COVID-19パンデミック時代に増加した合併症尿管結石のリスク

The Increased Risk of Complicated Ureteral Stones in the Era of COVID-19 Pandemic.

• Murat Gül
• Mehmet Kaynar
• Mehmet Yıldız
• Ali Furkan Batur
• Murat Akand
• Ozcan Kılıc
• Serdar Göktaş

抄録

背景:

尿管結石症は、適切な管理を適時に行わなければ、緊急性の高い疾患である可能性がある。COVID-19の世界的な流行に伴い，各国政府による隔離・制限命令がパンデミック対策の中心となっている．そこで本研究では，COVID-19の隔離・制限期間中の尿管結石の発生状況を調査することを目的とした．

BACKGROUND: Ureteral stone disease may be an emergent condition if the appropriate management is not performed in a timely manner. As the COVID-19 continues to spread globally, isolation and restriction orders taken by the governments have become the cores to control the pandemic. In this study, we, therefore, aimed to investigate the ureteral stone presentations in a high-volume university hospital during the COVID-19 restrictions order period.

材料と方法:

COVID-19パンデミック制限期間中および前年の対応する期間（COVID-19以外の期間）に尿管結石により入院した149人のデータを収集し、レトロスペクティブに分析した。連続変数の比較には、Unpaired Student's t 検定を用いた。カテゴリカルデータはカイ二乗検定を用いて評価した。

MATERIAL AND METHODS: The data of 149 patients who were hospitalized due to ureteral stone both during the COVID-19 pandemic restrictions period and the corresponding period (non-COVID-19) of the previous year were collected and analyzed retrospectively. Unpaired Student's t test was used to compare continuous variables. The categorical data were assessed using a chi-square test.

結果:

149人の患者のうち、35人がCOVID-19期に入院した。両群の平均年齢および結石の特徴に有意差はなかったが、入院時の血清クレアチニン値（1.91.85 vs 1.150.64）および白血球数（12.456.54 vs 8.214.15）はCOVID期間群の方が有意に高かった（それぞれp=0.034、p=0.005）。COVID-19パンデミック時に適用されたEuropean Urorology Guidelines Office Rapid Reaction Group Urolithiasis Guidelines Panelの優先度分類によると、COVID期とCOVID期では有意差が認められた（X2=9.907、p=0.019）。特に救急患者の発生率はCOVID-19期に3倍以上の差が認められた。入院時の水腎症のグレードについては、両群間で有意差はなかったが、グレード3と4の水腎症の割合はCOVID-19期群の方が高く（それぞれ1.8倍、3.3倍）、COVID-19期群とCOVID-19期群との間では、グレード3と4の水腎症の割合はCOVID-19期群の方が高くなっていた。

RESULTS: Of 149 patients, 35 were hospitalized in the COVID-19 period. While the mean age and the stone characteristics of the two groups did not differ significantly, serum creatinine levels (1.91.85 vs 1.150.64) and the white blood cell counts (12.456.54 vs 8.214.15) at hospital admission were significantly higher in the COVID-period group (p=0.034 and p=0.005, respectively). According to the priority classification of the European Urology Guidelines Office Rapid Reaction Group Urolithiasis Guidelines Panel applicable during the COVID-19 pandemic, a significant difference was observed between the two periods (X2=9.907, p=0.019). In particular, the rate of emergency cases was found more than 3-fold in the COVID-19 period. Although there was no significant difference in terms of the grade of hydronephrosis at hospital admission between the two groups, the rate of grade 3 and 4 hydronephroses was higher in the COVID-period group (1.8- and 3.3-fold, respectively).

結論:

COVID-19の制限期間中、複雑な尿管結石疾患の発生率が有意に増加した。泌尿器科医は、社会的危機のようにCOVID-19期間中に緊急治療を最も必要とする患者を優先すべきである。

CONCLUSION: The rate of complicated ureteral stone disease significantly increased during the COVID-19 restrictions period. Urologists should prioritize the patients most in need of urgent care during COVID-19 like social-crisis.