复杂性肾结石患者经皮肾镜碎石术后感染性并发症发生风险的列线图构建  

Construction of Nomogram of the Risk of Infectious Complications after Percutaneous Nephrolithotripsy in Patients with Complex Kidney Stones

作　　者：魏峰[1] 周广军[1] 李双辉[1] 王艳艳 季智杰 WEI Feng;ZHOU Guangjun;LI Shuanghui(Cangzhou Hospital of Integrated Traditional and Western Medicine,Hebei 061000,China)

机构地区：[1]河北省沧州中西医结合医院,061000

出　　处：《医学研究杂志》2024年第9期151-156,161,共7页Journal of Medical Research

基　　金：河北省沧州市科技计划项目(222106081)。

摘　　要：目的构建个体化预测复杂性肾结石患者经皮肾镜碎石术(percutaneous nephrolithotripsy,PCNL)后感染性并发症发生风险的列线图模型并验证。方法选择2021年3月~2023年6月河北省沧州中西医结合医院收治的585例复杂性肾结石患者为研究对象,按照7∶3分为建模组(n=410)和验证组(n=175)。根据PCNL术后是否出现感染性并发症将建模组进一步分为无并发症组(n=342)和并发症组(n=68)。收集临床资料并采用多因素Logistic回归分析确定影响复杂性肾结石患者PCNL术后发生感染性并发症的因素,并构建预测复杂性肾结石患者PCNL术后感染性并发症发生的列线图模型。结果建模组和验证组患者性别、年龄、体重指数、手术时间、白细胞介素-6(interleukin-6,IL-6)水平、C反应蛋白(C-reactive protein,CRP)水平、结石位置和数量等资料比较,差异无统计学意义(P>0.05);与无并发症组比较,并发症组患者手术时间、结石直径较长,IL-6、CRP水平较高(t分别为5.084、6.727、5.936、7.869,P<0.05),糖尿病和术前尿路感染的比例较高(χ^(2)分别为12.520、35.117,P<0.05)。多因素Logistic回归分析结果显示,手术时间(OR=1.077)、结石直径(OR=1.303)、IL-6(OR=1.334)、CRP(OR=1.381)、糖尿病(OR=3.288)、术前尿路感染(OR=5.458)均为影响复杂性肾结石患者PCNL后发生感染性并发症的独立危险因素(P<0.05)。建模组和验证组曲线下面积分别为0.919(95%CI:0.889~0.949)、0.939(95%CI:0.882~0.996)。Hosmer-Lemeshow拟合优度检验结果显示,建模组χ^(2)=5.484,P=0.705;验证组χ^(2)=10.101,P=0.258。结论手术时间、结石直径、IL-6、CRP、糖尿病、术前尿路感染是影响复杂性肾结石患者PCNL后发生感染性并发症的独立危险因素,基于此构建的列线图模型具有较高的区分度和一致性。Objective To construct and verify Nomogram model for individualized prediction of the risk of infectious complications in patients with complex kidney stones after percutaneous nephrolithotripsy(PCNL).Methods A total of 585 patients with complex kidney stones admitted to Cangzhou Hospital of Integrated Traditional and Western Medicine from March 2021 to June 2023 were collected as the study subjects,and divided into modeling group(n=410)and validation group(n=175)at 7∶3.The modeling group was further divided into non-complication group(n=342)and complication group(n=68)according to whether there were infectious complications after PCNL surgery.The clinical data were collected and multivariate Logistic regression analysis was applied to determine the factors that affected the occurrence of infectious complications after PCNL surgery in patients with complex kidney stones,and Nomogram model was constructed to predict the occurrence of infectious complications after PCNL surgery in patients with complex kidney stones.Results There were no statistically significant differences in gender,age,body mass index,surgical time,interleukin-6(IL-6)level,C-reactive protein(CRP)level,location and number of stone between the modeling group and the validation group(P>0.05);compared with the non-complication group,the operation time and stone diameter,the levels of IL-6,CRP in the complication group was higher(t were 5.084,6.727,5.936,7.869,P<0.05),and the proportions of diabetes and preoperative urinary tract infection were higher(χ^(2) were 12.520,35.117,P<0.05).The results of multivariate Logistic regression analysis showed that operation time(OR=1.077),stone diameter(OR=1.303),IL-6(OR=1.334),CRP(OR=1.381),diabetes(OR=3.288),preoperative urinary tract infection(OR=5.458)were all independent risk factors for infection complications after PCNL surgery in patients with complex kidney stones(P<0.05).The area under the curve for the modeling group and validation group were 0.919(95%CI:0.889-0.949)and 0.939(95%CI:0.882-0.996),resp

关 键 词：复杂性肾结石 经皮肾镜碎石术 感染性并发症 列线图模型 个体化预测 

分 类 号：R692.4[医药卫生—泌尿科学]