Multivariate logistic regression analysis of retrograde ureteral stent for malignant ureteral obstruction
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摘要: 目的 分析影响逆行置管治疗恶性输尿管梗阻失败的主要危险因素。方法 回顾性分析2015年1月—2018年8月94例行逆行置管治疗的恶性输尿管梗阻患者的临床资料。对所研究的21个临床指标进行单因素分析，再将单因素分析中差异有统计学意义的相关因素进行多因素logistic回归分析。结果 对21项相关因素进行单因素分析，结果发现血清白蛋白水平、梗阻原因、膀胱浸润、肾积水程度、是否使用超滑导丝、CRF分级、腹膜后转移等7项之间的差异有统计学意义(P＜0.05)，再将上述7项相关因素作多因素logistic回归分析，统计结果显示血清白蛋白水平、梗阻原因、肾积水程度、未使用超滑导丝是影响逆行置管治疗恶性输尿管梗阻的主要危险因素。结论 患者血清白蛋白水平、梗阻原因、肾积水程度是影响逆行置管治疗恶性输尿管梗阻的主要危险因素，置管时使用超滑导丝是保护因素(OR=39.21)。Abstract: Objective To explore the main risk factors of retrograde ureteral stent failure in patients with malignant ureteral obstruction.Methods The clinical date of 94 patients with malignant ureteral obstruction who underwent retrograde ureteral stenting between January 2015 and August 2018 were retrospectively analyzed. Univariate analysis was used in 21 clinical variables, then multivariate logistic regression analysis was used in the selected variables.Results The results showed that there were statistically significant differences in serum albumin level, cause of obstruction, bladder invasion, level of hydronephrosis, unused super-slip guidewire, CRF classification and retroperitoneal metastasis (P < 0.05). Then the above 7 relevant factors were subjected to the logistic multivariate regression analysis, and the results showed that the main risk factors for stent failure in patients with malignant ureteral obstruction who underwent retrograde ureteral stenting were serum albumin level, cause of obstruction, level of hydronephrosis and whether to use superslip guide wire.Conclusion The main risk factors for stent failure in patients with malignant ureteral obstruction who underwent retrograde ureteral stenting were serum albumin level, cause of obstruction, level of hydronephrosis, whereas using super-slip guidewire is a protective factor (OR=39.21).
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Key words:
- malignant ureteral obstruction /
- retrograde ureteral stent /
- risk factors
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表 1 计数资料的Fisher精确检验
例 相关因素 成功 失败 P值 肿瘤类型 0.475 胃癌 6 6 结肠癌 4 5 直肠癌 2 6 卵巢癌 4 6 宫颈癌 18 21 膀胱癌 0 3 前列腺癌 0 1 其他a) 8 4 放疗史 0.125 有 0 4 无 42 48 注：a)其他肿瘤中，5例为淋巴瘤，5例为腹膜后巨大肿物，2例为腹膜后低分化癌。 
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表 2 计量资料的t检验
X±S 相关因素 成功 失败 t P值 年龄/岁 52.57±14.08 53.75±13.50 -0.413 0.681 血清白蛋白水平/(g·L-1) 41.33±4.97 36.65±6.01 4.049 0.000
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表 3 等级资料的非参数检验
相关因素 Wilcoxon W Z P值 肿瘤分期(1：Ⅰ期，2：Ⅱ期，3：Ⅲ期，4：Ⅳ期) 1481.000 -0.78 0.432 肾积水程度(1：1级，2：2级，3：3级，4：4级，5：5级) 1364.500 -5.066 0 CRF分期(1：代偿期，2：失代偿期，3：衰竭期，4：尿毒症期) 1654.000 -2.979 0.003
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表 4 计数资料的χ2检验
相关因素 成功/例 失败/例 χ2 P值 OR 相关因素 成功/例 失败/例 χ2 P值 OR 性别 0.672 0.412 0.673 膀胱浸润 9.097 0.003 0.123 男 9 15 是 2 15 女 33 37 否 40 37 侧别 0.265 0.679 0.807 手术史 0.255 0.614 1.235 左侧 22 30 有 24 27 右侧 20 22 无 18 25 梗阻原因 15.906 0.001 化疗史 0.081 0.776 1.126 原发肿瘤压迫 16 6 有 19 22 转移淋巴结压迫 16 14 无 23 30 肿瘤直接浸润输尿管 9 29 复发 0.053 0.818 1.100 其他a) 1 3 是 22 26 梗阻段 34.07 0.182 否 20 26 上段 8 10 支架管管径 3.078 0.098 2.100 中段 21 17 F4.7 27 24 下段 13 25 F7.0 15 28 腹腔转移 0.010 0.922 1.042 超滑导丝 22.568 0 8.686 是 19 23 使用 32 14 否 23 29 未使用 10 38 盆腔转移 2.265 0.132 0.529 泌尿系感染 0.895 0.344 0.662 是 21 34 是 13 21 否 21 18 否 29 31 腹膜后转移 4.130 0.042 0.425 是 17 32 否 25 20 注：a)其他中3例为腹膜后纤维化，1例为不明原因；OR：比值比。
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表 5 多因素logistic逐步回归分析结果分析(前进法)
变量 β SE(β) Wald χ2 P值 OR 95.0%CI 下限 上限 血清白蛋白水平 -0.198 0.075 6.935 0.008 0.820 0.708 0.951 梗阻原因 1.447 0.442 10.700 0.001 4.252 1.786 10.121 肾积水分级 1.405 0.367 14.663 0 4.074 1.985 8.361 是否使用超滑导丝 3.669 0.875 17.578 0 39.210 7.055 217.915 常量 -4.325 3.055 2.004 0.157 0.013
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