上尿路结石患者术后发生真菌感染的危险因素分析及预测模型的构建  

Analysis of risk factors of postoperative fungal infection in patients with upper urinary tract calculi and construction of a risk prediction nomograph model

作　　者：张豪放 王硕 王晓甫[1] 张胜威[1] 谢恩旭 胡一帆 许长宝[1] Zhang Haofang;Wang Shuo;Wang Xiaofu;Zhang Shengwei;Xie Enxu;Hu Yifan;Xu Changbao(Department of Urology,The Second Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China)

机构地区：[1]郑州大学第二附属医院泌尿外科,郑州450000

出　　处：《中华泌尿外科杂志》2025年第3期205-212,共8页Chinese Journal of Urology

摘　　要：目的探讨上尿路结石患者术后发生真菌感染的影响因素,并构建列线图风险预测模型。方法回顾性分析2019年1月至2023年12月于郑州大学第二附属医院行上尿路结石手术的2329例患者的临床资料。男1410例,女919例;患者年龄50.0(38.0,58.0)岁。根据术后3个月内是否发生真菌感染分为真菌感染组和非真菌感染组。通过单因素logistic回归、LASSO回归筛选上尿路结石患者术后发生真菌感染的潜在影响因素。使用R语言按照7∶3的比例将患者随机分为训练集(n=1630例)与验证集(n=699例)。基于训练集采用多因素logistic逐步回归筛选独立危险因素,构建列线图预测模型。基于验证集,绘制受试者工作特征(ROC)曲线、校准曲线、决策曲线评估模型的区分度、准确性、临床适用性。结果术后真菌感染组97例,非真菌感染组2232例。单因素logistic回归分析结果提示,女性、年龄、糖尿病、恶性肿瘤病史、长期卧床、长期应用免疫抑制剂、入院血红蛋白、血肌酐、血白细胞计数、血中性粒细胞计数、肾积水程度、术前留置输尿管支架、手术时间、住院时间、应用碳青霉烯类抗菌药物、抗菌药物应用时间、术后48 h内发热,以及术后血白细胞计数、中性粒细胞计数、C反应蛋白、尿管留置时间、输尿管支架留置时间与上尿路结石术后真菌感染有关(P<0.05)。使用LASSO回归对单因素logistic回归结果进行筛选,训练集多因素logistic逐步回归分析结果提示,年龄(OR=1.041,95%CI 1.017~1.066,P=0.001)、糖尿病(OR=3.138,95%CI 1.517~6.492,P=0.002)、长期卧床(OR=10.627,95%CI 3.671~30.767,P<0.001)、恶性肿瘤病史(OR=11.934,95%CI 5.473~26.022,P<0.001)、入院血白细胞计数(OR=1.276,95%CI 1.134~1.436,P<0.001)、术后48 h内发热(OR=3.940,95%CI 1.956~7.937,P<0.001)、应用碳青霉烯类抗菌药物(OR=5.826,95%CI 2.783~12.196,P<0.001)、住院时间(OR=1.201,95%CI 1.131~1.277,P<0.001)、术后ObjectiveTo explore the risk factors of fungal infection in patients with upper urinary tract calculi after surgery and construct a risk prediction nomograph model.MethodsThe clinical data of 2329 patients who had undergone upper urinary calculus surgery in the Second Affiliated Hospital of Zhengzhou University from January 2019 to December 2023 were retrospectively analyzed.According to the presence or absence of fungal infection within 3 months after surgery,the patients were divided into fungal infection group(n=97)and non-fungal infection group(n=2232).Univariate logistic regression analysis and LASSO regression were used to screen the potential influencing factors.The enrolled patients were randomly divided into a training set(n=1630)and a validation set(n=699)at a ratio of 7∶3.Based on the training set,multivariate logistic stepwise regression was used to screen independent risk factors and to construct a nomogram.Based on the validation set,ROC curve,calibration curve and decision curve were drawn to evaluate the model's differentiation,accuracy and clinical applicability.ResultsUnivariate logistic regression analysis showed that female gender,age,diabetes mellitus,history of malignant tumor,long-term bedridden disease,long-term use of immunosuppressants,hemoglobin on admission,serum creatinine,uric acid,white blood cell count on admission,neutrophil count on admission,degree of hydronephrosis,preoperative indwelling ureteral stent,duration of surgery,postoperative fever within 48 hours,white blood cell count,neutrophil count,CRP,urinary catheter indwelling time,length of hospital stay,use of carbapenem antibiotics,the duration of antibiotic use and the duration of postoperative ureteral stent indwelling were related to fungal infection.screening after upper urinary calculi surgery(P<0.05).Univariate logistic regression results were screened after LASSO regression.Multivariate logistic stepwise regression analysis for the training set showed that age(OR=1.041,95%CI 1.017-1.066,P=0.001),diabetes(OR=3.138,

关 键 词：上尿路结石 真菌感染 危险因素 列线图 预测模型 

分 类 号：R699[医药卫生—泌尿科学]