基于倾向性评分匹配分析的经皮肾镜取石术后尿路感染的危险因素探讨

夏金生; 李林; 洪波; 陈先国

doi:10.13201/j.issn.1001-1420.2021.12.007

基于倾向性评分匹配分析的经皮肾镜取石术后尿路感染的危险因素探讨

- 1. 安徽省庐江县人民医院泌尿外科(合肥, 231500);
- 2. 安徽医科大学第一附属医院泌尿外科

详细信息

通讯作者: 夏金生,E-mail:hfcx1977@yeah.net

中图分类号: R692.4

收稿日期: 2021-07-06

Risk factors of urinary tract infection after percutaneous nephrolithotomy based on propensity score matching analysis

- 1. Department of Urology, Lujiang County People's Hospital of Anhui Province, Hefei, 231500, China;
- 2. Department of Urology, First Affiliated Hospital of Anhui Medical University

More Information

Corresponding author: XIA Jinsheng, E-mail: hfcx1977@yeah.net

Received Date: 06 July 2021

摘要

摘要: 目的：分析经皮肾镜取石术（PCNL）术后发生尿路感染的相关影响因素，为预防和治疗PCNL术后发生尿路感染提供依据。方法：纳入2017年1月—2021年6月于我院泌尿外科行PCNL治疗的467例患者作为研究对象，根据术后是否出现尿路感染将全部患者分为尿路感染组（n=63）和非感染组（n=404）。运用倾向性评分匹配法（PSM）对尿路感染组和非感染组进行1∶1匹配。匹配后进行组间单因素分析，然后将单因素分析有意义者进一步行非条件二分类logistic回归分析。结果 PSM成功匹配61对病例。单因素分析显示年龄、合并糖尿病、结石最大径、术前肾积水、手术时间、术后拔管时间和PCNL术后泌尿系感染发生密切相关（均P<0.05）。多因素分析显示年龄（OR=2.061，95%CI：1.633~4.755，P=0.003）、糖尿病（OR=1.950，95%CI：1.038~3.690，P=0.020）以及术后拔管时间（OR=4.585，95%CI：2.189~6.847，P<0.001）是PCNL术后发生尿路感染的独立影响因素。结论：PCNL术后尿路感染发生率较高，经PSM控制混杂因素影响后显示老年患者、合并糖尿病以及术后拔管时间延长能独立影响术后尿路感染的发生，应针对相关影响因素加强干预。
- 经皮肾镜碎石术 /
- 尿路感染 /
- 倾向性评分匹配法 /
- logistic回归分析 /
- 危险因素
Abstract: Objective: To analyze the related factors of urinary tract infection after percutaneous nephrolithotomy(PCNL), and provide evidence for the prevention and treatment of urinary tract infection after PCNL.Methods: A total of 467 patients who underwent PCNL in our hospital's urology department from Jan. 2017 to Jun. 2021 were enrolled in this study. All patients were divided into urinary tract infection group(n=63) and non-infection group(n=404) according to whether there was postoperative urinary tract infection. Propensity score matching(PSM) was used to match urinary tract infection group and non-infection group. After matching, univariate analysis was performed between groups, and then unconditional binary logistic regression analysis was performed for those with significant univariate analysis.Results: Sixty-one pairs of cases were successfully matched. Univariate analysis showed that age, diabetes mellitus, stone diameter, preoperative hydronephrosis, operative time, postoperative extubation time were closely related to the incidence of postoperative urinary tract infection(P<0.05). Multivariate analysis showed that age(OR=2.061, 95%CI:1.633-4.755, P=0.003), diabetes(OR=1.950, 95%CI:1.038-3.690, P=0.020) and postoperative extubation time(OR=4.585, 95%CI:2.189-6.847, P<0.001) were independent factors affecting urinary tract infection after PCNL.Conclusion: The incidence of urinary tract infection after PCNL is relatively high. After controlling the influence of confounding factors by PSM, it has been shown that elderly patients, diabetes mellitus, and prolonged extubation time can independently affect the occurrence of postoperative urinary tract infection. Intervention measures should be strengthened according to related influencing factors.
- percutaneous nephrolithotomy /
- urinary tract infection /
- propensity score matching /
- logistic regressive analysis /
- risk factor

HTML全文

参考文献(20)

[1]	Roger C, Abid N, Dubourg L, et al.Composition of urinary calculi:Lessons from a French epidemiologic retrospective study[J].Prog Urol, 2020, 30(6):339-345.
[2]	Waseda Y, Takazawa R, Kobayashi M, et al.Successful outcomes of endoscopic lithotripsy in completely bedridden patients with symptomatic urinary calculi[J].Sci Rep, 2020, 10(1):8839.
[3]	冯超, 郑宇飞, 张保朝, 等.经皮肾镜取石术在泌尿系结石中的应用与进展[J].国际泌尿系统杂志, 2019, 39(3):549-552.
[4]	Lorenzo Soriano L, Ordaz Jurado DG, Pérez Ardavín J, et al.Predictive factors of infectious complications in the postoperative of percutaneous nephrolithotomy[J].Actas Urol Esp(Engl Ed), 2019, 43(3):131-136.
[5]	Jung CE, Brubaker L.Postoperative urinary tract infection after urogynecologic surgery:timing and uropathogens[J].Int Urogynecol J, 2020, 31(8):1621-1626.
[6]	Wagenius M, Borglin J, Popiolek M, et al.Percutaneous nephrolithotomy and modern aspects of complications and antibiotic treatment[J].Scand J Urol, 2020, 54(2):162-170.
[7]	王姗姗, 陆静尔, 杨迪.2型糖尿病泌尿系统感染病原学特点及影响因素[J].中华医院感染学杂志, 2021, 31(5):711-715.
[8]	王静, 李凡.输尿管结石患者术后发生泌尿道感染的logistic分析[J].中国卫生统计, 2020, 37(5):740-741, 744.
[9]	张江容, 罗旭, 李梦芝, 等.肾结石患者经皮肾镜取石术后泌尿系感染的病原学特点及影响因素分析[J].中华医院感染学杂志, 2019, 29(2):265-268.
[10]	陈文航, 李慧慧, 周权, 等.基于倾向评分匹配法的高血压对妊娠相关性急性肾损伤预后影响的回顾性队列研究[J].中南大学学报(医学版), 2020, 45(7):797-803.
[11]	Feng Y, He XG, Zhou CM, et al.Comparison of hepatic resection and systemic treatment of breast cancer liver metastases:A propensity score matching study[J].Am J Surg, 2020, 220(4):945-951.
[12]	解晓曦, 赵晓明.基于倾向性评分匹配的患者术后医院感染的影响因素再评价[J].现代预防医学, 2019, 46(4):743-746.
[13]	Hsiao CY, Chen TH, Lee YC, et al.Risk factors for uroseptic shock in hospitalized patients aged over 80 years with urinary tract infection[J].Ann Transl Med, 2020, 8(7):477-489.
[14]	李新亮, 杨思伟, 郭艳, 等.经皮肾镜微创取石术后尿路感染危险因素及血清HMGB1、TLR4、NF-κB水平[J].中华医院感染学杂志, 2021, 31(2):249-253.
[15]	Kamei J, Yamamoto S.Complicated urinary tract infections with diabetes mellitus[J].J Infect Chemother, 2021, 27(8):1131-1136.
[16]	汪秋实, 孙维敏, 赵琪, 等.留置尿管患者泌尿道多重耐药菌的分离及危险因素[J/OL].中华临床医师杂志(电子版), 2021, 15(2):103-108.
[17]	Kamei J, Yamamoto S.Complicated urinary tract infections with diabetes mellitus[J].J Infect Chemother, 2021, 27(8):1131-1136.
[18]	中华医学会泌尿外科学分会结石学组, 中国泌尿系结石联盟.经皮肾镜取石术中国专家共识[J].中华泌尿外科杂志, 2020, 41(6):401-404.
[19]	卫超, 张宇聪, 甘家骅, 等.标准经皮肾镜取石术与无管化经皮肾镜取石术治疗肾结石的比较研究[J].中华泌尿外科杂志, 2018, 39(7):532-536.
[20]	Xun Y, Wang Q, Hu H, et al.Tubeless versus standard percutaneous nephrolithotomy:an update meta-analysis[J].BMC Urol, 2017, 17(1):102.