经尿道等离子电切术联合吡柔比星膀胱灌注治疗腺性膀胱炎后复发的影响因素及其风险预测

Influencing factors and risk prediction of recurrence after transurethral plasma electrocautery combined with pirarubicin bladder instillation in treatment of glandular cystitis

目的探讨经尿道等离子电切术联合吡柔比星膀胱灌注治疗腺性膀胱炎(CG)后复发的影响因素及其风险预测。方法回顾性分析2017年8月-2020年8月联勤保障部队第九八〇医院收治并行经尿道等离子电切术后吡柔比星膀胱灌注化疗的240例CG患者临床资料。分析患者复发情况,比较复发与未复发患者临床资料,采用Logistic多因素回归分析CG复发的危险因素并建立风险模型,绘制受试者工作特征(ROC)曲线评估风险模型的预测效能。结果CG复发34例,复发率为14.17%。复发组患者年龄、RDW、NLR及尿路感染、尿路结石、高危型、肠化生型、弥漫型比例高于未复发组(P<0.05)。临床分型[OR=4.335,95%CI 2.470~7.607]、病理类型[OR=1.709,95%CI 1.059~2.757]、红细胞分布宽度(RDW)[OR=1.799,95%CI 1.173~2.757]、中性粒细胞与淋巴细胞比值(NLR)[OR=1.900,95%CI 1.282~2.818]是CG经尿道等离子电切术联合吡柔比星膀胱灌注化疗后复发的独立危险因素(P<0.05)。风险模型预测CG复发的曲线下面积(AUC)为0.843(95%CI:0.791~0.887),最佳阈值为0.221,敏感度67.5%,特异度87.9%。结论经尿道等离子电切术联合吡柔比星膀胱灌注可减少CG复发,但复发率仍较高,不能使患者显著获益,临床分型、病理类型、RDW、NLR是CG复发的主要危险因素,建立风险模型对CG复发具有一定预测价值。

Objective To investigate the effect of transurethral plasma electrosurgery combined with pirarubicin bladder instillation on the recurrence of cystitis glandularis(CG)and its risk prediction value.Methods The clinical data of 240 CG patients admitted to the 980th Hospital of the PLA Joint Logistics Support Force from August 2017 to August 2020 who underwent parallel transurethral plasma electrocautery followed by piroxicam bladder perfusion chemotherapy were retrospectively analyzed.The patients’recurrence was analyzed,the clinical data of recurrent and non-recurrent patients were compared,the risk factors of CG recurrence were analyzed by logistic multifactorial regression and a risk model was established,and the predictive efficacy of the risk model was assessed by plotting the subjects’operating characteristics(ROC)curves.Results There were 34 cases of CG recurrence,with a recurrence rate of 14.17%.The proportion of patients with age,RDW,NLR,and urinary tract infection,urinary stones,high-risk type,intestinal chemosis type,and diffuse type was higher in the recurrence group than in the non-recurrence group(P<0.05).Clinical staging[OR=4.335,95%CI 2.470-7.607],pathological type[OR=1.709,95%CI 1.059-2.757],red blood cell distribution width(RDW)[OR=1.799,95%CI 1.173-2.757],and neutrophil to lymphocyte ratio(NLR)[OR=1.900,95%CI 1.282-2.818]were independent risk factors for the recurrence of CG after transurethral plasma electrosurgery combined with pirarubicin bladder perfusion chemotherapy(P<0.05).The area under the curve(AUC)of the risk model predicting CG recurrence was 0.843(95%CI:0.791-0.887),with an optimal threshold of 0.221,and a sensitivity of 67.5%and specificity of 87.9%.Conclusions Transurethral plasma electrosurgery combined with pirarubicin bladder instillation can reduce CG recurrence,but the recurrence rate is still high and cannot benefit the patients significantly.Clinical staging,pathologic type,RDW,and NLR are the main risk factors for CG recurrence,and the establishment of a risk model has a certain predictive value for CG recurrence.