列线图模型预测2.0～3.0 cm高CT值肾结石老年患者微创经皮肾镜取石术后全身炎症反应综合征的风险

Prediction of SIRS risk after MPCNL in elderly patients with 2.0 ~3.0 cm high CT value of renal calculi based on nomogram model

摘要:

目的 建立预测2.0～3.0 cm高CT值肾结石老年患者微创经皮肾镜取石术（MPCNL）后发生全身炎症反应综合征（SIRS）风险的列线图模型。方法 选取2018年1月－2020年1月于该院就诊的CT值 > 1 200 Hu的肾结石老年患者336例，根据MPCNL术后是否发生SIRS，分为SIRS组（76例）和非SIRS组（260例）。比较两组患者临床资料，行单因素和多因素Logistic回归分析，获得MPCNL术后发生SIRS的独立危险因素，并建立列线图预测模型，采用受试者操作特征曲线（ROC曲线）判定该模型的预测价值。结果 两组患者性别、年龄、结石位置、结石类型、糖尿病史、术前尿培养阳性、患侧泌尿系统手术史、术中肾盂高压、结石表面积、手术时间和术后2 h中性粒细胞/淋巴细胞比值（NLR）等临床指标比较，差异有统计学意义（P < 0.05），经单因素分析，上述因素为潜在危险因素（P < 0.05）。进一步进行多元Logistic回归分析，结果发现：女性、鹿角结石或肾盏多发结石、糖尿病史、术前尿培养阳性、手术时间、术后2 h NLR是2.0～3.0 cm高CT值肾结石老年患者MPCNL术后发生SIRS的独立危险因素（P < 0.05）。列线图模型预测术后发生SIRS风险的ROC曲线下面积（AUC）为0.860（95%CI：0.809～0.911），敏感度84.21%，特异度83.08%。结论 女性、鹿角结石或肾盏多发结石、糖尿病史、术前尿培养阳性、手术时间、术后2 h NLR是2.0～3.0 cm高CT值肾结石老年患者MPCNL术后发生SIRS的独立危险因素，列线图模型可以应用于术后SIRS发生风险的预测。

Abstract:

Objective To establish a nomogram prediction for SIRS after minimally invasive percutaneous nephrolithotomy (MPCNL) in elderly patients with 2.0~3.0 cm high CT value renal calculi.Methods 336 elderly patients with 2.0 ~3.0 cm renal calculi of CT value > 1 200 Hu from January 2018 to January 2020 were divided into SIRS group (76 cases) and non SIRS group (260 cases) according to whether SIRS occurred after MPCNL operation. The clinical data of the two groups were compared and analyzed by univariate and multivariate Logistic regression. The independent risk factors of SIRS were obtained, the nomogram prediction model was established, and the receiver operator characteristic curve (ROC curve) was used to determine the prediction value of the nomogram prediction model.Results There were significant differences in gender, age, stone position, type of stone, diabetes, preoperative urine culture positive, surgical history of urinary tract, intraoperative renal pelvis hypertension, stone surface area, operative time, postoperative 2 h neutrophil/lymphocyte ratio (NLR) (P < 0.05), and the univariate analysis showed that the above factors were potential risk factors (P < 0.05). Further multivariate Logistic regression analysis showed that female, antler calculus or calyx multiple stones, diabetes, preoperative urine culture positive, operative time and postoperative 2 h NLR were independent risk factors for SIRS in elderly patients with 2.0 ~ 3.0 cm renal calculi after MPCNL (P < 0.05). The area under ROC curve of nomogram model in predicting postoperative SIRS was 0.860 (95%CI: 0.809 ~ 0.911), with sensitivity of 84.21% and specificity of 83.08%.Conclusion Female, antler calculus or calyx multiple stones, diabetes, preoperative urine culture positive, operation time and postoperative 2 h NLR are independent risk factors for SIRS after MPCNL in elderly patients with 2.0 ~3.0 cm high CT value of renal calculi. This nomogram model has a higher predictive value for postoperative SIRS, which can be used for SIRS forcast.