PCNL术后肾出血行超选择性肾动脉栓塞术后再出血的临床预测模型

    Construction of the clinical prediction model of rebleeding after super-selective renal artery embolization after renal bleeding treated with PCNL

    • 摘要: 目的:探讨经皮肾镜取石术(PCNL)后肾出血的病人行超选择性肾动脉栓塞术(SRAE)后再出血的影响因素。方法:回顾性分析PCNL术后肾出血并接受SRAE的80例病人临床资料,根据SRAE术后是否再出血分为再出血组(9例)和对照组(71例)。单因素及多因素logistic分析影响SRAE术后再出血的因素并建立风险预测模型,用受试者工作特征(ROC)曲线对构建的预测模型效能进行验证。结果:80例PCNL术后肾出血病人中,71例(88.8%)病人接受一次SRAE治疗成功,9例(11.2%)病人首次SRAE治疗后再出血行二次栓塞成功止血。单因素分析发现,PCNL多穿刺通道、多出血病灶、SRAE术前血白细胞计数、SRAE术前血中性粒细胞计数(NEU)与SRAE术后再出血有一定关系(P<0.05~P<0.01);多因素logistic回归分析结果显示SRAE术前血NEU(OR=2.873,P<0.05)和多出血病灶(OR=5.969,P<0.05)是SRAE术后再出血的独立预测因素,上述2个因素联合构建预测模型,预测模型效果良好(χ2=5.28,P>0.05)。ROC曲线下面积为0.806(95%CI:0.688~0.924),灵敏度和特异度分别为88.9%、67.6%。结论:多出血部位、SRAE术前血NEU是PCNL术后出血行SRAE术后再出血的危险因素,基于此构建的风险预测模型有一定的临床适用性。PCNL术后出血应积极控制感染,SRAE术中需全面分辨及栓塞所有可疑出血点,可降低SRAE术后再出血的风险。

       

      Abstract: Objective: To investigate the influencing factors of rebleeding after super-selective renal artery embolization(SRAE) in renal bleeding patients treated with percutaneous nephrolithotomy(PCNL). Methods: The clinical data of 80 post-PCNL renal hemorrhage patients treated with SRAE were retrospectively analyzed,and the cases were divided into the rebleeding group(9 cases) and control group(71 cases) according to whether they had rebleeding after SRAE.The univariate and multivariate logistic analysis were used to analyze the factors affecting rebleeding after SRAE,and the risk prediction model was established.The effectiveness of the prediction model was verified by receiver operating characteristic(ROC) curve. Results: Among 80 patients with postoperative renal bleeding after PCNL,one time SRAE in 71 patients(88.8%) were successful,and the second embolization for hemostasis in 9 patients(11.2%) were successful after the first SRAE treatment.The results of univariate analysis showed that the PCNL multiple puncture channels,multiple bleeding foci,white blood cell count before SRAE,neutrophil count before SRAE were correlated with rebleeding after SRAE(P<0.05 to P<0.01).The results of multivariate logistic regression analysis showed that preoperative blood NEU(OR=2.873,P<0.05) and multiple bleeding lesions(OR=5.969,P<0.05) were the independent predictors of postoperative rebleeding after SRAE.The combination of the above two factors was used to construct the prediction model,and the effect of the prediction model were good(χ2=5.28,P>0.05).The area under ROC curve was 0.806(95%CI:0.688-0.924),and the sensitivity and specificity were 88.9% and 67.6%,respectively. Conclusions: Multiple bleeding sites and blood NEU before SRAE are the risk factors of rebleeding after SRAE after PCNL,and the risk prediction model constructed based on these factors has certain clinical applicability.The infection should be actively controlled after PCNL rebleeding,all suspected bleeding points should be comprehensively identified and embolization during SRAE,which can reduce the risk of rebleeding after SRAE.

       

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