输尿管结石致尿脓毒血症患者发生严重脓毒症或脓毒性休克的危险因素分析

Risk factors for severe sepsis or septic shock in patients with urosepsis due to ureteral calculi

摘要:

目的：探讨输尿管结石导致尿脓毒血症患者进展为严重脓毒症或脓毒性休克的相关危险因素，为临床识别高危患者提供参考。方法：回顾性收集我院2016年1月至2017年12月由急诊接诊的输尿管结石伴尿脓毒血症患者的临床资料，根据是否进展为严重脓毒症或脓毒性休克分为病例组和对照组，分别对性别、年龄、体质指数（body mass index，BMI）、糖尿病、既往结石手术史、结石部位、结石大小、肾积水程度、外周血白细胞计数、血小板计数、血清白蛋白水平、肌酐、C-反应蛋白（C-reactive protein，CRP）、降钙素原（procalcitonin，PCT）、尿培养、血培养等影响因素进行单因素分析，并对显著相关性危险因素进行Logistic回归分析。结果：单因素分析结果显示，2组间性别、年龄、合并糖尿病、外周血白细胞计数、血小板计数、血清肌酐值、CRP、PCT，差异有统计学意义（P<0.05）；BMI、既往结石手术史、结石大小、结石部位、肾积水程度、血清白蛋白水平、尿培养、血培养，差异无统计学意义（P＞0.05）。多因素分析显示，与尿脓毒血症进展最相关的因素为年龄、外周血白细胞计数、血小板计数及CRP。结论：输尿管结石致尿脓毒血症患者中，年龄、外周血白细胞计数、血小板计数及CRP是其进展为严重脓毒症或脓毒性休克的危险因素，对于此类患者应积极处理。

Abstract:

Objective：To explore risk factors for the ureteral stones leading to the development of patients with urosepsis as severe sepsis or septic shock. Methods：The clinical data of patients with ureteral calculi associated with urosepsis admitted to our hospital from January 2016 to December 2017 were retrospectively collected. According to the progress of severe sepsis or septic shock，the patients were divided into the case group and the control group. Univariate analysis was performed on the influencing factors of gender，age，body mass index（BMI），diabetes mellitus，history of previous stone surgery，stone site，stone size，degree of hydronephrosis，pe－ripheral white blood cell count，platelet count，serum albumin levels，creatinine，C-reactive protein（CRP），procalcitonin（PCT），urine culture and blood culture，and logistic regression analysis was performed on significant correlation risk factors. Results：Univariate analysis showed that the difference of gender，age，diabetes mellitus，peripheral blood leukocyte count，platelet count，serum creatinine，CRP，PCT were statistically significant（P<0.05）；the difference of BMI，the history of previous stone surgery，stone size，stones site，degree of hydronephrosis，serum albumin，urine culture，blood culture was not statistically significant（P>0.05）. Multivariate analysis showed that the most relevant factors associated with progression of urosepsis to severe sepsis/septic shock were age，peripheral white blood cell count，platelet count，and CRP. Conclusion：Age，peripheral blood leukocyte count，platelet count and CRP are the risk factors for the progression of ureteral calculi-causing sepsis to severe sepsis or septic shock and should be actively managed in these patients.