输尿管结石合并急性肾盂肾炎患者进展为尿脓毒症的危险因素

刘霞明; 檀立端; 王娴; 董旭萌; 刘小宇; 陈治国

doi:10.13201/j.issn.1009-5918.2023.08.004

输尿管结石合并急性肾盂肾炎患者进展为尿脓毒症的危险因素

- 1.
  承德医学院研究生学院(河北承德，067000)
- 2.
  承德医学院第二附属医院承德市中心医院急诊科

详细信息

通讯作者: 陈治国，E-mail：chenzhiguo1210@126.com

中图分类号: R473.6

收稿日期: 2023-06-06

刊出日期: 2023-08-10

Risk factors for urosepsis in patients with ureteral calculi complicated with acute pyelonephritis

- 1.
  Graduate School of Chengde Medical University, Chengde, Hebei, 067000, China
- 2.
  Department of Emergency, the Second Affiliated Hospital of Chengde Medical University, Chengde Central Hospital

More Information

Corresponding author: CHEN Zhiguo, E-mail: chenzhiguo1210@126.com

Received Date: 06 June 2023

Publish Date: 10 August 2023

摘要

摘要: 目的探讨输尿管结石合并APN患者进展为尿脓毒症的危险因素，为临床识别高危患者提供线索。方法回顾性收集2014年8月—2022年11月期间承德市中心医院收治的输尿管结石合并APN患者的临床资料，根据患者是否发生脓毒症组分为病例组和对照组，分别对性别、年龄、BMI、既往病史、结石特点、实验室资料、APACHEⅡ评分等影响因素进行单因素分析，并对单因素分析中具有统计学意义的变量进行多因素分析。结果输尿管结石合并APN患者发生尿脓毒症的比例为42.5%。单因素分析发现结石最大长径、结石最大横径、血WBC、Lymph#、Neut#、Neut%、Hb、RDW、PLT、MPV、血Na⁺、PT、PTA、INR、ALB、TBIL、DBIL、SCR、尿培养、NLR、RPR、MLR、RAR、APACHEⅡ评分等差异具有统计学意义(P < 0.05)；多因素分析发现结石最大长径>10.0 mm(P=0.026)、TBIL>20.4 μmol/L(P=0.003)、SCR>106 μmol/L(P < 0.001)、PLT较低(P < 0.001)、RAR(P=0.018)以及APACHEⅡ评分(P=0.001)较高是输尿管结石合并APN患者进展为尿脓毒症的独立危险因素。结论输尿管结石合并APN患者发生尿脓毒症的比例为42.5%。在输尿管结石合并APN的患者中，结石较大、TBIL、SCR、RAR以及APACHEⅡ评分较高、PLT较低是其进展为尿脓毒症的独立危险因素。
- 输尿管结石 /
- 急性肾盂肾炎 /
- 尿脓毒症 /
- 危险因素 /
- 红细胞分布宽度与白蛋白比值
Abstract: Objective To explore the risk factors of urosepsis in patients with ureteral calculi complicated with APN and to provide clues for clinical identification of high-risk patients.Methods Clinical data of patients with ureteral calculi complicated with APN treated in Chengde Central Hospital during the priod of August 2014 to November 2022 were collected retrospectively. Patients with sepsis were divided into case group and control group according to whether sepsis occurred. Univariate analysis was performed on sex, age, BMI, previous medical history, stone characteristics, laboratory data, APACHEⅡ score and other influencing factors, and multivariate analysis was performed on the statistically significant variables in univariate analysis.Results The incidence of urinary sepsis in patients with ureteral calculi complicated with APN was 42.5%. In the univariate analysis, variables have statistically significant in maximum length diameter, maximum transverse diameter, blood leukocyte count, Lymph#, Neut#, Neut%, Hb, RDW, PLT, MPV, serum sodium, PT, PTA, INR, ALB, TBIL, DBIL, creatinine, urine culture, NLR, RPR, MLR, RAR, APACHEⅡ scores. Multifactorial analysis revealed that maximum stone length>10.0 mm(P=0.026), total bilirubin>20.4 μmol/L(P=0.003), creatinine>106 μmol/L(P < 0.001), lower platelet count(P < 0.001), RAR(P=0.018), and higher APACHEⅡ score(P=0.001) were independent risk factors for progression to urosepsis in patients with ureteral calculi complicated with APN.Conclusion The percentage of patients with ureteral calculi complicated with APN who developed urosepsis was 42.5%. In patients with ureteral stones combined with APN, larger stones, higher total bilirubin as well as creatinine, RAR, and APACHEⅡ scores, and lower PLT were independent risk factors for progression to urinary sepsis.
- ureteral calculi /
- acute pyelonephritis /
- urosepsis /
- risk factors /
- red blood cell distribution width to albumin ratio

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图 1 输尿管结石合并APN患者发生脓毒症诊断预测模型ROC曲线

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表 1 两组患者一般资料的单因素分析例(%)

项目	脓毒症组 (57例)	非脓毒症组 (77例)	t/F/χ²	P
性别			2.136	0.144
男	11(19.3)	8(10.4)
女	46(80.7)	69(89.6)
年龄/岁			1.760	0.185
<60	29(50.9)	48(62.3)
≥60	28(49.1)	29(37.7)
BMI/(kg/m²)			0.674	0.412
<24.0	27(47.4)	31(40.3)
≥24.0	30(52.6)	46(59.7)
结石手术史			0.318	0.573
有	11(19.3)	12(15.6)
无	46(80.7)	65(84.4)
高血压			0.724	0.395
有	21(36.8)	34(44.2)
无	36(63.2)	43(55.8)
糖尿病			0.105	0.746
有	17(29.8)	21(27.3)
无	40(70.2)	56(72.7)
冠心病			0.687	0.407
有	6(10.5)	4(5.2)
无	51(89.5)	73(94.8)

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表 2 两组患者结石相关资料的单因素分析例(%)

项目	脓毒症组 (57例)	非脓毒症组 (77例)	t/F/χ²	P
结石部位			0.958	0.619
上段	35(61.4)	52(67.5)
中段	6(10.5)	9(11.7)
下段	16(28.1)	16(20.8)
结石患侧			2.963	0.085
左侧	33(57.9)	33(42.9)
右侧	24(42.1)	44(57.1)
同侧肾结石			0.001	0.992
有	23(40.4)	31(40.3)
无	34(59.6)	46(59.7)
最大长径/mm			5.466	0.019
≤10.0	32(56.1)	58(75.3)
>10.0	25(43.9)	19(24.7)
最大横径/mm			6.356	0.012
≤6.5	23(40.4)	48(62.3)
>6.5	34(59.6)	29(37.7)

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表 3 两组患者实验室相关资料的单因素分析 X±S，M(P₂₅，P₇₅)，例(%)

项目	脓毒症组(57例)	非脓毒症组(77例)	t/F/χ²	P
血常规
WBC/(×10⁹/L)	15.5±6.9	13.0±4.6	-2.304	0.023
Lymph#/(×10⁹/L)	0.68(0.38，0.87)	1.01(0.61，1.46)	1271.000	< 0.001
Mono#/(×10⁹/L)	0.73(0.36，0.97)	0.67(0.50，1.00)	2131.500	0.777
Neut#/(×10⁹/L)	13.40±6.48	10.92±4.36	-2.506	0.014
Neut%	89.6(86.5，91.8)	84.6(80.9，88.2)	1162.000	< 0.001
Hb/(g/L)	116(106，126)	122(114，131)	1697.000	0.025
HCT/(L/L)	0.351±0.052	0.364±0.049	1.562	0.121
RDW/%	13.4(12.3，14.9)	12.3(11.4，13.7)	1638.000	0.012
PLT/(×10⁹/L)	135±63	224±78	7.070	< 0.001
MPV/fL	8.6(7.8，9.5)	7.9(7.3，8.7)	1540.500	0.003
血Na⁺/(mmol/L)	136(133，138)	138(136，140)	1469.000	0.001
血K⁺/(mmol/L)	3.40(3.10，3.95)	3.47(3.06，3.78)	2165.500	0.896
PT/s	13.1(12.4，14.6)	12.5(11.8，13.5)	1596.500	0.007
PTA/%	79(72，89)	86(77，95)	1636.000	0.012
INR	1.15(1.09，1.27)	1.10(1.03，1.18)	1562.500	0.004
APTT/s	30.0(28.0，32.7)	29.3(27.5，30.9)	1866.000	0.139
FIB/(g/L)	5.73(4.22，7.17)	4.90(4.33，6.45)	2024.500	0.444
ALB/(g/L)			8.524	0.004
≤30	36(63.2)	29(37.7)
>30	21(36.8)	48(62.3)
TBIL/(μmol/L)			6.964	0.008
≤20.4	41(71.9)	69(89.6)
>20.4	16(28.1)	8(10.4)
DBIL/(μmol/L)			9.284	0.002
≤6.8	38(66.7)	68(88.3)
>6.8	19(33.3)	9(11.7)
SCR/(μmol/L)			64.617	< 0.001
≤106	14(24.6)	71(92.2)
>106	43(75.4)	6(7.8)
尿潜血			0.234	0.629
<2+	17(29.8)	26(33.8)
≥2+	40(70.2)	51(66.2)
尿亚硝酸盐			1.927	0.165
阴性	35(61.4)	56(72.7)
阳性	22(38.6)	21(27.3)
尿WBC			0.532	0.466
<2+	18(31.6)	29(37.7)
≥2+	39(68.4)	48(62.3)
尿培养			8.874	0.003
阳性	34(59.6)	26(33.8)
阴性	23(40.4)	51(66.2)

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表 4 两组患者衍生指标的单因素分析 M(P₂₅，P₇₅)

项目	脓毒症组(57例)	非脓毒症组(77例)	t/F/χ²	P
NLR	20.88(12.42，28.27)	10.54(6.23，14.55)	1066.000	< 0.001
PLR	211.11(126.32，302.89)	211.17(146.02，314.12)	2049.000	0.513
RPR	0.10(0.08，0.16)	0.06(0.04，0.07)	749.000	< 0.001
MLR	1.02(0.55，1.52)	0.68(0.37，1.14)	1533.500	0.003
RAR	0.45(0.39，0.52)	0.39(0.34，0.53)	1425.500	0.001
APACHEⅡ评分	9(8，14)	6(5，9)	898.000	< 0.001

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表 5 输尿管结石合并APN患者发生脓毒症的多因素分析结果

影响因素	β	P	OR	95%CI
结石最大长径	1.908	0.026	6.738	1.250~36.335
PLT	-0.028	< 0.001	0.972	0.959~0.986
TBIL	4.113	0.003	61.101	4.040~924.203
SCR	5.061	< 0.001	157.749	15.933~1 561.823
RAR	10.550	0.018	38 164.832	6.319~230 491 354.100
APACHEⅡ评分	0.583	0.001	1.791	1.254~2.558
常量	-18.971	< 0.001	< 0.001	-

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