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及NLR对其预测价值  

Multivariate analysis of systemic inflammatory response syndrome after percutaneous nephrolithotomy and the predictive value of NLR for it

作　　者：罗裕春 李世豪 凌峰 黄军成 刘宏伟 LUO Yuchun;LI Shihao;LING Feng;HUANG Juncheng;LIU Hongwei(Department of Urology,Central Hospital of Guangdong Nongken Affiliated to Guangdong Medical University,Guangdong,Zhanjiang 524002,China;Department of Urology,Affiliated Hospital of Guangdong Medical University,Guangdong,Zhanjiang 524001,China)

机构地区：[1]广东医科大学附属广东农垦中心医院泌尿外科,广东湛江524002 [2]广东医科大学附属医院泌尿外科,广东湛江524001

出　　处：《中国医药科学》2023年第10期154-158,170,共6页China Medicine And Pharmacy

基　　金：广东省湛江市科技计划项目(2021B01284)。

摘　　要：目的 研究上尿路结石患者行经皮肾镜碎石取石术(PCNL)后发生全身炎症反应综合征(SIRS)的危险因素,评估术前中性粒细胞与淋巴细胞比值(NLR)对PCNL术后发生SIRS的预测价值。方法 回顾性分析2020年1月至2021年12月广东医科大学附属广东农垦中心医院行PCNL的上尿路结石患者233例,根据术后是否发生SIRS分为SIRS组和非SIRS组,分析糖尿病史、同侧结石手术史、亚硝酸盐、尿培养、尿白细胞酯酶、通道数量、术前中性粒细胞比率、术前NLR、血红蛋白、白蛋白、尿白细胞数目、结石负荷、手术时间等因素与PCNL术后发生SIRS的关系,通过二元logistic回归分析哪些是独立危险因素,ROC曲线图分析NLR的预测价值。结果 31例患者PCNL术后发生SIRS。SIRS组术前亚硝酸盐阳性率、尿培养阳性率、尿白细胞酯酶阳性率、多通道比率、血红蛋白、白蛋白、尿白细胞数目、结石负荷、手术时间、术前中性粒细胞比率、术前NLR与非SIRS组比较,差异均有统计学意义(P <0.05),二元logistic回归分析显示术前NLR高(OR=1.336,P=0.042)、尿白细胞数目多(OR=1.000,P=0.028)和手术时间长(OR=1.024,P=0.001)是PCNL术后发生SIRS的独立危险因素。ROC曲线分析显示术前NLR预测PCNL术后发生SIRS的最佳截断点为3.08,其敏感度为51.60%,特异度为83.20%,曲线下面积为0.708。结论 PCNL术后发生SIRS与术前NLR高、尿白细胞增多、手术时间长等多种因素相关,其中术前NLR可以用于早期预测PCNL术后SIRS的发生。Objective To investigate the risk factors of systemic inflammatory response syndrome(SIRS)in patients with upper urinary calculi after percutaneous nephrolithotomy(PCNL),and to evaluate the predictive value of preoperative neutrophil to lymphocyte ratio(NLR)for SIRS after PCNL.Methods The clinical data of 233 patients with upper urinary calculi who underwent PCNL in Center Hospital of Guangdong Nongken Affiliated to Guangdong Medical University from January 2020 to December 2021 were retrospectively analyzed.According to whether SIRS occurred after operation,they were divided into the SIRS group and the non-SIRS group.The correlations between SIRS after PCNL and diabetes history,ipsilateral stone operation history,nitrite,urine culture,urinary leukocyte esterase,number of c hannels,preoperative neutrophil ratio,preoperative NLR,hemoglobin,albumin,urinary leukocyte number,stone burden,operation time and other factors were analyzed.And the independent risk factors were analyzed by binary Logistic regression,and the predictive value of NLR was analyzed by ROC curve.Results SIRS occurred in 31 patients after PCNL.The preoperative nitrite positive rate,urine culture positive rate,urine leukocyte esterase positive rate,multi-channel ratio,hemoglobin,albumin,urinary leukocyte number,stone burden,operation time,preoperative neutrophil ratio,and preoperative NLR in the SIRS group were remarkably different from those in the non-SIRS group(P<0.05).Binary Logistic regression analysis showed that the higher preoperative NLR(OR=1.336,P=0.042),the larger leukocyte number in urine(OR=1.000,P=0.028)and the longer operation tim e(OR=1.024,P=0.001)were independent risk factors for SIRS after PCNL.ROC curve analysis showed that the best cutoff point of preoperative NLR for predicting SIRS after PCNL was 3.08.Its sensitivity was 51.60%,specificity was 83.20%and the area under the curve was 0.708.Conclusion The occurrence of SIRS after PCNL is related to many factors,such as high preoperative NLR,large urinary leukocyte number,and lon

关 键 词：中性粒细胞与淋巴细胞比值 经皮肾镜碎石取石术 全身炎症反应综合征 危险因素 

分 类 号：R691.4[医药卫生—泌尿科学]