输尿管上段结石患者行RLUL后HSP70、sVCAM-1的变化及其对术后输尿管狭窄的评估价值

Changes of HSP70 and sVCAM-1 levels after RLUL and their value in evaluating postoperative ureteral stricture in upper ureteral calculi patients

目的分析输尿管上段结石患者单孔后腹腔镜输尿管切开取石术(RLUL)前后热休克蛋白70(HSP70)、可溶性血管细胞黏附分子-1(sVCAM-1)变化,并探讨二者评估术后输尿管狭窄的价值。方法选取2018年1月至2021年3月输尿管上段结石患者460例为研究对象,均行RLUL治疗,术前、术后1 d、术后2周分别检测血清HSP70、sVCAM-1水平。术后随访1年,统计输尿管狭窄发生率。分析术后输尿管狭窄的影响因素,绘制受试者工作特征(ROC)曲线分析血清HSP70、sVCAM-1评估术后输尿管狭窄的价值。结果术后1 d、术后2周输尿管结石患者血清HSP70、sVCAM-1水平高于术前,术后2周低于术后1 d(P<0.05);术后随访1年,输尿管狭窄发生率为4.84%(22/455)。二元logistic回归分析结果显示,校正病程、最大结石直径、手术时间、息肉绕结石、结石嵌顿、术前尿路感染后,HSP70低表达、sVCAM-1高表达仍会增加术后输尿管狭窄风险(P<0.05)。血清HSP70、sVCAM-1联合评估术后输尿管狭窄的AUC值为0.898,具有较高评估效能(χ^(2)=12.718,P<0.001)。结论输尿管上段结石患者RLUL后血清HSP70、sVCAM-1水平显著改变,且是术后输尿管狭窄的独立影响因素,二者联合可为临床评估术后输尿管狭窄风险提供参考。

Objective To analyze the changes in serum heat shock protein 70(HSP70)and soluble vascular cell adhesion molecule-1(sVCAM-1)levels before and after retroperitoneal laparoscopic ureterolithotomy(RLUL)in patients with upper ureteral calculi and explore their value in assessing postoperative ureteral stricture.Methods A total of 460 patients with upper ureteral calculi treated with RLUL from January 2018 to March 2021 were selected as the study subjects.Serum HSP70 and sVCAM-1 levels were measured before surgery,at 1 day,and 2 weeks after surgery.One-year follow-up was conducted to calculate the incidence of ureteral stricture after surgery.The influencing factors of postoperative ureteral stricture were analyzed using binary logistic regression,and receiver operating characteristic(ROC)curves were plotted to evaluate the value of serum HSP70 and sVCAM-1 in predicting postoperative ureteral stricture.Results Serum HSP70 and sVCAM-1 levels in patients with ureteral calculi were higher at 1 day and 2 weeks after surgery as compared to before surgery,and they decreased at 2 weeks after surgery(P<0.05).The incidence of ureteral stricture during one-year follow-up was 4.84%(22/455).After adjusting for disease course,maximum stone diameter,surgical time,stone entangled with polyps,stone impaction,and preoperative urinary tract infection,low expression of HSP70 and high expression of sVCAM-1 could still increase the risk of postoperative ureteral stricture(P<0.05).The combined assessment of serum HSP70 and sVCAM-1 in predicting postoperative ureteral stricture had an area under the curve(AUC)of 0.898,indicating high predictive efficacy(χ^(2)=12.718,P<0.001).Conclusion Serum HSP70 and sVCAM-1 levels significantly change after RLUL in patients with upper ureteral calculi and are independent risk factors for postoperative ureteral stricture.The combination of HSP70 and sVCAM-1 can provide a valuable reference for evaluating the risk of postoperative ureteral stricture clinically.