恒压灌注下MPCNL术后并发尿源性脓毒血症的危险因素分析及预测模型的建立  

Risk factors of urinary sepsis after microinvasive percutaneous nephrolithotomy with lithotomy under constant pressure perfusion and establishment of prediction models

作　　者：钟传华 黄华 何志强 晏恒馨 刘振 娄世洪 谭向金 田孟洪 Zhong ChuanHua;Huang Hua;He Zhiqiang;Yan Hengxin;Liu Zhen;Lou Shihong;Tan Xiangjin;Tian Menghong(Department of Urology,Guiqian International General Hospital,Guiyang 550000,China;Department of Urology,the People′s Hospital of Zunyi City Bozhou District,Zunyi 563100,China)

机构地区：[1]贵黔国际总医院泌尿外科,贵阳550000 [2]遵义市播州区人民医院泌尿外科,遵义563100

出　　处：《国际泌尿系统杂志》2023年第1期88-93,共6页International Journal of Urology and Nephrology

基　　金：遵义市科技计划项目(遵市科合社字(2018)264号)。

摘　　要：目的分析恒压灌注下微通道经皮肾镜碎石术(MPCNL)后并发尿源性脓毒血症的相关危险因素,并建立logistic回归预测模型。方法回顾性分析2018年12月至2020年12月期间在本院行恒压灌注下MPCNL治疗的56例上尿路结石患者的临床资料,以术后发生尿源性脓毒血症的患者为病例组(26例),采用巢式病例对照研究方法,以1∶5的比例匹配同期对照组(130例)。采用单因素及多因素logistic回归分析筛选恒压灌注下MPCNL术后尿源性脓毒血症发生的危险因素,建立logistic回归预测模型,用Bootstrap再抽样法(1000次)进行模型内部验证。采用Hosmer-Lemeshow检验对所建立的预测模型的拟合优度进行评估,采用受试者工作特征(ROC)曲线下面积对该模型的预测效能进行评定。结果单因素分析结果表明:性别、泌尿系结石手术史、肾积水、术前尿白细胞(WBC)≥2+、术前尿亚硝酸盐(NIT)阳性、术前血中性粒细胞与淋巴细胞比例(NLR)≥2.5与恒压灌注下MPCNL术后尿源性脓毒血症的发生均有相关性(均P<0.05);多因素logistic回归分析结果显示:女性(OR=3.145,P=0.030)、术前尿WBC≥2+(OR=2.970,P=0.047)、术前尿NIT阳性(OR=14.190,P<0.001)、术前血NLR≥2.5(OR=4.302,P=0.008)是恒压灌注下MPCNL患者术后发生尿源性脓毒血症的独立危险因素;Bootstrap方法得出的独立危险因素及OR值与多因素回归分析相同,提示多因素logistic回归分析得出的独立危险因素及OR值具有可重复性。将多因素logistic回归分析中差异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(-3.612+1.146×X1+1.088×X10+2.653×X11+1.459×X13)。Hosmer-Lemshow拟合优度检验提该预测模型拟合度为优度(χ^(2)=1.565,P=0.667),ROC曲线下面积为0.827(95%CI:0.732~0.922,P<0.001)。结论女性、术前尿WBC(≥2+)、术前尿NIT(阳性)、术前血NLR(≥2.5)是恒压灌注下MPCNL术后尿脓毒血症发生的独立危险因素,据此所建立的预Objective To analyze the risk factors of urinary sepsis after microinvasive percutaneous nephrolithotomy with lithotomy(MPCNL)under constant pressure perfusion,and to establish a logistic regression-based prediction model.Methods Clinical data of patients with upper urinary calculi were retrospectively analyzed,who were treated with MPCNL under constant pressure perfusion in urinary surgery of Bozhou people's hospital of Zunyi from December 2018 to December 2020.Patients with postoperative urinary sepsis were selected as case group(26 cases),nested case control method was adopted,and the ratio of 1∶5 was matched with the control group(130 cases)during the same period.Univariate and multivariate logistic regression analysis was brought to screen the risk factors of urinary sepsis after MPCNL under constant pressure perfusion.A logistic regression prediction model was established.Bootstrap resampling method(1000 times)was used for internal validation of the model.The Hosmer-Lemeshow test was adopted to evaluate the goodness of fit of the prediction model and the area under the ROC curve was used to evaluate the predictive efficiency of the model.Results The results of univariate analysis showed that sex,urolithiasis operation history,hydronephrosis(moderate-severe),urinary white blood cells(WBC)≥2+,positive urinary nitrite(NIT)and ratio of neutrophil to lymphocyte(NLR)≥2.5 were correlated with the occurrence of urinary sepsis after MPCNL under constant pressure perfusion(all P<0.05).The results of multivariate analysis revealed that the females(OR=3.145,P=0.030),urinary WBC≥2+(OR=2.970,P=0.047),positive urinary NIT(OR=14.190,P<0.001)、NLR≥2.5(OR=4.302,P=0.008)were independent risk factors of urinary sepsis patients after MPCNL under constant pressure perfusion.The independent risk factors and OR values obtained by Bootstrap were the same as those obtained by multivariate regression analysis,suggesting that the independent risk factors and OR values obtained by multivariate logistic regression analysis we

关 键 词：脓毒症 肾切开取石术 经皮 灌注 

分 类 号：R699[医药卫生—泌尿科学]