Chongruksut Wilaiwan, Lojanapiwat Bannakij, Tawichasri Chamaiporn, Paichitvichean Somboon, Euathrongchit Jantima, Ayudhya Vorvat Choomsai Na, Patumanond Jayanton
Clinical Epidemiology & Medical Statistics Unit, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand.
J Med Assoc Thai. 2012 Mar;95(3):342-8.
Stone recurrence after extracorporeal shock wave lithotripsy (ESWL) or percutaneous nephrolithotomy (PCNL) are common. Predictors for kidney stones vary among populations and areas.
To determine predictors for kidney stones recurrence after ESWL or PCNL.
A retrospective cohort study was conducted at a university hospital. The study cohort was patients aged more than 18 years, diagnosed with kidney stones, who were treated with ESWL or PCNL between 2006 and 2009. Medical files were reviewed for clinical profiles, stone characteristics, composition, type of treatment, presence of stone after treatment, stone reappearance, and related laboratory data. Predictors were determined by a multivariable poisson regression and presented as incidence rate ratios (IRRs) with 95% confidence interval.
From a cohort of 252 patients, 240 who had at least one follow-up and with complete plain kidney ureters and bladder (KUB) film or intravenous pyelogram (IVP) were included in analysis. At three years, the total incidence rate of recurrence was 46 per 1,000 person-months. After a multivariable poisson regression clustering by type of stone composition, independent predictors for stone recurrence were age < or = 50 years (adjusted IRR = 1.3, 95% CI = 1.2-1.4, p < 0.001), ESWL treatment (adjusted IRR = 2.1, 95% CI = 2.1-2.2, p < 0.001), stones located in lower calyx as compared to renal pelvis (adjusted IRR = 8.7, 95% CI = 2.9-25.9, p = 0.001), multiple stones (adjusted IRR = 5.9, 95% CI = 4.8-7.5, p < 0.001), and stone size larger than 20 mm (adjusted IRR = 1.4, 95% CI = 1.2-1.6, p < 0.001).
After stone removals, patients with these predictors should closely be followed up for regular clinical evaluations.
体外冲击波碎石术（ESWL）或经皮肾镜取石术（PCNL）后结石复发很常见。肾结石的预测因素在不同人群和地区有所不同。
确定ESWL或PCNL后肾结石复发的预测因素。
在一家大学医院进行了一项回顾性队列研究。研究队列是年龄超过18岁、被诊断为肾结石、在2006年至2009年间接受ESWL或PCNL治疗的患者。查阅医疗档案以获取临床资料、结石特征、成分、治疗类型、治疗后结石情况、结石复发情况及相关实验室数据。通过多变量泊松回归确定预测因素，并以发病率比（IRR）及95%置信区间表示。
在252名患者队列中，240名至少有一次随访且有完整的肾脏输尿管膀胱平片（KUB）或静脉肾盂造影（IVP）的患者纳入分析。三年时，复发的总发病率为每1000人月46例。按结石成分类型进行多变量泊松回归聚类后，结石复发的独立预测因素为年龄≤50岁（调整后IRR = 1.3，95%CI = 1.2 - 1.4，p < 0.001）、ESWL治疗（调整后IRR = 2.1，95%CI = 2.1 - 2.2，p < 0.001）、与肾盂相比位于下盏的结石（调整后IRR = 8.7，95%CI = 2.9 - 25.9，p = 0.001）、多发结石（调整后IRR = 5.9，95%CI = 4.8 - 7.5，p < 0.001）以及结石大小大于20 mm（调整后IRR = 1.4，95%CI = 1.2 - 1.6，p < 0.001）。
结石清除后，具有这些预测因素的患者应密切随访以进行定期临床评估。
