肾盂积水密度与输尿管镜碎石术后患者发生严重感染并发症的关系  

Relationship between the hounsfield units in renal pelvis urine and the risk of severe infection complications in patients undergoing ureteroscopic lithotripsy

作　　者：张凯淇 李志远 白松[1] 费翔[1] Zhang Kaiqi;Li zhiyuan;Bai Song;Fei Xiang(The Third Department of Urology,Shengjing Hospital of China Medical University,Shenyang,Liaoning 110022,China)

机构地区：[1]中国医科大学附属盛京医院第三泌尿外科,辽宁沈阳110022

出　　处：《泌尿外科杂志（电子版）》2024年第3期12-16,共5页Journal of Urology for Clinicians(Electronic Version)

摘　　要：目的探讨肾盂积水密度与输尿管镜碎石术(ureteroscopic lithotripsy,URS)后患者发生严重感染并发症的风险关系。方法回顾性分析2021年6月至2024年1月在中国医科大学附属盛京医院行URS的292例患者的临床资料,采用非增强计算机断层扫描(non-contrast CT,NCCT)测量肾盂积水密度。严重感染并发症包括全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)、败血症及感染性休克。采用二元逻辑回归模型评估OR值和95%CI。结果URS术后感染组肾盂积水密度、女性例数、体质量指数高于未感染组,结石密度、积水程度低于未感染组,差异有统计学意义(P<0.05)。在调整混杂变量后,比较肾盂积水密度最低四分位数患者,最高四分位数患者的OR(95%CI)为47.67(5.55,99.59)。输尿管结石患者肾盂积水密度与URS后严重感染并发症的风险呈正向线性相关(P<0.01)。肾盂积水密度的受试者工作特征曲线下面积和95%CI为0.8693(0.8033,0.9353)(P<0.01)。截断值为12.0 HU,灵敏度为79.62%,特异度为81.25%。结论在输尿管结石患者中,肾盂积水密度与URS后发生严重感染的风险呈正相关,这有助于临床制定输尿管镜碎石围手术期治疗决策。Objective To explore the relationship between the hounsfield units in renal pelvis urine and the risk of severe infection complications in patients undergoing ureteroscopic lithotripsy(URS).Methods Retrospective analysis of clinical data of 292 patients who underwent URS in Shengjing Hospital affiliated with China Medical University from June 2021 to January 2024.The hounsfield unit of urine in the renal pelvis was quantified using non-enhanced computed tomography.The severe infectious complications were systemic inflammatory response syndrome,sepsis,and septic shock.Binary logistic regression models were used to evaluate the OR and 95%CI.Results The density of hydronephrosis,number of females,and body mass index in patients with severe infection complications after URS were higher than those without severe infection,while the density of stones and degree of hydronephrosis were lower than those without severe infection,with statistical significance(P<0.05).After controlling for confounding variables,patients in the lowest quartile of renal pelvis urine density had an OR(95%CI)of 47.67(5.55,99.59)compared to those in the extreme quartile.A positive linear relationship was found between the hounsfield unit value of renal pelvis urine and the likelihood of severe infection complications during ureteroscopy(P<0.01).The area under the receiver operating characteristic curve of renal pelvis urine density was 0.8693 with a 95%CI of 0.8033 to 0.9353(P<0.01).The threshold value was 12.0 HU with a sensitivity of 79.62%and a specificity of 81.25%.Conclusions This retrospective study established a direct correlation between the hounsfield units in renal pelvis urine and the likelihood of severe infection complication in patients with ureteral stones and asymptomatic hydronephrosis following ureteroscopy.These findings could aid in the decision-making process for ureteroscopy treatment.

关 键 词：肾盂积水 CT值 输尿管镜碎石术 尿路感染 

分 类 号：R693.4[医药卫生—泌尿科学]