慢性肾脏病会影响体外冲击波碎石术治疗输尿管上段结石的结石清除率。

Chronic kidney disease affects the stone-free rate after extracorporeal shock wave lithotripsy for proximal ureteric stones.

机构信息

Department of Urology, National Taiwan University Hospital and College of Medicine, National Taiwan University, Taipei, Taiwan.

出版信息

BJU Int. 2010 Apr;105(8):1162-7. doi: 10.1111/j.1464-410X.2009.08974.x. Epub 2009 Nov 20.

DOI:10.1111/j.1464-410X.2009.08974.x

PMID:19930180

Abstract

OBJECTIVE

To investigate the effect of renal function on the stone-free rate (SFR) of proximal ureteric stones (PUS) after extracorporeal shock wave lithotripsy (ESWL), as urinary obstruction caused by PUS can impair renal function, and elevated serum creatinine levels are associated with decreased ureteric stone passage.

PATIENTS AND METHODS

From January 2005 to December 2007, 1534 patients had ESWL for urolithiasis, 319 having ESWL in situ for PUS; they were reviewed retrospectively. Patients requiring simultaneous treatment of kidney stones, placement of a double pigtail stent, or percutaneous pigtail nephrostomy tube were excluded. We divided patients into groups by chronic kidney disease (CKD) stage according to the estimated glomerular filtration rate (eGFR) of ≥ 60 and <60 mL/min/1.73 m(2). Stone-free status was defined as no visible stone fragments on a plain abdominal film at 3 months after ESWL. A logistic regression model was used to evaluate the possible significant factors that influenced the SFR of PUS after ESWL, and to develop a prediction model.

RESULTS

The overall SFR of PUS (276/319 patients) was 86.5%; the SFR was 93% in patients with an eGFR of ≥ 60 and 50% in those with an eGFR of <60 (P < 0.001). After univariate and multivariate analysis, the three significant factors affecting SFR were an eGFR of ≥ 60, stone width, and gender, with odds ratios (95% confidence intervals) of 19.54 (8.25-46.30) (P < 0.001), 0.67 (0.55-0.82) (P < 0.001) and 0.16 (0.05-0.50 (P = 0.002), respectively. A logistic regression model was developed to estimate the probability of SFR after ESWL, the equation being 1/(1 + exp [-(3.8137 - 0.3967 × (stone width) + 2.9724 × eGFR - 1.8120 × Male)]), where stone width is the observed value (mm), eGFR = 1 for eGFR ≥ 60 and 0 for <60, and male = 1 for male, 0 for female.

CONCLUSIONS

Gender, eGFR ≥ 60 and a stone width of >7 mm were significant predictors affecting the SFR after one session of ESWL for PUS.

摘要

目的

探讨肾功能对体外冲击波碎石术（ESWL）后输尿管上段结石（PUS）结石清除率（SFR）的影响，因为 PUS 引起的尿路梗阻会损害肾功能，而血清肌酐水平升高与输尿管结石排出减少有关。

方法

2005 年 1 月至 2007 年 12 月，1534 例患者因尿路结石接受 ESWL 治疗，319 例 PUS 原位接受 ESWL 治疗；回顾性分析这些患者的临床资料。排除同时需要治疗肾结石、放置双猪尾支架或经皮猪尾肾造瘘管的患者。我们根据估算肾小球滤过率（eGFR）≥60 和<60 mL/min/1.73 m² 将患者分为慢性肾脏病（CKD）阶段组。结石清除定义为 ESWL 后 3 个月腹部平片未见结石碎片。采用 logistic 回归模型评估影响 PUS 结石清除率的可能显著因素，并建立预测模型。

结果

PUS 的总体 SFR（276/319 例患者）为 86.5%；eGFR≥60 患者的 SFR 为 93%，eGFR<60 患者的 SFR 为 50%（P<0.001）。单因素和多因素分析后，影响 SFR 的三个显著因素是 eGFR≥60、结石宽度和性别，优势比（95%置信区间）分别为 19.54（8.25-46.30）（P<0.001）、0.67（0.55-0.82）（P<0.001）和 0.16（0.05-0.50）（P=0.002）。建立了一个用于估计 ESWL 后 SFR 概率的 logistic 回归模型，方程为 1/（1+exp[-(3.8137-0.3967×（结石宽度）+2.9724×eGFR-1.8120×Male)]），其中结石宽度为观察值（mm），eGFR=1 表示 eGFR≥60，0 表示<60，男性=1 表示男性，0 表示女性。