558例泌尿系梗阻性疾病的流行病学特点及影响肾功能预后的危险因素分析

Epidemiological characteristics of 558 cases with obstructive diseases of urinary system and analysis of the risk factors affecting the prognosis of renal functions

目的分析泌尿系梗阻性疾病的流行病学特点、探讨影响肾功能预后的危险因素。方法回顾性选取2015年1~6月就诊于贵州省5家三甲医院泌尿外科及肾内科,年龄≥18岁,经泌尿系B超或影像学诊断为尿路梗阻性疾病患者电子病历资料共558例,采集病历中的一般概况、梗阻原因、梗阻时间、积水程度、手术前后血白细胞、手术前后血肌酐、术前尿常规、血钙、血磷、血尿酸、血C反应蛋白、血清蛋白、血HCO_~3-浓度、并发症等信息进行分布特征描述,并对术后肾功能预后的危险因素进行分析。结果收集病例558例,其中男性384例;女性173例。农民253例(45.35%)。主要病因为泌尿系结石422例(75.6%)。发生肾功能损害构成比:354例(63.44%)患者发生肾功能损害(e GFR<60 ml/min),其中53例(9.5%)为终末期肾病。303例术前e GFR<60 ml/min患者进行手术治疗,治疗后3月内患者肾功能恢复(e GFR≥60 ml/min)242例(80%),肾功能未恢复(GFR<60 ml/min)61例(20%)。常见并发症有肾功能损害354例(63.44%)、膀胱炎252例(45.2%)。将术前e GFR<60 ml/min经手术治疗的患者的21种因素进行Logistic回归分析,得出男性、年龄、肾萎缩、术前e GFR下降为影响肾功能恢复的危险因素(P<0.05)。结论泌尿系梗阻性疾病男性发病率高、农民发病率高,最常见的疾病为泌尿系结石。发生肾功能损害的概率高。男性、年龄、肾萎缩、术前e GFR下降为影响肾功能恢复的危险因素。

Objective To analyze the epidemiologieal characteristics of urinary obstructive diseases and explore the risk factors affecting the prognosis of renal function. Methods The electronic medical records of 588 patients with urinary tract obstruction who were more than 18 years old and diagnosed by urinary tract B ultrasound or ieonography from Jan- uary to June 2015 in the department of urology and department of nephrology of 5 grade I]I A hospitals in Guizhou province were retrospectively selected. The distribution features of general situation, obstruction cause, obstruction time, water accumulation degree, preoperative and postoperative white blood cells, serum ereatinine and urine routine, preop- erative urine routine, blood calcium, blood phosphorus, blood uric acid, blood C reactive protein, serum albumin, blood HC03- concentration and complications were collected. And the risk factors of postoperative renal function prognosis were analyzed. Results Among 558 cases collected, there were 384 male and 173 female; and 253 cases were farmers （45.35%）. The main disease cause of 422 cases was urinary calculi （75.6%）. Renal function impairment was observed in 354 patients （63.44%） （eGFR〈60 ml/min）, of whom 53 （9.5%） had end-stage renal disease. 303 cases of preopera- tive eGFR〈60 ml/min patients were treated by surgery, of whom the renal function of 242 cases （eGFR 〉 60 ml/min,80%） was recovered and the renal function of 61 cases （20%） was not recovered （GFR〈60 ml/min） at postopera- tive 3 months. Common complications included renal im- pairment in 354 cases （63.44%） and cystitis in 252 cas-es （45.2%）. Logistic regression analysis of 21 factors was carried out in patients （eGFR〈60 ml/min） who underwent pre- operative surgery. The results showed that male, age, renal atrophy and preoperative eGFR decrease were risk factors affecting renal function recovery （P〈0.05）. Conclusion The incidence rate of urinary tract obstructive diseases is high in male patients and peasants. The most common disease is urinary calculi. There is a great chance of renal function damage. Male, age, renal atrophy and preoperative eGFR decrease are risk factors affecting renal function recovery.