摘要
背景输尿管结石的发病率和患病率逐年增加,其大多数可自行排出,但目前预测结石自行排出的方法尚不完善。目的通过前瞻性研究探讨血白细胞计数、C反应蛋白(CRP)水平及肾绞痛疼痛分级对输尿管结石自行排出的影响。方法采用简单随机抽样法选取2013年1—8月因肾绞痛在石河子大学医学院第一附属医院就诊的符合入选标准的233例输尿管结石患者的临床资料。记录患者的年龄、性别、体质指数(BMI)、疼痛分级、实验室检查指标、B超或CT影像学资料。1个月后根据患者结石的排出情况分为排石组和未排石组。采用Logistic回归分析筛选影响因素;绘制ROC曲线确定血白细胞计数预测输尿管结石自行排出的最佳截点。结果 138例患者(排石组)输尿管结石自行排出,排石率为59.23%;95例患者(未排石组)输尿管结石未排出。两组患者的结石大小及位置、年龄、疼痛分级、血白细胞计数、中性粒细胞分数、中性粒细胞计数、淋巴细胞分数、CRP水平间差异有统计学意义(P<0.05)。Logistic回归分析显示,结石大小、血白细胞计数、CRP水平、结石位置是输尿管结石自行排出的独立影响因素(OR=0.028、1.736、0.557、1.569,P<0.05)。根据ROC曲线,血白细胞计数预测输尿管结石自行排出的截点为9.10×109/L,灵敏度和特异度分别为0.70和0.58。结论与结石大小及位置一样,血白细胞计数和CRP水平可作为预测输尿管结石自行排出的独立影响因素。血白细胞计数<9.10×109/L的患者结石排出率低,建议直接行输尿管镜治疗。
Background It has been reported that the prevalence and incidence of ureteral calculi（ UC） have increased by years. Most UCs can be discharged spontaneously. But the method of predicting self- discharge remains unperfect.Objective To explore the effects of blood cell count（ WBCC）,C- reactive protein（ CRP） and renal colic pain rating on self- discharging UCs. Methods From January to August 2013,in the First Affiliated Hospital of Shihezi University,233 UC patients＇ clinical data were collected. Their age,gender,BMI,pain grading,laboratory parameters,B ultrasound or CT imaging data were recorded. The patients were divided,according to stone discharge after 1 month,into groups UC- discharging,non- UC- discharging. Logistic regression analysis was used to screen influencing factors; ROC curve drawn to determine WBCC predicting the best diagnostic cut- off point of UC self- discharge. Results A total of 138 patients self- discharged UC,the discharging rate was 59. 23%,95 did not self- discharged. There was significant difference in stone size,location,age,pain grading,WBCC,neutrophil percentage and count,lymphocyte percentage,CRP between 2 groups（ P〈 0. 05）. Logistic regression analysis showed that WBCC,CRP,stone size and location were factors influencing self- discharging UC（ OR = 0. 028,1. 736,0. 557,1. 569,P〈 0. 05）. By ROC curve,the cut- off point WBCC predicting UC self- discharging was 9. 10 ×10^9/L,the sensitivity and specificity were 0. 70 and 0. 58. Conclusion Like stone size and location,WBCC and CRP can be used as independent factors predicting UC self- discharging. The patients with WBC 9. 10 × 10^9/L and low stone discharging rate should be given ureteroscopy treatment.
出处
《中国全科医学》
CAS
CSCD
北大核心
2014年第32期3827-3830,共4页
Chinese General Practice
基金
国家科技支撑计划子课题(2013BIA05B05)
