根治性肾切除术后急性肾损伤危险因素分析和列线图模型建立  

Risk Factors Analysis and Nomogram Model Construction for Acute Kidney Injury after Radical Nephrectomy

作　　者：陈升 余泽森 余天一 解坤鹏 李望 王军起 陈仁富 CHEN Sheng;YU Zesen;YU Tianyi(Department of Urology,The Affiliated Hospital of Xuzhou Medical University,Jiangsu 221000,China)

机构地区：[1]徐州医科大学附属医院泌尿外科,221000

出　　处：《医学研究杂志》2024年第11期138-143,149,共7页Journal of Medical Research

基　　金：江苏省徐州市第二轮医学领军人才培养项目(XWRCHT20210027)。

摘　　要：目的探讨根治性肾切除术后急性肾损伤(acute kidney injury,AKI)的危险因素,并构建临床预测模型。方法回顾性分析2020年6月~2023年6月于徐州医科大学附属医院行根治性肾切除术的334例肾癌患者的临床资料,根据术后是否发生AKI将患者分为AKI组(n=128)和non-AKI组(n=216)。收集患者的临床资料,筛选独立预测因子,建立列线图预测模型。结果AKI组和non-AKI组患者的性别、糖尿病、健侧肾脏肾小球滤过率(glomerular filtration rate,GFR)、血红蛋白与红细胞分布宽度比值(hemoglobin to red cell distribution width ratio,HRR)、血小板与淋巴细胞比值(platelet to lymphocyte ratio,PLR)、白蛋白与球蛋白比值(albumin to globulin ratio,AGR)、肌酐、尿素氮、尿酸水平比较,差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,性别、糖尿病、健侧肾脏GFR、HRR和尿素氮为根治性肾切除术后发生AKI的独立危险因素。基于独立危险因素进一步构建列线图预测模型,模型的受试者工作特征(receiver operating characteristic,ROC)曲线下面积为0.804。校准曲线显示,实际观察和列线图预测具有良好的一致性,绝对误差为0.015;Hosmer和Lemeshow检验结果显示,χ^(2)=10.997,P=0.202;决策曲线分析显示,模型的最大净获益阈值概率为8.0%~92.0%。结论性别、糖尿病、健侧肾脏GFR、HRR、血尿素氮是根治性肾切除术后发生急性肾损伤的危险因素;基于临床因素构建的列线图模型可有效预测根治性肾切除术后发生急性肾损伤的风险,可应用于临床。Objective To investigate the risk factors for acute kidney injury(AKI)after radical nephrectomy and construct a clinical prediction model.Methods The clinical data of 334 renal cancer patients who underwent radical nephrectomy from June 2020 to June 2023 in the Affiliated Hospital of Xuzhou Medical University were retrospectively analyzed,and they were divided into AKI group(n=128)and non-AKI group(n=216)according to whether AKI occurred after operation.The clinical data of patients were collected,independent predictors were screened,and the nomogram prediction model was established.Results Comparison of gender,diabetes mellitus,glomerular filtration rate(GFR)of the healthy kidney,duration of surgery,hemoglobin to red cell distribution width ratio(HRR),platelet to lymphocyte ratio(PLR),albumin to globulin ratio(AGR),creatinine,urea nitrogen,and uric acid levels between AKI group and non-AKI group showed statistically significant differences(P<0.05).Multivariate Logistic regression analysis showed that gender,diabetes mellitus,GFR of the healthy kidney,HRR,and urea nitrogen were independent risk factors for AKI after renal insufficiency.A nomogram prediction model was further constructed based on independent risk factors,and the area under the receiver operating characteristic(ROC)curve was 0.804.The calibration curve showed good agreement between the actual observation and the nomogram prediction,with an absolute error of 0.015;the Hosmer and Lemeshow test showed χ^(2)=10.997,P=0.202;and the decision analysis curve showed that the model′s threshold probability of maximum net benefit was 8.0%-92.0%.Conclusion Gender,diabetes mellitus,GFR of the healthy kidney,HRR,and blood urea nitrogen are risk factors for acute kidney injury after radical nephrectomy.The column-line diagram model constructed on the basis of clinical factors can effectively predict the risk of developing acute kidney injury after radical nephrectomy,and can be applied to the clinic.

关 键 词：根治性肾切除术 急性肾损伤 列线图 肾癌 

分 类 号：R692.5[医药卫生—泌尿科学]