Analysis of flexible ureteroscopic lithotripsy on kidney stones combined with HIV infection
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摘要: 目的 研究输尿管软镜碎石术在肾结石合并HIV感染患者中应用的安全性和有效性。方法 单中心回顾性研究，收集2017年10月—2020年9月收治于首都医科大学附属北京地坛医院泌尿外科的肾结石患者的电子病历信息，纳入其中接受输尿管软镜碎石术治疗的患者151例，将36例合并HIV感染的患者作为观察组，另外115例不合并HIV感染的患者作为对照组。采用倾向性评分匹配对2组患者基本资料进行1∶1匹配，匹配后比较2组患者的手术时间、结石清除率、术后并发症(Clavien-Dindo分级)、术后住院时间。结果 在术后并发症方面，观察组有增多的现象，主要表现为术后发热(13.3% vs.3.3%，P=0.350)。而在手术时间、术后住院时间、结石清除率方面比较，2组间差异均无统计学意义。结论 经充分术前准备后，采用输尿管软镜碎石术治疗肾结石合并HIV感染患者有着较好的安全性及有效性。Abstract: Objective To study the safety and effectiveness of flexible ureteroscopic lithotripsy (fURL) in HIV infected patients with kidney stones.Methods Single center retrospective study included the electronic case information of renal stone patients in Beijing Ditan Hospital affiliated to Capital Medical University from October 2017 to September 2020, including 151 patients treated with fURL. Thirty-six patients with HIV infection were treated as observation group, and 115 ordinary patients without HIV infection as control group. The basic data of the two groups were matched by 1∶1. Then the operation time, stone clearance rate, postoperative complications (Clavien-Dindo classification) and postoperative hospitalization time of the two groups were compared.Results In terms of postoperative complications, the observation group increased, mainly in postoperative fever (13.3% vs. 3.3%, P=0.350). There was no difference in the operation time, the postoperative hospitalization time or the stone removal rate.Conclusion After full preoperative preparation, fURL was safely and effectively treated with kidney stones combined with HIV infection.
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表 1 倾向性评分匹配前观察组与对照组肾结石患者一般资料比较
X±S，M(Q1，Q3) 一般资料 观察组(n=36) 对照组(n=115) 统计值 P值 年龄/岁 43.0±14.4 49.3±12.8 -2.522 0.013 BMI 25.2±3.0 25.5±2.9 -0.604 0.547 血白蛋白/(g·L-1) 44.1±4.8 42.6±4.3 2.561 0.011 结石直径/cm 1.5(1.0，2.2) 1.5(1.0，2.0) -1.294 0.197 血肌酐/(μmol·L-1) 81.5(71.0，112.0) 75.0(65.0，91.0) -2.077 0.038 白细胞计数/(×109·L-1) 6.1(4.6，6.7) 6.6(5.5，7.8) -2.443 0.014 男性/例(%) 31(86.1) 82(71.3) 3.192 0.082 患侧(左)/例(%) 23(63.9) 63(54.8) 0.927 0.441 Guy’s分级/例(%) 5.995 0.040 Ⅰ级 30(83.3) 92(80.0) Ⅱ级 4(11.1) 23(20.0) Ⅲ级 2(5.6) 0(0.0) CT值/例(%) 11.703 0.006 1级(＜400 HU) 5(13.9) 13(11.3) 2级(400~799 HU) 21(58.3) 77(67.0) 3级(800~1199 HU) 2(5.6) 20(17.4) 4级(≥1200 HU) 8(22.2) 5(4.3) 
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表 2 倾向性评分匹配后观察组与对照组肾结石患者一般资料比较
X±S，M(Q1，Q3) 一般资料 观察组(n=30) 对照组(n=30) 统计值 P值 年龄/岁 43.8±14.8 42.9±12.8 0.252 0.802 BMI 25.0±3.0 24.64±3.1 0.489 0.626 血白蛋白/(g·L-1) 44.4(41.0，47.3) 45.0(42.8，47.3) -0.296 0.771 结石直径/cm 1.6(1.0，2.1) 1.5(1.0，2.0) -0.974 0.334 血肌酐/(μmol·L-1) 76.5(69.8，105.0) 83.5(71.2，112.0) -0.695 0.492 白细胞计数/(×109·L-1) 5.7(4.6，6.4) 6.2(5.2，7.6) -2.443 0.082 男性/例(%) 25(83.3) 24(80.0) 0.111 0.739 患侧(左)/例(%) 18(60.0) 14(46.7) 1.071 0.301 Guy’s分级/例(%) 4.006 0.111 Ⅰ级 25(83.3) 22(73.3) Ⅱ级 3(10.0) 8(26.7) Ⅲ级 2(6.7) 0(0.0) CT值/例(%) 5.613 0.125 1级(＜400 HU) 4(13.3) 3(10.0) 2级(400~799 HU) 18(60.0) 20(66.7) 3级(800~1199 HU) 2(6.7) 6(20.0) 4级(≥1200 HU) 6(20.0) 1(3.3)
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表 3 匹配后观察组与对照组肾结石术中及术后情况比较
M(Q1，Q3) 指标 观察组(n=30) 对照组(n=30) 统计值 P值 手术时间/min 90.0(70.0，122.5) 75.0(60.0，93.5) -1.910 0.056 术后住院时间/d 3.5(3.0，4.0) 3.5(3.0，4.0) -0.208 0.844 轻度并发症(Clavien ≤Ⅱ级)/例(%) 5(16.7) 2(6.7) 0.647 0.421 术后发热/例(%) 4(13.3) 1(3.3) 0.873 0.350 术后血尿/例(%) 1(3.3) 1(3.3) 0.000 1.000 结石清除/例(%) 27(90.0) 29(96.7) 0.268 0.605
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表 4 观察组与对照组术后并发症、结石残留情况及其治疗
例 类型 观察组(n=30) 对照组(n=30) 例数 治疗 例数 治疗 发热(T) ≥38.5℃ 1 抗感染及对症治疗 0 37.3~38.4℃ 3 对症治疗 1 对症治疗 血尿 病程＞24 h 1 对症治疗 1 对症治疗 结石残留 直径≥4 mm 3 软镜碎石 1 软镜碎石
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