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经皮肾镜取石术后全身炎症反应综合征的临床特征与危险因素分析

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文章导航 > 临床泌尿外科杂志 > 2023 > 38(1): 57-62
蒋政, 雷敏, 徐鹏, 等. 经皮肾镜取石术后全身炎症反应综合征的临床特征与危险因素分析[J]. 临床泌尿外科杂志, 2023, 38(1): 57-62. doi: 10.13201/j.issn.1001-1420.2023.01.013
引用本文: 蒋政, 雷敏, 徐鹏, 等. 经皮肾镜取石术后全身炎症反应综合征的临床特征与危险因素分析[J]. 临床泌尿外科杂志, 2023, 38(1): 57-62. doi: 10.13201/j.issn.1001-1420.2023.01.013
shu
JIANG Zheng, LEI Min, XU Peng, et al. Clinical features and risk factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy[J]. J Clin Urol, 2023, 38(1): 57-62. doi: 10.13201/j.issn.1001-1420.2023.01.013
Citation: JIANG Zheng, LEI Min, XU Peng, et al. Clinical features and risk factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy[J]. J Clin Urol, 2023, 38(1): 57-62. doi: 10.13201/j.issn.1001-1420.2023.01.013
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经皮肾镜取石术后全身炎症反应综合征的临床特征与危险因素分析

    • 1.

      广州医科大学附属第一医院泌尿外科 广东省泌尿外科重点实验室(广州，510230)

    • 2.

      广州医科大学附属第二医院泌尿外科

  • 基金项目:
    广州市科技计划市校(院)联合资助项目(No：202102010182)；广州市科技计划基础与应用基础研究项目(No：202002030042)；广州市泌尿疾病学重点学科资助项目(No：010G220184)
详细信息
    通讯作者: 吴文起，E-mail：wwqwml@163.com

  • 中图分类号: R692.4

Clinical features and risk factors of systemic inflammatory response syndrome after percutaneous nephrolithotomy

    • 1.

      Department of Urology, First Affiliated Hospital of Guangzhou Medical University, Guangdong Key Laboratory of Urology, Guangzhou, 510230, China

    • 2.

      Department of Urology, Second Affiliated Hospital of Guangzhou Medical University

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    摘要
  • 目的 探讨经皮肾镜取石术(PCNL)后并发全身炎症反应综合征(SIRS)的临床特征与危险因素。方法 回顾性分析2016年9月—2018年9月在广州医科大学附属第一医院行一期PCNL的1060例患者的临床资料，根据术后是否出现SIRS，将患者分为SIRS组和非SIRS组，对2组患者的临床资料进行单因素分析，将有统计学意义的变量纳入多因素logistic回归分析。结果 共纳入1060例患者，其中149例(14.1%)患者术后并发SIRS，非SIRS患者911例(85.9%)。与非SIRS组患者比较，SIRS组患者女性比例更高，术前血红蛋白更低，术前血白细胞升高患者比例更高，术前尿白细胞计数更多，术前尿亚硝酸盐、术前尿培养阳性率更高，穿刺通道数量更多、术后输血率更高，术后血红蛋白更低，结石负荷更大，结石培养阳性率更高，感染性结石患者比例更高，差异有统计学意义(P < 0.05)。多因素回归分析显示术前血白细胞升高、术前尿培养阳性、术后输血、结石培养阳性、感染性结石是PCNL术后发生SIRS的危险因素(P < 0.05)。SIRS组患者尿液中大肠埃希菌、屎肠球菌检出率更高，无乳链球菌检出率更低(P < 0.05)。结论 术前血白细胞升高、术前尿培养阳性、术后输血、结石培养阳性、感染性结石是PCNL术后发生SIRS的危险因素。
    Objective To investigate the clinical features and risk factors of systemic inflammatory response syndrome (SIRS) after percutaneous nephrolithotomy (PCNL).Methods We retrospectively analysed 1060 patients who underwent PCNL in the First Affiliated Hospital of Guangzhou Medical University from September 2016 to September 2018, according to whether SIRS occurred after surgery, and the patients were divided into SIRS group and non-SIRS group. The clinical data of the patients were subjected to univariate analysis, and the variables with statistical differences in the univariate analysis were included in the multivariate logistic regression analysis.Results A total of 1060 patients were included, of which 149 (14.1%) had postoperative SIRS, and 911 (85.9%) were in the non-SIRS group. Compared with the non-SIRS group, the SIRS group had a higher female composition ratio, lower preoperative hemoglobin, a higher composition ratio in patients with elevated preoperative leukocytes, higher preoperative urine leukocyte count, higher preoperative urine nitrite, higher urine culture positive rate, and higher number of puncture channels, higher blood transfusion rate, lower postoperative hemoglobin, higher stone burden, higher positive rate of stone culture, higher proportion of patients with infectious stones, with statistical difference (P < 0.05). Multivariate regression analysis showed that preoperative elevation of white blood cell, preoperative positive urine culture, postoperative blood transfusion, positive stone culture, and infectious stones were the risk factors for SIRS after PCNL surgery (P < 0.05). The detection rate of Escherichia coli and Enterococcus faecium in the urine of patients in the SIRS group was higher, and the detection rate of Streptococcus agalactiae was lower (P < 0.05).Conclusion Preoperative elevation of white blood cell, positive urine culture before surgery, postoperative blood transfusion, positive stone culture, and infectious stones were risk factors for SIRS after PCNL.
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  • 表 1  PCNL术后发生SIRS的单因素分析  例(%)，M(P25，P75)

    变量 SIRS组(149例) 非SIR组(911例) Z/χ2 P值
    女性 82(55.0) 364(40.0) 11.944 0.001
    年龄/岁 54.0(46.5，61.0) 54.0(45.0，61.0) -0.325 0.745
    高血压病 35(23.5) 234(25.7) 0.326 0.568
    糖尿病 11(7.4) 86(9.4) 0.652 0.419
    泌尿系畸形 3(2.0) 29(3.2) 0.266 0.606
    泌外手术史 71(47.7) 389(42.7) 1.278 0.258
    肾盂积水 123(82.6) 701(76.9) 2.322 0.128
    术前血肌酐/(μmol·L-1) 94.0(75.8，141.3) 93.6(74.7，121.8) -0.752 0.452
    术前血白细胞升高/(>10×109·L-1) 23(15.4) 84(9.2) 5.451 0.020
    术前血红蛋白/(g·L-1) 128.0(111.5，143.5) 137.0(122.0，150.0) -4.115 < 0.001
    术前尿培养阳性 82(55.0) 139(15.3) 122.769 < 0.001
    术前尿亚硝酸盐阳性 71(47.7) 123(13.5) 99.875 < 0.001
    术前尿白细胞计数 -8.561 < 0.001
        阴性 52(34.9) 630(69.2)
        + 24(16.1) 105(11.5)
        ++ 34(22.8) 91(10.0)
        +++ 30(20.1) 67(7.4)
        ++++ 9(6.0) 18(2.0)
    手术时间/min 90.0(75.0，109.8) 90.0(75.0，120.0) -0.571 0.568
    术后输血 7(4.7) 6(0.7) 14.075 < 0.001
    穿刺定位方式 4.611 0.100
        B超 81(54.4) 579(63.6)
        X线 50(33.6) 243(26.7)
        B超联合X线 18(12.1) 89(9.8)
    穿刺通道数 -3.058 0.002
        1 123(82.6) 827(90.8)
        2 20(13.4) 66(7.2)
        3 5(3.4) 14(1.5)
        4 0(0) 3(0.3)
        5 1(0.7) 1(0.1)
    结石负荷/cm 4.0(3.0，5.5) 3.8(2.6，5.5) -2.471 0.013
    术后血红蛋白/(g·L-1) 114.0(97.5，131.5) 126.0(111.0，138.0) -4.660 < 0.001
    术后结石培养阳性 107(71.8) 232(25.5) 126.442 < 0.001
    结石成分(感染性结石) 58(38.9) 178(19.5) 27.810 < 0.001
    下载: 导出CSV

    表 2  PCNL术后发生SIRS的多因素logistic回归分析

    变量 OR 95%CI P值
    术前血白细胞升高 1.792 1.030~3.120     0.039
    术前尿培养阳性 3.385 2.196~5.216 < 0.001
    术后输血 9.239 2.639~32.348 0.001
    结石培养阳性 3.907 2.501~6.105 < 0.001
    感染性结石 1.570 1.036~2.380 0.034
    下载: 导出CSV

    表 3  SIRS与非SIRS组患者尿液菌谱差异分析  例(%)

    菌谱 SIRS组
    (82例)    		 非SIRS组
    (139例)    		 χ2 P值 菌谱 SIRS组
    (82例)    		 非SIRS组
    (139例)    		 χ2 P值
    大肠埃希菌 52(63.4) 68(48.9) 4.366 0.037 光滑念珠菌 1(1.2) 1(0.7) 0.144 1.000
    屎肠球菌 5(6.1) 0(0) 8.672 0.007 摩根摩根菌 1(1.2) 1(0.7) 0.144 1.000
    铜绿假单胞菌 4(4.9) 9(6.5) 0.238 0.772 阿沙丝孢酵母 1(1.2) 0(0.0) 1.703 0.371
    粪肠球菌 4(4.9) 11(7.9) 0.751 0.386 热带念珠菌 0(0) 1(0.7) 0.593 1.000
    肺炎克雷伯菌 4(4.9) 9(6.5) 0.238 0.772 阴沟肠杆菌 0(0) 2(1.4) 1.191 0.531
    奇异变形菌 3(3.7) 14(10.1) 2.988 0.084 无乳链球菌 0(0) 9(6.5) 5.535 0.028
    表皮葡萄球菌 2(2.4)  0(0) 3.421 0.137 鲍曼不动杆菌 0(0) 1(0.7) 0.593 1.000
    产气肠杆菌 2(2.4) 1(0.7) 1.139 0.557 弗劳地柠檬酸杆菌 0(0) 3(2.1) 1.794 0.297
    白色假丝酵母菌 1(1.2) 1(0.7) 0.144 1.000 克柔念珠菌 0(0) 1(0.7) 0.593 1.000
    金黄色葡萄球菌 1(1.2) 2(1.4) 0.019 1.000 解没食子酸链球菌 0(0) 2(1.4) 1.191 0.531
    恶臭假单胞菌 1(1.2) 2(1.4) 0.019 1.000 约氏不动杆菌 0(0) 1(0.7) 0.144 1.000
    下载: 导出CSV

    表 4  SIRS与非SIRS组患者结石菌谱差异分析  例(%)

    菌谱 SIRS组
    (107例)    		 非SIRS组
    (232例)    		 χ2 P值 菌谱 SIRS组
    (107例)    		 非SIRS组
    (232例)    		 χ2 P值
    大肠埃希菌 51(47.7) 99(42.7) 0.74 0.39 头状葡萄球菌 0(0) 3(1.3) 1.396 0.555
    奇异变形菌 13(12.1) 29(12.5) 0.008 0.928 近平滑念珠菌 0(0) 2(0.9) 0.928 1.000
    铜绿假单胞菌 8(7.5) 11(4.7) 1.036 0.309 芽孢杆菌 0(0) 2(0.9) 0.928 1.000
    表皮葡萄球菌 4(3.7) 11(4.7) 0.174 0.783 荧光假单胞菌 0(0) 2(0.9) 0.928 1.000
    屎肠球菌 3(2.8) 4(1.7) 0.422 0.683 弗劳地柠檬酸杆菌 0(0) 1(0.4) 0.463 1.000
    白色假丝酵母菌 3(2.8) 3(1.3) 0.961 0.385 克柔念珠菌 0(0) 1(0.4) 0.463 1.000
    嗜麦芽窄食单胞菌 3(2.8) 3(1.3) 0.961 0.385 短小短小芽孢杆菌 0(0) 1(0.4) 0.463 1.000
    腐生葡萄球菌 3(2.8) 1(0.4) 3.536 0.095 格氏链球菌 0(0) 1(0.4) 0.463 1.000
    粪肠球菌 2(1.9) 8(3.4) 0.638 0.514 解葡萄糖醛酸棒状杆菌 0(0) 1(0.4) 0.463 1.000
    金黄色葡萄球菌 2(1.9) 3(1.3) 0.167 0.653 简单芽孢杆菌 0(0) 1(0.4) 0.463 1.000
    肺炎克雷伯菌 1(0.9) 9(3.9) 2.218 0.180 牛棒状杆菌 0(0) 1(0.4) 0.463 1.000
    无乳链球菌 1(0.9) 4(1.7) 0.314 1.000 卡他莫拉菌 0(0) 1(0.4) 0.463 1.000
    产气肠杆菌 1(0.9) 3(1.3) 0.081 1.000 彭氏变形杆菌 0(0) 1(0.4) 0.463 1.000
    恶臭假单胞菌 1(0.9) 3(1.3) 0.081 1.000 浸麻类芽孢杆菌 0(0) 1(0.4) 0.463 1.000
    光滑念珠菌 1(0.9) 2(0.9) 0.004 1.000 口普雷沃菌 0(0) 1(0.4) 0.463 1.000
    热带念珠菌 1(0.9) 2(0.9) 0.004 1.000 溶血葡萄球菌 0(0) 1(0.4) 0.463 1.000
    摩根摩根菌 1(0.9) 1(0.4) 0.317 0.532 杀鲑气单胞菌 0(0) 1(0.4) 0.463 1.000
    毗邻颗粒链菌 1(0.9) 1(0.4) 0.317 0.532 山羊葡萄球菌 0(0) 1(0.4) 0.463 1.000
    阴沟肠杆菌 1(0.9) 1(0.4) 0.317 0.532 少动鞘氨醇单胞菌 0(0) 1(0.4) 0.463 1.000
    蜂房哈夫尼亚菌 1(0.9) 0(0) 2.175 0.316 藤黄微球菌 0(0) 1(0.4) 0.463 1.000
    干燥棒杆菌 1(0.9) 0(0) 2.175 0.316 沃氏葡萄球菌 0(0) 1(0.4) 0.463 1.000
    玫瑰色库克菌 1(0.9) 0(0) 2.175 0.316 纹带棒状杆菌 0(0) 1(0.4) 0.463 1.000
    木糖氧化无色杆菌 1(0.9) 0(0) 2.175 0.316 粘质沙雷菌 0(0) 1(0.4) 0.463 1.000
    紫色色杆菌 1(0.9) 0(0) 2.175 0.316 恶臭假单胞菌 0(0) 1(0.4) 0.463 1.000
    洋葱伯克霍尔德菌 1(0.9) 0(0) 2.175 0.316 海氏肠球菌 0(0) 1(0.4) 0.463 1.000
    鲍曼不动杆菌 0(0) 3(1.3) 1.396 0.555 缓慢葡萄球菌 0(0) 1(0.4) 0.463 1.000
    下载: 导出CSV
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收稿日期:  2022-08-05
刊出日期:  2023-01-06

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