| 胡安定.上尿路腔内碎石术后并发严重感染的危险因素探讨及风险模型预测[J].浙江中西医结合杂志,2019,29(12): |
| 上尿路腔内碎石术后并发严重感染的危险因素探讨及风险模型预测 |
| Risk factors and risks of severe infection after upper urinary tract calculi Model prediction |
| 投稿时间：2019-05-07 修订日期：2019-11-04 |
| DOI： |
| 中文关键词: 上尿路腔内碎石术 严重感染 危险因素 风险模型预测 |
| 英文关键词:upper urinary tract lithotripsy severe infection risk factors risk model prediction |
| 基金项目: |
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| 摘要点击次数: 585 |
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| 中文摘要: |
| 目的: 探讨上尿路腔内碎石术后并发严重感染的危险因素及风险模型预测。方法: 选取2015年9月到2019年1月在我院接受上尿路结石手术治疗的患者328例，采用Logistic回归方程筛选上尿路腔内碎石术后并发严重感染的危险因素。进一步得出上尿路腔内碎石术后并发严重感染预测的回归方程，并使用ROC曲线来评估预测模型的最佳诊断分界值及诊断效能。结果:两组身高、体重、BMI、高血脂、结石停留时间、手术史、高血压及高血糖均无统计学差异（P>0.05），两组性别及年龄差异有统计学意义（P<0.05）。两组结石部位、结石直径、结石类型及术中出血量均无统计学差异（P>0.05），两组术前感染、肾积水量及手术时间差异有统计学意义（P<0.05）。性别、术前感染、肾积水量及手术时间相关性分别为0.120、7.334、1.452及1.023，具有统计学差异（P<0.05），均与上尿路腔内碎石术后并发严重感染高度相关。最终上尿路腔内碎石术后并发严重感染的概率预测模型为P=1／[1+e（9.575+2.121性别-1.992术前感染-0.373肾积水量-0.023手术时间）]。性别的ROC曲线的AUC 值为0.760，术前感染的AUC值为0.258，肾积水量的AUC为0.821，手术时间的AUC值为0.621。新变量P的AUC为0.922，高于性别、术前感染、肾积水量及手术时间，新变量P检验的诊断效能最好。依据Youden指数最大时作为临界值，可知新变量P的临界值为0.002，此时的敏感性为99.60%，特异性为100.00%。结论：对行上尿路腔内碎石术后患者联合性别、术前感染、肾积水量及手术时间估算并发严重感染的发生率，能够提高对上尿路腔内碎石术后并发严重感染的诊断效能，可提高其诊断敏感性和特异性，具有较高的临床应用价值，值得进一步推广使用。 |
| 英文摘要: |
| Objective: To investigate the risk factors and risk model prediction of severe infection after upper urinary tract lithotripsy. Methods: A total of 328 patients who underwent upper urinary calculi surgery in our hospital from September 2015 to January 2019 were enrolled. Logistic regression equation was used to screen for risk factors for severe infection after upper urinary tract lithotripsy. Further, a regression equation for predicting severe infection after upper urinary tract lithotripsy was obtained, and the ROC curve was used to evaluate the optimal diagnostic cutoff value and diagnostic efficacy of the predictive model. Results: There were no significant differences in height, weight, BMI, hyperlipidemia, stone retention time, surgical history, hypertension and hyperglycemia between the two groups (P>0.05). There were significant differences in gender and age between the two groups (P<0.05). There were no significant differences in the stones, stone diameter, stone type and intraoperative blood loss between the two groups (P>0.05). There were significant differences in preoperative infection, hydronephrosis and operation time between the two groups (P<0.05). Gender, preoperative infection, hydronephrosis and operative time were 0.120, 7.334, 1.452, and 1.023, respectively, with statistical differences (P<0.05), both with upper urinary tract lithotripsy and severe infection height. Related. The probability prediction model of severe infection after upper urinary tract calculi is P=1/[1+e(9.575+2.121 sex-1.992 preoperative infection-0.373 hydronephrosis-0.023 operative time)], The sex AUC value of the ROC curve was 0.760, the AUC value of preoperative infection was 0.258, the AUC of hydronephrosis was 0.821, and the AUC value of the operation time was 0.621. The new variable P had an AUC of 0.922, which was higher than gender, preoperative infection, hydronephrosis and operative time. The new variable P test had the best diagnostic performance. According to the maximum value of the Youden index, the critical value of the new variable P is 0.002, and the sensitivity at this time is 99.60% and the specificity is 100.00%. Conclusion: The incidence of combined infection, gender, age, preoperative infection and hydronephrosis combined with severe infection in patients with upper urinary tract calculi can improve the incidence of severe infection after lithotripsy in the upper urinary tract. The diagnostic efficacy can improve its diagnostic sensitivity and specificity, and has high clinical application value, which is worth further promotion. |
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