重度肾积水患者梗阻解除后肾功能恢复的影响因素分析

Influencing factors analysis for renal function recovery after relief of obstruction in patients with severe hydronephrosis

目的:分析重度肾积水患者梗阻解除后肾功能恢复的影响因素。方法:回顾性分析2021年2月—2022年2月某院收治的125例重度肾积水患者的病历资料,均行手术解除上尿路梗阻,术后随访12个月,统计所有患者肾功能恢复情况,将肾小球滤过率改善≥5 mL/min的患者纳入恢复组,肾小球滤过率改善<5 mL/min纳入未恢复组;以本院自制一般资料调查问卷收集患者的年龄、性别等一般资料,单因素和多因素Logistic回归模型分析重度肾积水患者梗阻解除后肾功能恢复的影响因素。结果:125例重度肾积水患者梗阻解除后,92例肾功能恢复,33例未恢复;单因素分析显示,不同性别、BMI、吸烟史、饮酒史、高血压史、糖尿病史、病程、手术方式、病变部位、血肌酐(Scr)、血尿素氮(BUN)的重度肾积水患者梗阻解除后肾功能恢复率比较,差异无统计学意义(P>0.05);不同年龄、尿路感染、尿PH值、肾实质厚度的重度肾积水患者梗阻解除后肾功能恢复率比较,差异有统计学意义(P<0.05);多因素Logistic回归分析显示,年龄>60岁(B=1.491,OR=4.442,95%CI=1.914~10.311)、有尿路感染(B=0.873,OR=2.393,95%CI=1.060~5.402)、尿pH值>7.0(B=1.808,OR=6.095,95%CI=2.514~14.776)、肾实质厚度<1.5 cm(B=1.874,OR=6.517,95%CI=2.713~15.651)为影响重度肾积水患者梗阻解除后肾功能恢复的独立危险因素。结论:年龄>60岁、有尿路感染、尿pH值>7.0、肾实质厚度<1.5 cm为重度肾积水患者梗阻解除后肾功能恢复的独立影响因素,临床可针对影响因素制定相应的干预措施,提高肾功能恢复率。

Objective:To analyze the influencing factors for renal function recovery after relief of obstruction in patients with severe hydronephrosis.Methods:Clinical data of 125 patients with severe hydronephrosis in a hospital from February 2021 to February 2022 were retrospectively analyzed.All of the patients underwent operations to relieve upper urinary tract obstruction and were followed up for 12 months.Data about the patients'renal function recovery were looked into and those with improved glomerular filtration rate≥5 mL/min were included in a recovered group,and those<5 mL/min were recruited in an uncovered group.General data such as the patients'age and gender were collected by questionnaire made by the hospital and influencing factors related to renal function recovery after relief of obstruction in patients with severe hydronephrosis were analyzed with the univariate and multivariate logistic regression model.Results:After relief of obstruction,of the 125 patients with severe hydronephrosis,92 cases were recovered in renal function and 33 cases were not.Univariate logistic regression analysis showed that in comparison of renal function recovery rates among patients with severe hydronephrosis after relief of obstruction,the differences in age,BMI,history of smoking,history of drinking,history of hypertension,history of diabetes mellitus,operation mode,lesion site,Scr,and BUN were not statistically significant(P>0.05).However,when it came to the comparison of renal function recovery rates among patients with severe hydronephrosis after relief of obstruction with different age,urinary tract infection,urinary pH value,and renal parenchymal thickness,the differences were significant(<0.05).Multivariate logistic regression analysis indicated that age>60(B=1.491,OR=4.442,95%CI=1.914~10.311),urinary tract infection(B=0.873,OR=2.393,95%CI=1.060~5.402),urinary pH value>7.0(B=1.808,OR=6.095,95%CI=2.514~14.776),and renal parenchymal thickness<1.5 cm(B=1.874,OR=6.517,95%CI=2.713~15.651)were independent risk factors for renal function recovery in patients with severe hydronephrosis after relief of obstruction.Conclusion:Age>60,urinary tract infection,urinary pH value>7.0,and renal parenchymal thickness<1.5cm are independent risk factors for renal function recovery in patients with severe hydronephrosis after relief of obstruction.Clinically,intervention measures against the influencing factors should be made to promote the rate of recovery.