Department of Urology, Institute of Urology, West-China Hospital, Sichuan University, Chengdu, China.
J Endourol. 2019 Nov;33(11):946-953. doi: 10.1089/end.2019.0404. Epub 2019 Sep 20.
How to quantify the impact of metabolic syndrome (MetS) on percutaneous nephrolithotomy (PCNL) is unclear. We aimed to evaluate the quantified effect of the number of MetS components on the outcome of PCNL. In this retrospective cohort study, consecutive 606 patients with idiopathic staghorn renal stones undergoing PCNL were included. The participants were divided into two groups: MetS(+) and MetS(-). The number of MetS components were calculated as 0 to 5. Primary outcomes were stone-free rate (SFR) and overall complication rate. MetS, obesity, hypertension, increased triglycerides (TG), decreased high-density lipoprotein cholesterol (HDL), and diabetes mellitus were found in 24.1%, 38.1%, 70.0%, 29.9%, 34.5%, and 26.4% of the patients, respectively. SFR values were comparable between groups. MetS resulted in a higher rate of overall complication ( < 0.001, odds ratio [OR] = 2.4, 95% confidence interval [CI] 1.67-3.69), blood transfusion, urosepsis, larger hemoglobin deficiency, and length of hospital stay. Multivariable analysis confirmed that fasting plasma glucose (FPG) ( = 0.033, OR = 1.164, 95% CI 10.22-1.348) and number of MetS components ( = 0.001, OR = 1.496, 95% CI 1.184-1.890) were independent risk factors, whereas HDL ( = 0.014, OR = 0.428, 95% CI 0.217-0.837) played an independent protective role. Compared with 0, having 3, 4, and 5 MetS components was associated with stepwise increase in complication rate (19.5% 34.2%, 41.5%, 62.5%, = 0.027, 0.006, <0.001; OR = 2.1, 2.9, 6.9). Subgroup analysis showed that MetS(+) patients without complications were associated with lower systolic blood pressure, TG, and FPG ( = 0.010, 0.031, 0.002, respectively). The number of MetS components is the central predictor in assessing both inner severity of MetS and outer risk for PCNL. The number of MetS components is recommended to be calculated on a scale of 0 to 5. Three, four, and five MetS components increase risk for PCNL in a stepwise manner regardless of the presence or absence of obesity. MetS components should be controlled preoperatively.
代谢综合征（MetS）对经皮肾镜碎石术（PCNL）的影响程度如何尚不清楚。我们旨在评估 MetS 成分数量对 PCNL 结果的量化影响。
在这项回顾性队列研究中，纳入了 606 例接受 PCNL 的特发性鹿角状肾结石患者。将参与者分为两组：MetS(+)和 MetS(-)。MetS 成分数量计算为 0 至 5。主要结局为结石清除率（SFR）和总体并发症发生率。
MetS、肥胖、高血压、甘油三酯（TG）升高、高密度脂蛋白胆固醇（HDL）降低和糖尿病在患者中的发生率分别为 24.1%、38.1%、70.0%、29.9%、34.5%和 26.4%。各组间 SFR 值无差异。MetS 导致总体并发症发生率更高（<0.001，优势比[OR] = 2.4，95%置信区间[CI]为 1.67-3.69）、输血、尿脓毒症、更大的血红蛋白缺乏和住院时间延长。多变量分析证实空腹血糖（FPG）（=0.033，OR = 1.164，95%CI 为 10.22-1.348）和 MetS 成分数量（=0.001，OR = 1.496，95%CI 为 1.184-1.890）是独立危险因素，而 HDL（=0.014，OR = 0.428，95%CI 为 0.217-0.837）起独立保护作用。与 0 相比，有 3、4 和 5 个 MetS 成分与并发症发生率的逐步增加相关（19.5%、34.2%、41.5%、62.5%，=0.027、0.006、<0.001；OR = 2.1、2.9、6.9）。亚组分析显示，无并发症的 MetS(+)患者的收缩压、TG 和 FPG 较低（=0.010、0.031、0.002）。
MetS 成分数量是评估 MetS 内部严重程度和 PCNL 外部风险的核心预测因子。建议在 0 到 5 的范围内计算 MetS 成分数量。无论是否存在肥胖，三个、四个和五个 MetS 成分都会逐渐增加 PCNL 的风险。应在术前控制 MetS 成分。
