泌尿系结石相关梗阻性肾病及碎石术后急性肾损伤发生的危险因素分析  

Analysis of risk factors of urinary calculi-related obstructive nephropathy and post-lithotripsy acute kidney injury

作　　者：王欢 张英慧 张德伟 金艳华 辛雨 谌卫 郭志勇 张艳宁 关欣 Wang Huan;Zhang Yinghui;Zhang Dewei;Jin Yanhua;Xin Yu;Chen Wei;Guo Zhiyong;Zhang Yanning;Guan Xin(Department of Nephrology,General Hospital of Chinese PLA Northern Theater Command,Shenyang 110016,Liaoning Province;Department Of Nephrology,First Affiliated Hospital of Chinese PLA Naval Military Medical University,Shanghai 200433,China)

机构地区：[1]解放军北部战区总医院肾脏病科,沈阳110016 [2]解放军海军军医大学第一附属医院肾内科,上海200433

出　　处：《中华肾病研究电子杂志》2023年第6期323-328,共6页Chinese Journal of Kidney Disease Investigation（Electronic Edition）

基　　金：辽宁省应用基础研究计划(2023JH2/101300078)。

摘　　要：目的探讨泌尿系结石相关梗阻性肾病及碎石术后急性肾损伤(AKI)发生的危险因素。方法本研究为回顾性研究。收集2016年1月至2019年1月在北部战区总医院以及海军军医大学第一附属医院行碎石术治疗泌尿系结石患者的人口学特征、既往史、实验室检查指标等基线资料和碎石术方式等信息,多因素Logistic回归方法分析梗阻性肾病及碎石术后AKI发生的相关因素。结果本研究共纳入2159例泌尿系结石患者,其中梗阻性肾病373例(17.28%)。在梗阻性肾病患者中,女性占54.2%,男性占45.8%,年龄(57.14±11.52)岁。校正后多因素Logistic回归分析显示,高龄(OR=1.054,95%CI:1.042~1.066,P<0.001)、较高的血尿酸(OR=1.004,95%CI:1.003~1.005,P<0.001)、较高的二氧化碳结合力(OR=0.820,95%CI:0.783~0.859,P<0.001)和血红蛋白(OR=0.991,95%CI:0.983~0.998,P=0.014)是梗阻性肾病发生的危险因素。碎石术后共有174例患者发生AKI(8.06%),多因素Logistic回归分析提示,经皮肾镜碎石术(OR=1.658,95%CI:1.209~2.274,P=0.002)、较高的血尿酸(OR=1.002,95%CI:1.000~1.003,P=0.019)和较高的二氧化碳结合力(OR=0.921,95%CI:0.868~0.976,P=0.005)是碎石术后AKI发生的危险因素。结论高龄、较高的血尿酸与梗阻性肾病的发生相关;经皮肾镜碎石术和较高的血尿酸与碎石术后AKI的发生相关。Objective To explore the risk factors of urinary calculi-related obstructive nephropathy and post-lithotripsy acute kidney injury(AKI).Methods Patients with urinary calculi who underwent lithotripsy treatment in the hospitals from January 2016 to January 2019 were selected.Multivariate logistic regression method was used to analyze the related factors of obstructive nephropathy and post-lithotripsy AKI.Results Among the 2159 patients,373 patients(17.28%)had obstructive nephropathy.Among the patients with obstructive nephropathy,the female patients accounted for 54.2%and the male accounted for 45.8%,with an average age of 57.14±11.52 years.The multivariate logistic regression analysis after adjustment showed that older age(OR=1.054,95%CI:1.042-1.066,P<0.001),increased blood uric cid(OR=1.004,95%CI:1.003-1.005,P<0.001),increased carbon dioxide combining power(OR=0.820,95%CI:0.783-0.859,P<0.001),and decreased hemoglobin(OR=0.991,95%CI:0.983-0.998,P=0.014)were the risk factors of the obstructive nephropathy.A total of 174 patients developed AKI after the lithotripsy(8.06%).Multivariate logistic regression analysis showed that percutaneous nephrolithotripsy(OR=1.658,95%CI:1.209-2.274,P=0.002),elevated blood uric acid(OR=1.002,95%CI:1.000-1.003,P=0.019)and elevated carbon dioxide combining power were the risk factors of post-lithotripsy AKI(P<0.05).Conclusion Older age and increased blood uric acid were related to the obstructive nephropathy.percutaneous nephrolithotripsy and elevated blood uric acid were related to the post-lithotripsy AKI.

关 键 词：梗阻性肾病 急性肾损伤 泌尿系结石 血尿酸 危险因素 

分 类 号：R692[医药卫生—泌尿科学]