对结石性重度肾功能受损患者预后指标的评价

Evaluation of prognostic indexes for patients with severe renal impairment by urinary calculus

目的评价结石性重度肾功能受损者预后指标的准确性。方法收集45例结石性重度肾功能受损患者的临床资料,分析患肾术前肾小球滤过率(GFR)、术后24h尿量、尿pH值、尿比重、尿Na^+浓度及尿K^+浓度与预后的关系,确定临界值,建立预测模型。结果患肾术前GFR、术后24h尿量及尿pH值作为预后指标有统计学意义,其临界值分别为15mL/min、485mL和6.9,此时各指标的诊断效能最大,患肾术后尿比重、尿Na^+浓度及尿K^+浓度与患肾术前GFR相关性较差,无统计学意义。患肾术前GFR预测模型方程拟合度较低。结论患肾术前GFR是评价预后恢复程度的首选指标,术后24h尿量、尿pH值对肾功能不恢复事件的预测准确性较好;患肾术后尿比重、尿Na^+及尿K^+浓度不宜作为预后指标;患肾术前GFR预后临界值应调整为15mL/min;患肾术后24h尿量预后判别临界值区间应为375~625mL,尿pH值的预后临界值为6.9;除尿比重外,患肾术前GFR与术后各预后指标间存在相关性;患肾术前GFR预测模型方程拟合度低,预测精确度差。

Objective To evaluate the accuracy of the prognostic indexes for severe renal impairment by urinary calculus.Methods The clinical data of 45 patients with severe renal impairment by urinary calculus were collected.The relationship between prognosis and preoperative glomerular filtration rate（GFR）of the involved kidney,urinary volume within 24 hours,urinary pH,urinary specific gravity,and urinary Na＋ and K＋ concentrations were analyzed.The critical values were determined to establish the prediction model.Results As prognostic indexes,the preoperative GFR,postoperative urinary volume within 24 hours and pH value were statistically significant.Their critical values were respectively 15 mL/min,485 mL and 6.9.There was a low correlation between preoperative GFR and urinary specific gravity,and concentration of urinary Na＋ and K＋.The prediction model for preoperative GFR was established,but with a low degree of fitting.Conclusions The preoperative GFR is the first choice to evaluate the prognosis.The postoperative urinary volume within 24 hours and pH are good predictive indexes for non-restoring renal function.Postoperative urinary specific gravity,concentration of urinary Na＋ and K＋ should not serve as prognostic indexes.The critical values of preoperative GFR,urinary volume within 24 hours and pH should be adjusted to be 15 mL/min,375~625 mL and 6.9.The preoperative GFR is related to postoperative drainage indexes except urinary specific gravity.Because of the low fitting degree of the prediction equation,it is impossible to accurately predict the drainage condition by the preoperative GFR.