尿路结石成分对经皮肾镜取石术后发生急性肾损伤的影响

Effect of urinary stone composition on acute kidney injury after percutaneous nephrolithotomy

目的:评估经皮肾镜取石术(PCNL)后更容易发生急性肾损伤(AKI)的病例的临床特征,并探究各结石成分是否影响PCNL术后AKI的发生。方法:收集2016年3月—2022年1月北京清华长庚医院收治的483例PCNL治疗的尿路结石患者的临床资料,包括人口学相关参数、检验参数、结石特征参数、手术相关资料共4方面的数据,将所有患者根据是否发生术后AKI分成2组,计算整体AKI的发生率,并比较组间各临床因素的差异,并对组间差异有统计学意义的尿酸结石患者进行进一步各临床参数的亚组分析。结果:483例患者PCNL术后AKI的发生率为6.00%,与非AKI组患者比较,既往有结石病史、术前血清肌酐升高、术前血清尿酸增高、血清钙离子降低及结石成分为尿酸结石的患者PCNL术后发生AKI的可能性增高(P<0.05)。72例尿酸结石患者PCNL术后AKI的发生率为12.50%,术后发生AKI与未发生AKI的尿酸结石患者比较,各临床参数差异均无统计学意义(P>0.05),但发生AKI的尿酸结石患者术前血清肌酐及尿酸水平略高,合并糖尿病及术前尿培养阳性的患者比例亦有增高。结论:本中心患者PCNL术后AKI的发生率为6.00%,尿酸结石患者术后AKI发生率可能增高,PCNL术后AKI还多见于既往有结石病史、术前血清肌酐、尿酸增高及钙离子降低的患者。

Objective: To evaluate the clinical characteristics of patients who are more likely to develop acute kidney injury(AKI) after percutaneous nephrolithotomy(PCNL), and to explore whether each stone composition affects the occurrence of AKI after PCNL. Methods: The clinical data of 483 patients with urinary calculi treated by PCNL in Beijing Tsinghua Changgung Hospital from March 2016 to January 2022 were collected, including demographic-related parameters, test parameters, stone characteristic parameters, and operation-related data. All the patients were divided into two groups according to whether they had postoperative AKI. The overall incidence of AKI was calculated, and the differences in clinical factors between the two groups were compared. Results: The incidence of AKI after PCNL was 6.00% in 483 patients. Compared with the non-AKI group, patients with a history of stones, an increase in preoperative serum creatinine, an increase in preoperative serum uric acid, a decrease in serum calcium, and uric acid stones were more likely to have AKI after PCNL(P<0.05). The incidence of AKI after PCNL in 72 patients with uric acid stones was 12.50%. There was no significant difference in clinical parameters between patients with AKI and those without AKI(P>0.05). Nonetheless, the preoperative serum creatinine and uric acid levels of patients with AKI were slightly higher. The proportion of patients with diabetes mellitus and positive urine culture before operation also increased. Conclusion: The incidence of AKI after standard PCNL in our center is 6.00%. The incidence of AKI may increase in patients with uric acid stones after PCNL. The incidence of AKI after PCNL is also common in patients with a history of stones, an increase in preoperative serum creatinine and uric acid and a decrease in serum calcium.