非肌层浸润性膀胱癌患者TURBT术后并发尿路感染危险因素及预测模型构建

Risk factors and prediction model of urinary tract infection after TURBT in patients with non-musculoinvasive bladder cancer

目的分析非肌层浸润性膀胱癌(NMIBC)患者经尿道膀胱肿瘤电切术(TURBT)后并发尿路感染的危险因素,并构建风险模型用于尿路感染预测。方法选择安阳市肿瘤医院泌尿外科2016年9月-2021年9月因NMIBC接受TURBT治疗的患者为研究对象,将符合纳排标准的146例NMIBC患者分为感染组(29例)和非感染组(117例)。统计感染组病原菌分布。回顾性收集患者年龄、性别、合并糖尿病、肿瘤数量等资料。NMIBC患者TURBT术后尿路感染危险因素采用多因素Logistic回归分析法进行分析,采用受试者工作特征(ROC)曲线评价预测模型对尿路感染预测价值。结果29例尿路感染患者共检出病原菌29株,其中革兰阴性菌占68.97%,革兰阳性菌占31.03%;与非感染组比较,感染组年龄、术前住院时间、术前尿培养阳性率较高,具有统计学差异(P<0.05);二元Logistic回归分析结果显示年龄、术前住院时间、术前尿培养阳性均为NMIBC患者TURBT术后尿路感染的独立影响因素(P<0.05);Hosmer-Lemeshow检验结果显示预测模型与实际发生χ^(2)=2.302,P=0.313,说明预测模型与实际发生有较好拟合程度。ROC分析结果显示预测模型预测NMIBC患者TURBT术后尿路感染曲线下面积为0.879,约登指数为0.546,95%CI值0.792~0.939,标准误为0.034,预测模型不同危险分层下感染率整体比较具有统计学差异(P<0.05)。结论NMIBC患者TURBT术后尿路感染的独立影响因素包括年龄、术前住院时间、术前尿培养阳性,需加以针对性防范和干预。

OBJECTIVE To analyze the risk factors for urinary tract infection in patients with nonmuscular invasive bladder cancer(NMIBC)after transurethral resection of bladder tumor(TURBT),and to establish risk model to predict urinary tract infection.METHODS The patients received TURBT treatment for NMIBC from Sep 2016 to Sep 2021 in the department of urology were enrolled as the research objects.The 146 NMIBC patients who met the inclusion and exclusion criteria were divided into the infection group(29 cases)and the non-infection group(117 cases).Distribution of pathogenic bacteria in the infection group was analyzed.Data of the patients′age,gender,diabetes mellitus and tumor number were retrospectively collected.The risk factors for urinary tract infection in NMIBC patients after TURBT were analyzed by multivariate Logistic regression analysis,and the receiver operating characteristic curve(ROC)was used to evaluate the predictive value of the predictive model for urinary tract infection.RESULTS A total of 29 strains of pathogens were detected in 29 patients with urinary tract infections,including gram-negative bacteria,accounting for 68.97%,gram-positive bacteria,accounting for 31.03%.Compared with the non-infected group,age,preoperative hospital stay and the positive rate of preoperative urine culture the infected group were higher,with statistical differences(P<0.05).Binary logistic regression analysis showed that age,preoperative hospital stay,and preoperative urine culture positive were all risk factors for urinary tract infection after TURBT in NMIBC patients(P<0.05).Hosmer Lemeshow test showed that theχ^(2)test statistic value of the prediction model and the actual occurrence is 2.302,P=0.313,indicating the good degree of fit of prediction model in the actual occurrence.ROC analysis showed that the prediction model predicted that the area under the curve for the prediction of urinary tract infection after TURBT in NMIBC patients was 0.879,with the Youden index of 0.546,95%CI value of 0.792-0.939,and the standard error of 0.034.The overall infection rates under different risk stratification of the prediction model were statistical different(P<0.05).CONCLUSION The independent influencing factors for urinary tract infection in NMIBC patients after TURBT included age,preoperative hospital stay,and positive preoperative urine culture,and targeted prevention and intervention were carried out.