腹腔镜单侧肾上腺切除术后肾上腺皮质功能不全的影响因素  

Influencing Factors of Adrenal Insufficiency After Laparoscopic Unilateral Adrenalectomy

作　　者：张智峰 李世宾 冀阳 吴辉[2] ZHANG Zhifeng;LI Shibin;JI Yang;WU Hui(Urology,Xinxiang Central Hospital/the Fourth Clinical College of Xinxiang Medical College,Xinxiang 453000,China;Department of Urology and Andrology,Zhengzhou First People’s Hospital,Zhengzhou 451475,China)

机构地区：[1]新乡市中心医院/新乡医学院第四临床学院泌尿外科,河南新乡453000 [2]郑州市第一人民医院泌尿男科,河南郑州451475

出　　处：《河南医学研究》2024年第18期3345-3349,共5页Henan Medical Research

摘　　要：目的探讨腹腔镜单侧肾上腺切除术后肾上腺皮质功能不全(AI)的影响因素。方法收集2018年1月至2021年12月新乡市中心医院收治的100例腹腔镜单侧肾上腺切除术患者为研究对象,根据其术后血浆皮质醇水平将患者分为AI组、非AI组,收集术前和术中可能导致AI发生的资料,经单因素、多因素logistic回归分析腹腔镜单侧肾上腺切除术后AI发生的危险因素。绘制受试者工作特征(ROC)曲线分析危险因素对腹腔镜单侧肾上腺切除术后AI发生的预测价值。结果与术前比较,患者术后即刻、术后6 h的血浆皮质醇水平升高(P<0.05),术后12~72 h降低再回升,但与术前比较,差异无统计学意义(P>0.05)。与非AI组比较,AI组患者年龄较大,血清C反应蛋白(CRP)和白介素6(IL-6)水平较低(P<0.05)。多因素logistic回归分析,结果提示高龄、血清CRP和IL-6水平高为腹腔镜单侧肾上腺切除术后AI发生的独立危险因素。年龄、血清CRP和IL-6水平单一及联合预测腹腔镜单侧肾上腺切除术后AI发生的曲线下面积(AUC)为0.661、0.681、0.684、0.739,联合预测AUC最大。结论高龄、血清CRP和IL-6水平高为腹腔镜单侧肾上腺切除术后AI发生的独立危险因素,且对AI发生风险有一定预测价值,以联合应用时预测效能最高。Objective To investigate the influencing factors of adrenal insufficiency(AI)after laparoscopic unilateral adrenalectomy.Methods A total of 100 patients with laparoscopic unilateral adrenalectomy admitted to Xinxiang Central Hospital from January 2018 to December 2021 were collected as the study objects.The patients were divided into AI group and non AI group according to their plasma cortisol concentration after operation.The data that may lead to AI before and during the operation were collected.The risk factors of AI after laparoscopic unilateral adrenalectomy were analyzed by single factor and multiple factor logistic regression.The predictive value of risk factors for AI after laparoscopic unilateral adrenalectomy was analyzed by drawing the receiver operating characteristic(ROC)curve.Results Compared with that before operation,the plasma cortisol concentration of patients in this group immediately increased after operation and 6 hours after operation(P<0.05),and decreased and recovered 12-72 hours after operation,but there was no statistical significance compared with that before operation(P>0.05).Compared with the non AI group,the patients in the AI group were older,the levels of serum C-reactive protein(CRP)and interleukin-6(IL-6)were lower(P<0.05).Multivariate logistic regression analysis showed that old age,high serum CRP and IL-6 levels were independent risk factors for AI after laparoscopic unilateral adrenalectomy.The area under the curve(AUC)of AI after laparoscopic unilateral adrenalectomy predicted by age,serum CRP and IL-6 levels alone or jointly was 0.661,0.681,0.684,0.739,and the AUC predicted jointly was the largest.Conclusion Old age,high serum CRP and IL-6 levels are independent risk factors of AI after laparoscopic unilateral adrenalectomy,and they have certain predictive value for the risk of AI and the combination of them has the highest predictive effect.

关 键 词：腹腔镜单侧肾上腺切除术 肾上腺皮质功能不全 皮质醇 危险因素 预测价值 

分 类 号：R586[医药卫生—内分泌]