基于决策曲线分析血清CorCys-C与肾结石患者ESWL术后急性肾损伤发生的关系  

Analysis on relationship between serum Cor,Cys-C and acute renal injury in patients with renal calculi after ESWL based on decision curve

作　　者：阿衣丁·西热牙孜旦 高新[1] 乃比江·毛拉库尔班[1] 阿斯木江·阿不拉[1] 宋光鲁[1] Ayidin·Xireyazidan;GAO Xin;Naibijiang·Maolakuerban;Asimujiang·Abula;SONG Guanglu(Department of Urology,First Affiliated Hospital of Xinjiang Medical University,Urumqi,830054,China)

机构地区：[1]新疆医科大学第一附属医院泌尿外科,乌鲁木齐830054

出　　处：《临床泌尿外科杂志》2022年第11期841-845,852,共6页Journal of Clinical Urology

基　　金：新疆维吾尔自治区自然科学基金(No:2018D01C426)。

摘　　要：目的:观察肾结石患者血清皮质醇(Cor)、胱抑素C(Cys-C)表达及其体外冲击波碎石术(ESWL)术后肾损伤发生情况,并基于决策曲线分析血清指标与术后急性肾损伤发生的关系。方法:选取2018年8月—2021年8月于新疆医科大学第一附属医院接受ESWL治疗的215例肾结石患者,术后随访7 d并评估患者急性肾损伤发生情况,由研究者设计基线资料调查表,详细统计发生组和未发生组基线资料,分析ESWL术前血清Cor、Cys-C水平与术后急性肾损伤发生的关系,并基于受试者工作特征(ROC)曲线及决策曲线分析术前血清Cor、Cys-C水平预测肾结石患者术后发生急性肾损伤的价值。结果:215例肾结石患者术后随访7 d,发生急性肾损伤17例,占比7.91%;发生组血肌酐(Scr)、Cor、Cys-C水平高于未发生组,差异有统计学意义(P<0.05);组间性别、年龄、体重指数、结石直径、结石位置、手术时间、结石手术史、长期饮酒史、甘油三酯(TG)、总胆固醇(TC)、血红蛋白(HGB)比较,差异无统计学意义;回归分析结果显示,Scr、Cor、Cys-C过高表达均是肾结石患者术后急性肾损伤发生的危险因子(OR>1,P<0.05);绘制ROC曲线,结果显示,血清Cor、Cys-C水平预测肾结石患者术后急性肾损伤发生风险的曲线下面积(AUC)均>0.7,具有一定的预测价值,且联合预测价值较高;绘制决策曲线,结果显示,在阈值0.06~0.15及0.21~1.00范围内,血清Cor、Cys-C水平联合的预测模型预测肾结石患者术后急性肾损伤发生的净收益率高于血清Cor、Cys-C单独检测。结论:血清Cor、Cys-C水平与肾结石患者术后急性肾损伤发生有关,检测血清Cor、Cys-C水平可预测肾结石患者术后急性肾损伤发生风险,且二者联合预测收益率更高。Objective:To observe the expression of serum cortisol(Cor),cystatin-C(Cys-C)and the occurrence of renal injury after extracorporeal shock wave lithotripsy(ESWL)in patients with renal calculi,and to analyze the relationship between serum indexes and postoperative acute renal injury based on decision curve.Methods:From August 2018 to August 2021,215 patients with renal calculi who underwent ESWL in First Affiliated Hospital of Xinjiang Medical University were selected.The patients were followed up for 7 days and the occurrence of acute renal injury of patients was evaluated.The baseline data questionnaire was designed by the researcher,and the baseline data of the occurrence group and non occurrence group were counted in detail.The relationship between serum Cor and Cys-C levels before ESWL and postoperative acute renal injury was analyzed,and the value of preoperative serum Cor and Cys-C levels in predicting postoperative acute renal injury in patients with renal calculi was analyzed based on receiver operating characteristic(ROC)curve and decision curve.Results:Two hundred and fifteen patients with renal calculi were followed up for 7 days.Seventeen cases had acute renal injury,accounting for 7.91%.The levels of serum creatinine(Scr),Cor and Cys-C in the occurrence group were significantly higher than those in the non occurrence group,and the difference was statistically significant(P<0.05).However,there was no statistical significant difference in gender,age,body mass index,calculi diameter,calculi location,operation time,calculi operation history,long-term drinking history,triglyceride(TG),total cholesterol(TC)or hemoglobin(HGB).The results of regression analysis showed that the overexpression of Scr,Cor and Cys-C were the risk factors of postoperative acute renal injury in patients with renal calculi(OR>1,P<0.05).The ROC curve was drawn,and the results showed that the area under the curve(AUC)of serum Cor and Cys-C levels in predicting the risk of postoperative acute renal injury in patients with renal calculi

关 键 词：肾结石 急性肾损伤 体外冲击波碎石术 皮质醇 胱抑素C 

分 类 号：R692.4[医药卫生—泌尿科学]