糖尿病患者经皮肾镜取石术后发生全身炎症反应综合征的危险因素分析

Risk factor analysis of systemic inflammatory response syndrome in type 2 diabetics after percutaneous nephrolithotomy

目的：分析合并糖尿病的尿路结石患者在经皮肾镜取石（percutaneous nephrolithotomy,PCNL）术后发生全身炎症反应综合征（systemic inflammatory response syndrome,SIRS）的可能危险因素。方法：回顾北京大学人民医院泌尿外科2006年6月至2015年12月期间,因尿路结石行PCNL术且术前诊断为2型糖尿病的患者资料,分析患者的临床特征与术后SIRS之间的相关性。符合条件的患者共461例,其中男性281例,女性180例,平均年龄57岁,术后137例（29.7%）患者出现SIRS。根据术后是否发生SIRS,将患者分为两组,比较两组患者的各项临床参数的差异。结果：与未发生SIRS的患者组相比,发生SIRS的患者组术前白细胞计数（×109/L）更高[7.76（4.00～17.96）vs.6.31（2.00～17.40）,P〈0.001];术前血糖（mmol/L）更高[7.30（3.08～19.90）vs.6.40（3.42～16.78）,P〈0.001];手术时间（min）更长[75（20～270）vs.60（20～200）,P〈0.001];相应的住院时间（d）也更长[12（2～46）vs.11（3～29）,P=0.019]。术前血糖偏高的患者术后SIRS的发生率高于术前血糖控制在正常范围内的患者[35.1%（100/285）vs.21.0%（37/176）,P=0.001];鹿角形结石的患者术后SIRS的发生率高于非鹿角形结石的患者[38.8%（33/85）vs.27.7%（104/376）,P=0.042];术前合并尿路感染的患者术后SIRS的发生率高于无感染患者[36.8%（50/136）vs.26.6%（81/304）,P=0.032];两组间年龄、性别、体重指数（body mass index,BMI）、术前血红蛋白水平、是否输血、手术时间与术后SIRS发生率的差异无统计学意义。多因素Logistic回归分析结果显示,术后SIRS发生与患者的性别、术前是否合并尿路感染以及是否为鹿角形结石无显著相关性,而与术前白细胞计数高于正常（OR=3.194,95%CI：1.531～6.666,P=0.002）、手术时间大于60 min（OR=1.635,95%CI：1.088～2.456,P=0.018）以及术前血糖水平有显著相关性,术前血糖控制在正常值范围内（3.3～6.1 mmol/L）的患者与术前血糖〉7.1 mmol/L的患者相比,PCNL术后SIRS的发生率差异有统计学意义。结论：对于合并2型糖尿病的尿路结石患者,PCNL术后SIRS的发生与患者术前白细胞水平、手术时间、术前空腹血糖水平存在显著相关性。术前白细胞计数升高、手术时间大于60 min、术前空腹血糖较高的患者PCNL术后发生SIRS的风险增加。

Objective： To evaluate the risk factors of systemic inflammatory response syndrome （SIRS） in the patients with type 2 diabetes diagnosed with kidney stone after percutaneous nephrolithotomy （PCNL）. Methods： In this study, 461 patients with type 2 diabetes who received PCNL in Peking Uni- versity People＇s Hospital from June 2006 to December 2015 were reviewed. There were 281 males and 180 females with an average age of 57 years were included, of whom, 137 were diagnosed with SIRS after PCNL. The demographic data, clinical features, and test results were compared between the patients with SIRS and without SIRS, trying to identify the correlation between their clinical characters and the occurrence of SIRS. Results： The SIRS was significantly correlated with the patients＇ preoperative white blood cell counting （×10^9/L） [7.76 （4.00-17.96） vs. 6.31 （2.00-17.40）, P〈0.001], preoperational blood glucose level （mmol/L） [ 7.30 （3.08 - 19.90 ） vs. 6.40 （ 3.42 - 16.78 ）, P 〈 0. 001 ], operative time （min） [75 （20-270） vs. 60 （20-200）, P 〈0. 001], length of stay （d） [12 （2- 46） vs. 11 （3-29）, P=0.019], staghorn stones [38.8% （33/85） vs. 27.7% （104/376）, P=0. 0421, and preoperational urinary tract infection [ 36.8% （50/136） vs. 26.6% （81/304）, P = 0. 032 ]. There was no significant correlation between the SIRS and the patients＇ age, body mass index, preoperative hemoglobin level, preoperative serum creatinine, and transfusion. In multivariate analysis, abnormal preoperative white blood cell counting （OR = 3. 194, 95% CI： 1. 531 -6. 666, P = 0. 002）, operative time longer than 60 rain （ OR = 1. 635, 95% CI： 1. 088 -2. 456, P =0. 018） , and preoperational blood glucose level higher than normal 7.1 mmol/L were significantly correlated with the presence of SIRS. Conclusion： The high level of preoperational blood glucose, abnormal preoperative white blood cell counting, and long operative time were significantly correlated with the presence of SIRS in patients with type 2 diabetes after PCNL.