输尿管结石并发急性肾损伤的影响因素探讨:基于PSM法  

Exploration of Risk Factors for Acute Kidney Injury Associated with Ureteral Stones:Based on Propensity Score Matching(PSM)

作　　者：鲁照平 张喆 蒲枫 LU Zhaoping;ZHANG Zhe;PU Feng(Department of Urology,Kaifeng People's Hospital,Kaifeng Henan 475000,China)

机构地区：[1]开封市人民医院泌尿外科,河南开封475000

出　　处：《临床研究》2025年第3期68-71,共4页Clinical Research

摘　　要：目的基于倾向性评分匹配(PSM)法探讨输尿管结石并发急性肾损伤(AKI)的影响因素。方法回顾性分析2020年1月至2023年6月开封市人民医院收治的358例输尿管结石患者的临床资料,根据有无并发AKI分为AKI组和非AKI组。应用PSM法均衡AKI组和非AKI组协变量,包括性别、年龄、体质量指数、合并高血压、合并糖尿病、结石手术史,并采用单因素和多因素分析PSM后输尿管结石并发AKI的影响因素。结果输尿管结石患者AKI并发率为9.22%;PSM前,AKI组和非AKI组年龄、合并高血压、合并糖尿病、结石手术史比较差异均无统计学意义(P>0.05),AKI组女性、体质量指数均高于非AKI组(P<0.05);经PSM共成功匹配31对患者,PSM后两组各协变量比较差异均无统计学意义(P>0.05);单因素分析结果显示,AKI组上段结石、输尿管梗阻、中重度肾积水、经皮肾镜碎石取石术占比以及术前肌酐水平均高于非AKI组,输尿管软镜碎石取石术占比低于非AKI组,差异有统计学意义(P<0.05);多因素分析结果显示,上段结石、输尿管梗阻、中重度肾积水、经皮肾镜碎石取石术以及术前肌酐水平升高均是输尿管结石患者并发AKI的危险因素(P<0.05)。结论经PSM控制混杂因素后,上段结石、输尿管梗阻、中重度肾积水、经皮肾镜碎石取石术以及术前肌酐水平升高均是输尿管结石患者并发AKI的危险因素。Objective To explore the risk factors for acute kidney injury(AKI)associated with ureteral stones based on the propensity score matching(PSM)method.Methods A retrospective analysis was conducted on the clinical data of 358 patients with ureteral stones admitted to Kaifeng People's Hospital from January 2020 to June 2023.Patients were divided into the AKI group and non-AKI group based on the presence or absence of AKI.The PSM method was used to balance covariates between the two groups,including sex,age,body mass index,presence of hypertension,presence of diabetes,and history of stone surgeries.Univariate and multivariate analyses were performed to identify risk factors for AKI after PSM.Results The incidence of AKI in patients with ureteral stones was 9.22%.Before PSM,there were no statistically significant differences in age,presence of hypertension,presence of diabetes,or history of stone surgeries between the AKI and non-AKI groups(P>0.05).However,the AKI group had a higher proportion of females and higher body mass index compared to the non-AKI group(P<0.05).A total of 31 pairs of patients were successfully matched after PSM,and there were no statistically significant differences in covariates between the two groups post-matching(P>0.05).Univariate analysis indicated that the AKI group had a higher proportion of upper ureteral stones,ureteral obstruction,moderate to severe hydronephrosis,percutaneous nephrolithotripsy procedures,and higher preoperative creatinine levels compared to the non-AKI group,while the proportion of ureteroscopy procedures was lower in the AKI group(P<0.05).Multivariate analysis revealed that upper ureteral stones,ureteral obstruction,moderate to severe hydronephrosis,percutaneous nephrolithotripsy procedures,and elevated preoperative creatinine levels were independent risk factors for AKI in patients with ureteral stones(P<0.05).Conclusion After controlling for confounding factors through PSM,upper ureteral stones,ureteral obstruction,moderate to severe hydronephrosis,percutaneous nep

关 键 词：输尿管结石 急性肾损伤 影响因素 倾向性评分匹配法 

分 类 号：R693.4[医药卫生—泌尿科学]