经皮肾镜钬激光碎石术后急性肾损伤高危因素分析

Analysis of risk factors for acute kidney injury after percutaneous nephrolithotomy with holmium laser

目的:分析经皮肾镜钬激光碎石术治疗泌尿系结石术后急性肾损伤(AKI)发生的高危因素。方法:回顾性分析上海长海医院泌尿外科2012年8月~2014年2月间行经皮肾镜钬激光碎石术治疗的泌尿系结石患者的临床资料,根据患者术后血肌酐升高程度,分为AKI组和非AKI组,采用单因素和多因素Logistic回归分析经皮肾镜钬激光碎石术后AKI发生的高危因素。结果:共纳入405例经皮肾镜钬激光碎石术患者,27例术后出现AKI,发生率为6.7%(27/405)。单因素分析显示,AKI组平均年龄高于非AKI组[(54.63±8.97)岁vs.(49.03±12.29)岁,P=0.021];AKI组糖尿病比例高于非AKI组(18.5%vs.6.1%,P=0.014);AKI组孤立肾比例高于非AKI组(18.5%vs.3.7%,P=0.002)。进一步的多因素分析显示糖尿病(OR=5.409)、孤立肾(OR=6.997)和术前eGFR<60ml·min-1·1.73m^(-2)(OR=2.649)是经皮肾镜钬激光碎石术后急性肾损伤的独立危险因素。结论:糖尿病、孤立肾和eGFR降低(<60 ml·min^(-1)·1.73 m^(-2))是经皮肾镜钬激光碎石术后AKI发生的独立危险因素。

Objective：To investigate risk factors for acute kidney injury（AKI）after percutaneous nephrolithotomy（PCNL）with holmium laser.Method：Clinical data of patients treated by PCNL from Aug.2012 to Feb.2014 in Shanghai Changhai Hospital were collected retrospectively.According to the elevated level of postoperative serum creatinine,patients were divided into AKI and non-AKI groups.Univariate analysis and multivariate logistic regression analysis were used to analyse the independent risk factors for AKI after PCNL with holmium laser.Result：Totally 405 patients were included in the study and AKI occurred postoperatively in 27 of them,which showed incidence of AKI was 6.7%（27/405）.Mean age of patients was significantly higher in AKI group than that of non-AKI group[（54.63±8.97）vs.（49.03±12.29）yrs,P =0.021].Occurrence of diabetes mellitus was significantly higher in AKI group than that of non-AKI group（18.5% vs.6.1%,P =0.014）.Occurrence of solitary kidney was significantly higher in AKI group than that of non-AKI group（18.5% vs.3.7%,P =0.002）.Multivariate logistic regression analysis showed that diabetes mellitus（OR=5.409）,solitary kidney（OR=6.997）and baseline eGFR60ml·min^-1·1.73m^-2（OR=2.649）were independent risk factors for AKI following PCNL with holmium laser.Conclusion：Diabetes mellitus,solitary kidney and lower eGFR（60 ml·min^-1·1.73m^-2）are independent risk factors for AKI after PCNL with holmium laser.