老年尿路结石患者脓尿的影响因素分析

Analysis of influencing factors of pyuria in elderly patients with urolithiasis

目的 探索老年尿路结石患者发生脓尿的影响因素。方法 回顾性分析2021年12月—2022年10月复旦大学附属金山医院泌尿外科的198例老年尿路结石患者临床资料,按照是否发生脓尿分为脓尿组(n=84)和无脓尿组(n=114)。比较2组的临床资料,分析老年尿路结石患者发生脓尿的影响因素。结果 与无脓尿组比较,脓尿组年龄较大,女性患者构成比较多,身高较矮,多发性结石患者较多,中性粒细胞/淋巴细胞比值(NLR)较高,血红蛋白(Hb)较低,差异均有统计学意义(P<0.05)。二元Logistic回归分析显示,结石多发和NLR升高是老年患者尿路结石发生脓尿的独立危险因素(P<0.05), Hb升高是老年患者尿路结石发生脓尿的保护因素(P<0.05)。以NLR为3.54作为预测脓尿的临界值,结果受试者操作特征曲线下面积(AUC)为0.639,特异度为86.90%,敏感度为41.20%,正确诊断指数为28.10%;以Hb为139.50 g/L作为预测脓尿的临界值,结果AUC为0.703,特异度为70.20%,敏感度为64.00%,正确诊断指数为34.20%;NLR与Hb联合预测的AUC为0.757,特异度为68.40%,敏感度为78.60%,正确诊断指数为47.00%。结论 结石多发和NLR升高可能是老年尿路结石患者发生脓尿的危险因素,Hb升高可能是老年尿路结石患者发生脓尿的保护因素。

Objective To investigate the influencing factors of pyuria in elderly patients with urolithiasis.Methods The clinical data of 198 elderly patients with urolithiasis treated in Department of Urology,Jinshan Hospital,Fudan University from December 2021 to October 2022 were retrospectively analyzed.According to the occurrence of pyuria,the patients were divided into pyuria group(n=84)and non⁃pyuria group(n=114).The clinical data of the two groups were compared,and the influen⁃cing factors of pyuria in elderly patients with urolithiasis were analyzed.Results Compared with the non⁃pyuria group,the pyu⁃ria group was older,with higher female composition ratio,shorter height,more patients with multiple stones,higher neutrophil/lymphocyte ratio(NLR),and lower hemoglobin(Hb),with statistical significances(P<0.05).Binary Logistic regression analysis showed that multiple stones and elevated NLR were independent risk factors for the occurrence of pyuria in elderly pa⁃tients with urolithiasis(P<0.05),while elevated Hb was a protective factor for the occurrence of pyuria in elderly patients with urolithiasis(P<0.05).Taking 3.54 as the critical value of NLR for predicting pyuria,the area under the receiver operating characteristic curve(AUC)was 0.639,the specificity was 86.90%,the sensitivity was 41.20%,and the correct diagnosis index was 28.10%.Taking 139.50 g/L as the critical value of Hb for predicting pyuria,the AUC,specificity,sensitivity and the cor⁃rect diagnostic index was 0.703,70.20%,64.00%,34.20%,respectively.The AUC,specificity,sensitivity and correct diag⁃nostic index of the combination of NLR and Hb for predicting pyuria were 0.757,68.40%,78.60%and 47.00%,respectively.Conclusion Multiple stones and elevated NLR may be risk factors for pyuria in elderly patients with urolithiasis,while elevated Hb may be a protective factor for pyuria in elderly patients with urolithiasis.