国内经皮肾镜取石术后发生全身炎症反应综合征相关因素的Meta 分析*

Risk factors associated with systemic inflammatory responsesyndrome after percutaneous nephrolithotomy in China:A Meta-analysis*

摘要:

目的 探讨国内经皮肾镜取石术（PCNL）后发生全身炎症反应综合征（SIRS）的危险因素。 方法 计算机检索国内有关PCNL 术后发生SIRS 的相关研究，时间截止至2016 年10 月，采用RevMan 5.3 进行Meta 分析。结果 共纳入18 个研究，5 323 例患者，Meta 分析结果显示：①单因素分析结果： 肾功能不全[OR ^ =2.78，95%CI（1.96，3.95），P =0.000]、术前尿培养细菌阳性[OR ^ =3.41，95%CI（1.89， 6.15），P =0.000]、术前尿常规白细胞异常[OR ^ =3.78，95%CI（3.02，4.72），P =0.000]、糖尿病[OR^ =2.14， 95%CI（1.33，3.45），P =0.002]、结石细菌培养阳性[OR ^ =5.14，95%CI（2.46，10.73），P =0.000] 和手术时 间≥ 120 min[OR ^ =2.31，95%C（I 1.40，3.82），P =0.001]是PCNL术后发生SIRS的危险因素；②多因素分析显示： 术前尿培养细菌阳性[OR^ =6.83，95%CI（2.82，16.57），P =0.000]、术前尿常规白细胞异常[OR ^ =5.43，95%CI （3.51，8.41），P =0.000]、糖尿病[OR ^ =2.85，95%CI（1.45，5.58），P =0.002]、结石细菌培养阳性[OR ^ =4.30， 95%CI（1.30，14.21），P =0.020] 和手术时间≥ 120 min[OR ^ =2.72，95%CI（1.62，4.59），P =0.000] 是PCNL 术 后发生SIRS 的独立危险因素。结论 糖尿病、术前尿培养细菌阳性、术前尿常规白细胞异常、结石细菌培 养阳性和手术时间是PCNL 术后发生SIRS 的独立危险因素，受纳入研究数量和质量影响，需开展更多高质量 研究证实上述结论。

Abstract:

Objective To explore the risk factors of systemic inflammatory response syndrome crisis (SIRS) after percutaneous nephrolithotomy (PCNL) in china. Methods Databases of CNKI, CBM, WanFan and VIP were searched to retrieve studies about systemic inflammatory response syndrome after percutaneous nephrolithotomy to October, 2016. Results 18 studies involving 5,323 patients were included. The results of meta-analysis showed that: a) univariate analysis indicated that renal insufficiency [OR ^ =2.78, 95%CI (1.96 to 3.95), P = 0.000], preoperative positive urine culture [OR ^ = 3.41, 95%CI (1.89 to 6.15), P = 0.000], preoperative routine urine leucocyte positive [OR ^ = 3.78, 95%CI (3.02 to 4.72), P = 0.000], diabetes mellitus [OR ^ = 2.14, 95%CI (1.33 to 3.45), P = 0.002], pelvic positive urine culture [OR ^ = 5.14, 95%CI (2.46 to 10.73), P = 0.000] and operation time ≥120 min [OR ^ = 2.31, 95%CI (1.40 to 3.82), P = 0.001] were the risk factors of SIRS; b) multivariate analysis showed that, preoperative positive urine culture [OR ^ = 6.83, 95%CI (2.82 to 16.57), P = 0.000], preoperative routine urine leucocyte positive [OR ^ = 5.43, 95%CI (3.51 to 8.41), P = 0.000], diabetes mellitus [OR ^ = 2.85, 95%CI (1.45 to 5.58), P = 0.002], pelvic positive urine culture [OR ^ = 4.30, 95%CI (1.30 to 14.21), P = 0.020] and operation time ≥120 min [OR ^ = 2.72, 95%CI (1.62 to 4.59), P = 0.000] were the independent risk factors of MCAT. Conclusion The independent risk factors of SIRS for patients after PCNL are diabetes mellitus, preoperative positive urine culture, preoperative routine urine leucocyte positive, pelvic positive urine culture and operation time. However, due to the quantity and low quality of the included literature, the conclusion needs the support from high quality studies.