上尿路结石患者经皮肾镜取石术后感染危险因素分析及血清PCT、TNF-α和外周血WBC的预测价值

中华养生保健 ›› 2023, Vol. 41 ›› Issue (4): 15-18.

上尿路结石患者经皮肾镜取石术后感染危险因素分析及血清PCT、TNF-α和外周血WBC的预测价值

庞华¹, 边建华¹, 刘文杰¹, 智静涛^2,*

1.北京核工业医院泌尿外科,北京, 102413;
2.北京市房山区良乡医院泌尿外科,北京, 102401

出版日期:2023-02-16 发布日期:2023-02-16
通讯作者: ^*智静涛,E-mail：zhijingtao@126.com。
作者简介:庞华（1979—）,男,汉族,籍贯：河北省石家庄市,本科,副主任医师,研究方向：泌尿系统疾病。

Analysis of Risk Factors of Infection and Clinical Significance of Serum PCT, TNF-α and WBC after Percutaneous Nephrolithotomy in Patients with Upper Urinary Tract Calculi

PANG Hua¹, BIAN Jian-hua¹, LIU Wen-jie¹, ZHI Jing-tao^2,*

1. Department of Urology, Beijing Nuclear Industry Hospital, Beijing, 102413, China;
2. Department of Urology, Liangxiang Hospital, Fangshan District, Beijing, 102401, China

Online:2023-02-16 Published:2023-02-16

摘要/Abstract

摘要： 目的探究上尿路结石患者术后发生泌尿系统感染的危险因素及血清降钙素原（PCT）、肿瘤坏死因子（TNF-α）和外周血白细胞（WBC）的预测价值。方法回顾性分析2014年6月—2021年6月北京核工业医院泌尿外科收治的118例上尿路结石行经皮肾镜碎石取石手术的患者资料。采用logistic回归分析患者术后并发泌尿系统感染的危险因素;采用ELISA法检测并发感染或未并发感染患者的血清PCT、TNF-α表达水平,并记录外周血WBC计数,采用ROC曲线评估三者对术后并发泌尿系统感染的诊断价值。结果患者结石大小、手术时长、术前尿培养阳性、尿蛋白阳性是术后并发泌尿系统感染的危险因素（P<0.05）;ROC曲线结果血清PCT、TNF-α、外周血WBC及三者联合分析曲线下面积AUC分别为0.903、0.893、0.854、0.994。结论结石大小、手术时长及术前尿路感染是术后并发泌尿系统感染的危险因素,术后血清PCT、TNF-α、外周血WBC联合分析对并发泌尿系统感染的诊断效能最优。

关键词: 上尿路结石, 泌尿系统感染, 经皮肾镜

Abstract: Objective To explore the risk factors of postoperative urinary tract infection in patients with upper urinary tract calculi and the diagnostic value of serum PCT, TNF - α and WBC for postoperative urinary tract infection. Methods The data of 118 patients with upper urinary tract calculi who underwent percutaneous nephrolithotomy in the Department of Urology, Beijing Nuclear Industry Hospital from June 2014 to June 2021 were retrospectively analyzed. Logistic regression was used to analyze the risk factors of postoperative urinary tract infection in patients; serum PCT and TNF-α expression levels in patients with or without infection were detected by ELISA, and WBC counts in peripheral blood were recorded. Diagnostic value of postoperative urinary tract infection. Results Stone size, operation time, positive urine culture and positive urine protein were the risk factors of postoperative urinary tract infection (P<0.05). AUC for PCT, TNF- α, WBC, and combined analysis curve were 0.903, 0.893, 0.854 and 0.994, respectively. Conclusions tone size, operation time and preoperative urinary tract infection are the risk factors of postoperative urinary tract infection. The combined analysis of postoperative PCT, TNF - α and WBC get the best diagnostic efficacy for urinary tract infection.

Key words: upper urinary tract calculi, urinary tract infection, percutaneous nephrolithotomy

中图分类号:

庞华, 边建华, 刘文杰, 智静涛. 上尿路结石患者经皮肾镜取石术后感染危险因素分析及血清PCT、TNF-α和外周血WBC的预测价值[J]. 中华养生保健, 2023, 41(4): 15-18.

PANG Hua, BIAN Jian-hua, LIU Wen-jie, ZHI Jing-tao. Analysis of Risk Factors of Infection and Clinical Significance of Serum PCT, TNF-α and WBC after Percutaneous Nephrolithotomy in Patients with Upper Urinary Tract Calculi[J]. ZHONGHUA YANGSHENG BAOJIAN, 2023, 41(4): 15-18.

参考文献

[1] LI R, RUCKLE D, KEHEILA M, et al.High-Frequency Dusting Versus Conventional Holmium Laser Lithotripsy for Intrarenal and Ureteral Calculi[J]. Journal of Endourology,2017,31(3):272.
[2] 陈奇. 经皮肾镜取石术通道研究新进展[J].中国医刊,2019,54(10): 1054-1058.
[3] RAO D, YU H, ZHU H, et al.Percutaneous nephrostomy via the central venous catheter in combination with selective ureteroscopic lithotripsy for the treatment of ureteral stones in the middle-upper segment[J]. J Cancer Res Ther,2018,14(3):567-569.
[4] 中华人民共和国卫生部.医院感染诊断标准(试行)[J].中华医学杂志,2003,15:460-465.
[5] ABOU-ELELA A.Epidemiology, pathophysiology, and management of uric acid urolithiasis: A narrative review[J]. Journal of Advanced Research 2017,8(5):513-527.
[6] CHEN L, XIONG L L, HUANG X B.Minimally Percutaneous Nephrolithotomy in the Treatment of Pediatric Upper Urinary Calculi: Report of 114 Cases[J]. Chinese Journal of Minimally Invasive Surgery,2019,19(3):229-231.
[7] 王维国,夏菲,蒋欣杰,等.无管化微通道经皮肾镜取石术治疗上尿路结石的疗效及安全性[J].国际泌尿系统杂志,2020,40(6):1020-1023.
[8] 邓慕夏. 经皮肾镜手术治疗上尿路结石100例的体会[J].智慧健康,2022,8(13):20-22.
[9] LIU Y H, XIE R Q.In 275 Cases of Patients with Urinary Tract Infection Pathogenic Bacteria Distribution and Drug Resistance Analysis[J]. Guide of China Medicine,2013,14:435-436.
[10] 程传宇,郝建伟,武玉东,等.HIV感染肾结石患者行输尿管软镜钬激光碎石术后发生尿路感染的危险因素分析.中华泌尿外科杂志,2019,40(9):690-694.
[11] GUTIERREZ J, SMITH A, GEAVLETE P, et al.Urinary tract infections and post-operative fever in percutaneous nephrolithotomy[J].World Journal of Urology,2013,31(5):1135-1140.
[12] ZHAO C B, CHANG-BIN J I, WANG X H, et al. Research Progress of Factors Affecting Fever Following Percutaneous Nephrolithotomy[J].Progress in Modern Biomedicine,2014,14(2):383-385.
[13] ASSIMOS D, KRAMBECK A, MILLER N L, et al.Surgical Management of Stones: American Urological Association/Endourological Society Guideline, PART I[J]. The Journal of urology, 2016,196(4):1161-1169.
[14] MATLAGA B R, SHAH O D, ASSIMOS D G.Complications of Percutaneous Approaches, Including Incisions[M].Advanced Endourology, 2006:283-297.
[15] 关则想,李红,白婷,等.喘憋性肺炎合并患儿血清PCT,CRP水平观察[J].广州医药,2020,51(2):111-114.
[16] 龚剑锋,万华,李秋红.降阶梯疗法治疗新生儿细菌感染性肺炎的疗效及对血清PCT、WBC和CRP的影响[J].东南大学学报(医学版),2018,37(5):868-872.
[17] 郭辉,葛亮,张思.血清PCT、TNF-α、CD14+/CD16+联合检测对新生儿败血症的诊断价值[J].海南医学,2017,28(1):83-86.
[18] WU C, BING Y, CHEN J.Diagnostic value of serum PCT and CRP levels for VUR in children patients with urinary tract infection[J].Medical Journal of National Defending Forces in Southwest China,2018,28(11):1030-1032.