120 min [OR = 2.72, 95%CI （1.62 to 4.59）, P = 0.000] were the independent risk factors of MCAT. Conclusion The independent risk factors of SIRS for patients after PCNL are diabetes mellitus, preoperative positive urine culture, preoperative routine urine leucocyte positive, pelvic positive urine culture and operation time. However, due to the quantity and low quality of the included literature, the conclusion needs the support from high quality studies.

关 键 词：经皮肾镜取石术(PCNL) 全身炎症反应综合征(SIRS) META分析 

分 类 号：R619[医药卫生—外科学]