术前血糖水平对糖尿病患者行输尿管软镜碎石术后发生感染相关并发症的影响

doi:10.13481/j.1671-587X.20220326

Abstract

Abstract: Objective

To observe the influencing factors of infection-related complications of the patients with type 2 diabetes mellitus （T2DM） after flexible ureteroscopic lithotripsy （FURL），and to explore the relationship between the preoperative glycemic level and postoperative infection-related complications of the T2DM patients， and to provide the basis for the early prevention and treatment of infection-related complications of the T2MD patients after FULR.

Methods

A total of 83 patients diagnosed as urolithiasis with concurrent T2DM and received FURL were retrospectively analyzed. They were divided into infection group and non-infection group according to whether or not infection occurred after surgery. Univariate and multivariate Logistic regression analysis were used to examine the independent risk factors for the postoperative infections. Receiver operating characteristic （ROC） curve was used to define the well-controlled level of preoperative glycemic；based on the optimal cut-off value， the patients were divided into good glycemic control group （glycemic level≤7.7 mmol·L^－1） and poor glycemic control group （glycemic level>7.7 mmol·L^－1）.The incidence frequency of postoperative infection-related complications and avarage postoperative hospital stay of the patients in two groups were compared.

Results

The univariate Logistic regression analysis results showed that the preoperative glycemic level， the stone diameter≥2 cm， preoperative urine routine leukocyte count ≥10/HP，the positive preoperative urine culture，and the operation time≥90 min were the independent influencing factors for the postoperative infection-related complications of the T2DM patients.The multivariate Logistic regression analysis reesults showed that the preoperative glycemic level，the operation time ≥90 min，the stone diameter≥2 cm，and positive preoperative urine culture were the independent influencing factors for the postoperative infection-related complications of the T2DM patients.The ROC curve analysis results showed that if the optimal cut-off value of the preoperative glycemic level was 7.7 mmol·L^－1， the sensitivity to predict the postoperative infection-related events of the patients was 70.37%， and the specificity was 96.43%.The incidence frequency of postoperative infection-related complications and the average postoperative hospital stay of the patients in good glycemic control group were lower than those in poor glycemic control group （P<0.05）.

Conclusion

The preoperative glycemic level， positive preoperative urine culture， operative time≥90 min and stone diameter≥2 cm are the independent influencing factors for the infection-related complications of the T2DM patients after FURL. When the preoperative glycemic level≤7.7 mmol·L^－1 is used as the standard for good glycemic control， the incidence of postoperative infection can be effectively reduced and the postoperative hospital stay can be shortened.

Key words: Flexible ureteroscope, Holmium laser lithotripsy, Type 2 diabetes mellitus, Infection-related complications, Glycemic control

CLC Number:

R587.1

Yongxin ZHAI,Huaifeng TA,Yi ZHANG,Qijia SUN,Ming ZHANG,Shuqiang FENG,Ranwei LI. Effect of preoperative glycemic level on infection-related complications of diabetic patients after flexible ureteroscopic lithotripsy[J].Journal of Jilin University(Medicine Edition), 2022, 48(3): 766-772.

Figures/Tables 4

Tab. 1

Tab. 2

Fig.1

Tab. 3

References 25

1	DOIZI S， TRAXER O. Flexible ureteroscopy： technique， tips and tricks［J］.Urolithiasis， 2018， 46（1）： 47-58.
2	BERARDINELLI F， CINDOLO L， FRANCESCO P， et al. The surgical experience influences the safety of retrograde intrarenal surgery for kidney stones： a propensity score analysis［J］. Urolithiasis， 2017， 45（4）： 387-392.
3	MI Q， MENG X， MENG L， et al. Risk factors for systemic inflammatory response syndrome induced by flexible ureteroscope combined with holmium laser lithotripsy［J］. Biomed Res Int， 2020， 2020： 6842479.
4	LI T， SUN X Z， LAI D H， et al. Fever and systemic inflammatory response syndrome after retrograde intrarenal surgery： Risk factors and predictive model［J］. Kaohsiung J Med Sci， 2018， 34（7）： 400-408.
5	BHOJANI N， MILLER L E， BHATTACHARYYA S， et al. Risk factors for urosepsis after ureteroscopy for stone disease： a systematic review with meta-analysis［J］. J Endourol， 2021， 35（7）： 991-1000.
6	BERRÍOS-TORRES S I， UMSCHEID C A， BRATZLER D W， et al. Centers for disease control and prevention guideline for the prevention of surgical site infection， 2017［J］.JAMA Surg，2017，152（8）： 784-791.
7	孙颖浩. 吴阶平泌尿外科学［M］. 北京：人民卫生出版社， 2019.
8	黄健. 中国泌尿外科和男科疾病诊断治疗指南（2019版）［M］. 北京：科学出版社， 2019.
9	中国老年 2 型糖尿病防治临床指南编写组，中国老年医学学会老年内分泌代谢分会，中国老年保健医学研究会老年内分泌与代谢分会，等. 中国老年2型糖尿病防治临床指南（2022年版）［J］. 中华内科杂志， 2022， 61（1）： 12-50.
10	梅烨，陈凌武，高新. 泌尿外科手术学［M］. 3版. 北京：人民卫生出版社， 2006.
11	胡卫国，王碧霄，姬超岳，等. 上尿路结石合并CRE菌尿行内镜手术后控制感染并发症的经验［J］. 中华泌尿外科杂志， 2020， 41（10）： 764-768.
12	SINGER M， DEUTSCHMAN C S， SEYMOUR C W， et al. The Third International Consensus Definitions for Sepsis and Septic Shock （Sepsis-3）［J］. JAMA， 2016， 315（8）： 801.
13	杨斌. 糖尿病与肾结石关系的研究进展［J］. 国际泌尿系统杂志， 2021， 41（1）： 191-193.
14	HEIN S， PETZOLD R， SCHOENTHALER M， et al. Thermal effects of Ho： YAG laser lithotripsy： real-time evaluation in an in vitro model［J］. World J Urol， 2018， 36（9）： 1469-1475.
15	JIAN Z， MA Y， LIU R， et al. Preoperative positive urine nitrite and albumin-globulin ratio are independent risk factors for predicting postoperative fever after retrograde Intrarenal surgery based on a retrospective cohort［J］. BMC Urology， 2020， 20（1）： 50.
16	PAINTER J D， AKBARI O. Type 2 innate lymphoid cells： protectors in type 2 diabetes［J］. Front Immunol， 2021， 12： 727008.
17	TONG Z W M， GRANT E， GRAS S， et al. The role of T-cell immunity in COVID-19 severity amongst people living with type Ⅱ diabetes［J］. FEBS J， 2021， 288（17）： 5042-5054.
18	BARKAI L J， SIPTER E， CSUKA D， et al. Decreased ficolin-3-mediated complement lectin pathway activation and alternative pathway amplification during bacterial infections in patients with type 2 diabetes mellitus［J］. Front Immunol， 2019， 10： 509.
19	申智勇，钟渠梁，石家齐，等. 逆行上尿路腔内碎石术后并发急性尿源性感染的相关危险因素分析［J］. 国际泌尿系统杂志， 2020， 40（3）： 440-444.
20	GAO X， LU C， XIE F， et al. Risk factors for sepsis in patients with struvite stones following percutaneous nephrolithotomy［J］.World J Urol，2020，38（1）：219-229.
21	MARTOV A， GRAVAS S， ETEMADIAN M， et al. Postoperative infection rates in patients with a negative baseline urine culture undergoing ureteroscopic stone removal： A matched case-control analysis on antibiotic prophylaxis from the CROES URS Global Study［J］. J Endourol， 2015， 29（2）： 171-180.
22	曹金龙，李攀，杨欣，等. 经输尿管镜碎石术后尿源性脓毒性休克的预后影响因素分析［J］. 国际泌尿系统杂志， 2021， 41（1）： 44-48.
23	刘肖肖，李书青，张倩，等.糖尿病合并肾功能不全患者HbA_（1c）估算平均血糖校正模型的建立［J/OL］.解放军医学杂志：1-9［2022-06-08］..
24	DEMIR D， DOLUOGLU O， YILDIZ Y， et al. Risk factors for infectious complications in patients undergoing retrograde intrarenal surgery［J］. J Coll Physicians Surg Pak， 2019， 29（6）： 558–562.
25	杜浩杰. 上尿路腔镜碎石术中肾盂内压的控制方法和意义［J］.国际泌尿系统杂志，2020，40（6）：1134-1136.

Group	n	Gender		BMI≥25 (kg·m^－2)		Age≥60 (years)		Hypertension		History of stone surgery		Preoperative glycemic [c_B/(mmol·L^－1)]
Group	n	Male	Female	Yes	No	Yes	No	Yes	No	Yes	No	Preoperative glycemic [c_B/(mmol·L^－1)]
Non-infection	24	9	15	15	9	6	18	10	14	10	14	8.0±1.6
Infection	59	18	41	38	21	21	38	26	33	26	33	6.5±1.2
t/ χ²		0.380		0.027		0.872		0.040		0.040		－4.546
P		0.538		0.870		0.350		0.841		0.841		<0.001
Group	n	Urine culture			Urinary leukocyte count >10/HP			Stone diameter ≥2 cm		Operation time ≥90 min		Stone location
Group	n	Positive	Negative		Yes		No	Yes	No	Yes	No	Kidney	Ureter
Non-infection	24	8	16		8		16	10	14	10	14	12	12
Infection	59	7	52		9		50	12	47	9	50	30	29
t/ χ²		3.960			4.624			3.984		6.743		0.005
P		0.047			0.032			0.046		0.009		0.944

Factor	Regression coefficient (β)	Wald value	Standard error (SE)	P	OR (95% CI)
Positive preoperative urine culture	1.814	4.815	0.826	0.028	6.132 (1.214－30.983)
Urinary leukocyte count>10/HP	1.525	3.810	0.781	0.051	4.595 (0.994－21.250)
Stone size≥2 cm	1.408	4.096	0.695	0.043	4.086 (1.045－15.968)
Operation time≥90 min	2.090	7.374	0.770	0.007	8.084 (1.789－36.531)
Preoperative glycemic level （mmol·L^－1）	1.043	14.214	0.277	<0.001	2.837 (1.650－4.877)

Group	n	Preoperative glycemic level [c_B/（mmol·L^－1）]		Age (year)		BMI (kg·m^－2)	Gender		Hypertension
Group	n	Preoperative glycemic level [c_B/（mmol·L^－1）]		Age (year)		BMI (kg·m^－2)	Male	Female	Yes	No
Poor glycemic control	21	8.70(8.30,9.45)		53.71±10.13		26.77±2.89	14	7	9	12
Good glycemic control	62	6.20(5.60,7.12)		55.92±11.18		26.52±2.75	42	20	27	35
t/χ²/Z		－8.625		0.799		－0.353	0.008		0.003
P		<0.001		0.427		0.752	0.928		0.956
Group	n	History of stone surgery		Urine culture		Urinary leukocyte count>10/HP		Stone location
Group	n	Yes	No	Positive	Negative	Yes	No	Kidney	Ureter
Poor glycemic control	21	10	11	5	16	4	17	11	10
Good glycemic control	62	26	36	10	52	12	50	30	32
t/χ²/Z		0.206		0.214		<0.001		0.100
P		0.650		0.644		1.000		0.752
Group	n	Stone diameter (l/mm)		Operation time (t/min)		Postoperative infection- related complications		Average postoperative hospital stay（t/d）
Group	n	Stone diameter (l/mm)		Operation time (t/min)		Yes	No	Average postoperative hospital stay（t/d）
Poor glycemic control	21	17.65(15.85,19.59)		60.00(42.50,92.00)		15	6	4(4,6)
Good glycemic control	62	16.73(13.46,20.58)		53.50(45.75,80.00)		9	53	2(2,3)
t/χ²/Z		－0.466		－0.524		24.720		－6.155
P		0.641		0.600		<0.001		<0.001

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Effect of preoperative glycemic level on infection-related complications of diabetic patients after flexible ureteroscopic lithotripsy

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