PCNL治疗孤立肾结石与常规肾结石患者的预后风险评估  

Prognostic risk assessment in treating patients with solitary kidney calculus and conventional renal calculus by PCNL

作　　者：常俊锴 侯俊清 李铁强 朱朝阳 徐文超 杜信毅 胡晓华[2] CHANG Junkai;HOU Junqing;LI Tieqiang;ZHU Chaoyang;XU Wenchao;DU Xinyi;HU Xiaohua(Department of Urology,Huaihe Hospital of Henan University,Kaifeng,Henan 475000,China;;Affiliated Yueyang Hospital of Integrated Traditional Chinese and Western Medicine, Shanghai University of Traditional Chinese Medicine,Shanghai 200437,China)

机构地区：[1]河南大学淮河医院泌尿外科,河南开封475000 [2]上海中医药大学附属岳阳中西医结合医院,200437

出　　处：《重庆医学》2018年第25期3261-3265,共5页Chongqing medicine

基　　金：上海市卫生和计划生育委员会中医药科研基金(2012L016A)

摘　　要：目的观察经皮肾镜取石术(PCNL)治疗孤立肾结石与常规肾结石患者的预后风险。方法选取2014年3月至2016年12月就诊于河南大学淮河医院被诊断为孤立肾结石患者64例为孤立肾组,选取同期就诊的常规肾结石患者50例为对照组,两组均行经皮肾镜取石术(PCNL)治疗。记录两组患者术前Guy′S肾结石评分、手术时间、失血量、术后血红蛋白与尿蛋白下降值、结石清除率等。Cox回归分析预后产生影响的因素,ROC曲线评价影响因素预测其预后风险的能力。结果孤立肾组预后不良率高于对照组(26.56%vs.18.00%,P<0.05),结石清除率明显低于对照组(χ2=4.085,P=0.043)。Cox回归显示Guy′S肾结石评分为GⅢ(RR=1.267,P=0.036)、GⅣ(RR=2.307,P=0.031)及结石清除率(RR=0.712,P=0.039)对孤立肾结石患者预后存在影响;结石清除率(RR=0.575,P=0.046)、Guy′S肾结石评分为GⅣ(RR=1.971,P=0.037)对对照组患者预后有影响。孤立肾组中Guy′S肾结石评分为GⅣ与术后结石清除率的危险系数均高于对照组。孤立肾组Guy′S肾结石评分为GⅣ的曲线下面积(AUC)最高(0.816)。结论孤立肾结石患者经PCNL治疗后的预后不良风险较常规肾结石患者更高,其Guy′S肾结石评分为GⅣ有望作为早期监测患者预后风险的指标之一。Objective To observe the prognosis risk of solitary nephrolithiasis and conventional renal calculi treated by percutaneous nephrolithotomy(PCNL).Methods Sixty-four patients with solitary kidney stones diagnosed in Huaihe Hospital of Henan University from March 2014 to December 2016 were selected as the solitary kidney group,and 50 patients with conventional kidney stones were selected as the control group.Both groups were treated with percutaneous nephrolithotomy(PCNL).The preoperative Guy′S renal calculi score,operative time,blood loss,postoperative decrease of hemoglobin and urinary protein,stone clearance rate were recorded.Cox regression was used to analyze prognostic factors,and ROC curves were used to assess the ability of influencing factors to predict prognostic risk.Results The poor prognosis rate at the end of follow up in the solitary kidney group was higher than that in the control group(26.56%vs.18.00%),while the stone-free rate was significantly lower than that in the control group(χ2=4.085,P=0.043);the Cox regression analysis showed that Guy′s renal calculus score GⅢ(RR=1.267,P=0.036),GⅣ(RR=2.307,P=0.031)and the stone-free rate(RR=0.712,P=0.039)had significant effect on the prognosis of the patients with solitary kidney calculus;while the stone-free rate(RR=0.575,P=0.046)and GⅣ(RR=1.971,P=0.037)had the influence on the prognosis in the control group;the risk coefficient of GⅣand postoperative stone-free rate in the solitary kidney group were higher than those in the control group;the ROC analysis of GⅢ,GⅣand stone-free rate in the solitary group showed that the AUC of GⅣwas highest(AUC=0.816).Conclusion The risk of poor prognosis in the patients with solitary kidney calculi treated by PCNL is higher than that in the patients with conventional renal calculus,and the Guy′s score of renal calculus GⅣis expected to be one of indicators for early monitoring the prognostic risk in the patients.

关 键 词：孤立肾结石 经皮肾镜取石术 预后风险 Guy′S肾结石评分 

分 类 号：R692.4[医药卫生—泌尿科学]