双镜联合治疗复杂性肾结石后尿路感染发生的列线图预警模型构建与验证  

Construction of a nomogram warning model for the occurrence of urinary tract infection after dual-lens combined treatment of complicated renal calculi

作　　者：申凯[1] 廖有刚 雷波[1] 颜良英[3] Shen Kai;Liao Yougang;Lei Bo;Yan Liangying(Department of Urology,Jiangyou People's Hospital,Jiangyou 621700,China;Department of Urology,Mianyang Central Hospital,Mianyang 621000,China;Department of Urology,the Second People's Hospital of Qinzhou,Qinzhou 535000,China)

机构地区：[1]江油市人民医院泌尿外科,江油621700 [2]绵阳市中心医院泌尿外科,绵阳621000 [3]钦州市第二人民医院泌尿外科,钦州535000

出　　处：《国际泌尿系统杂志》2024年第2期206-211,共6页International Journal of Urology and Nephrology

基　　金：钦州市科学研究与技术开发计划(20202735)。

摘　　要：目的通过分析双镜联合治疗复杂性肾结石后尿路感染的影响因素来构建并验证列线图模型对尿路感染的预测价值。方法选取本院2020年3月至2022年1月收治的115例复杂性肾结石患者,根据术后是否出现尿路感染分为感染组(32例)与非感染组(83例)。比较两组患者的性别、年龄、体质量指数、糖尿病、高血压、冠心病、既往ESWL史、术前尿路感染、肾功能障碍、结石大小、手术时间、鹿角形结石、术前血糖水平、术中灌注量、术中通道类型、术后留置导尿管时间等资料,并进行尿路感染的单因素、多因素logistic回归分析,将筛选出的影响因素应用R软件拟合列线图模型,并绘制受试者工作特征(ROC)曲线评估列线图模型对尿路感染的预测价值。结果感染组与非感染组的性别、年龄、高血压、冠心病比较,差异均无统计学意义(均P>0.05)。感染组的体质量指数>24 kg/m^(2)、糖尿病、既往ESWL史、术前尿路感染、肾功能障碍、结石>3.5 cm、手术时间>100 min、鹿角形结石、术前血糖>6.1 mmol/L、术中灌注量>30 L、术中多通道、术后留置导尿管时间>7 d的占比均明显高于非感染组(均P<0.05)。经单因素及多因素logistic回归分析结果显示,术前尿路感染、肾功能障碍、结石大小、手术时间、鹿角形结石、术前血糖、术中灌注量是双镜联合治疗复杂性肾结石后尿路感染的影响因素(均P<0.05)。根据logistic回归分析结果绘制双镜联合治疗复杂性肾结石术后发生尿路感染的列线图模型,该模型预测尿路感染的ROC曲线下面积为0.889(95%CI:0.823~0.969)。Bootstrap法内部验证的平均绝对误差为0.020,预测曲线与标准曲线基本拟合,提示模型预测有较高的准确度。H-L拟合优度检验结果提示列线图模型预测概率与实际尿路感染率有较高一致性(χ^(2)=1.968,P=0.121)。结论术前尿路感染、肾功能障碍、结石大小、手术�Objective To construct and verify the predictive value of a nomogram model for urinary tract infection by analyzing the influencing factors of urinary tract infection after dual-lens combined treatment of complicated kidney stones.Methods From March 2020 to January 2022,115 patients withcomplicated kidney stones who were admitted to our hospital were selected and divided into infection group(32 cases)and non-infection group(83 cases)according to whether urinary tract infection occurred after operation.The gender,age,body mass index,diabetes mellitus,hypertension,coronary heart disease,previous extracorporeal shock wave lithotripsy(ESWL)history,preoperative urinary tract infection,renal dysfunction,stone size,operation time,staghorn stones,preoperative blood glucose level,and operation time were compared between the two groups.The univariate and multivariate logistic regression of urinary tract infection was carried out,and the selected influencing factors were fitted to the nomogram model by R software,and the receiver operating characteristic(ROC)curve was drawn to evaluate the predictive value of the nomogram model for urinary tract infection.Results There were no significant difference in gender,age,hypertension and coronary heart disease between the infection group and the non-infection group(all P>0.05).In the infection group,body mass index>24 kg/m2,diabetes mellitus,previous history of ESWL,preoperative urinary tract infection,renal dysfunction,stones>3.5 cm,operation time>100 min,staghorn stones,preoperative blood glucose>6.1 mmol/L,the percentages of intraoperative perfusion volume>30 L,intraoperative multi-channel and postoperative indwelling catheter>7 days were significantly higher than those in the non-infection group(all P<0.05).Univariate and multivariate logistic regression analysis showed that preoperative urinary tract infection,renal dysfunction,stone size,operation time,staghorn stones,preoperative blood sugar,and intraoperative perfusion volume were the most important factors in the urinary t

关 键 词：肾结石 输尿管镜检查 经皮肾镜碎石术 尿路感染 

分 类 号：R699.2[医药卫生—泌尿科学]