经皮肾镜碎石术后尿路感染尿IL-6/STAT3通路水平及其诊断及预后价值

Analysis of urinary IL-6/STAT3 pathway in patients with urinary tract infection after percutaneous nephrolithotomy and its diagnostic and prognostic value

目的探讨经皮肾镜碎石术后尿路感染患者尿白细胞介素-6(IL-6)/信号传导与转录激活因子3(STAT3)通路水平对其诊断及预后价值。方法选择邢台市人民医院泌尿外科2019年1月-2019年12月行PCNL术后发生尿路感染患者70例为感染组,选择同期于医院行PCNL术但术后未发生尿路感染患者70例作为非感染组。分析感染组病原菌特点,检测两组手术前、手术后6、12、24 h血清降钙素原(PCT)、C-反应蛋白(CRP)水平,酶联免疫吸附法检测尿液IL-6、STAT3水平。采用受试者工作特征曲线(ROC)分析各指标对于患者不良预后的预测价值。结果70例病原培养阳性感染组患者尿液培养共检出病原菌76株,其中革兰阴性菌50株,占65.79%,革兰阳性菌26株,占34.21%,大肠埃希菌检出率最高,占25.00%;术前两组IL-6、STAT3、CRP、PCT水平比较差异无统计学意义;术后6、12、24 h感染组血清CRP、PCT和尿IL-6、STAT3均高于非感染组(P<0.05);下尿路感染组患者血清CRP、PCT及尿IL-6、STAT水平高于上尿路感染组(P<0.05);ROC分析结果显示,血CRP、PCT、尿IL-6、STAT3用于PCNL合并尿路感染患者不良预后的预测,其曲线下面积分别为0.743、0.765、0.840、0.821,四指标联合检测时曲线下面积为0.897,均具有统计学意义(P<0.05)。结论PCNL术后尿路感染伴随IL-6/SITA3信号通路激活,通过尿液中IL-6/STAT3水平可预测患者不良预后。

OBJECTIVE To explore the urinary interleukin-6(IL-6)/signal Transducer and Activator of Transcription 3(STAT3)pathway and its value in diagnosis and prognosis of patients with urinary tract infection after percutaneous nephrolithotomy.METHODS Seventy patients with urinary tract infection after PCNL were recruited as the infection group in the Department of Urology of Xingtai People′s Hospital from Jan 2019 to Dec 2019;and 70 patients who underwent PCNL in the same period but did not have urinary tract infection were enrolled in the non-infection group.The characteristics of pathogenic bacteria between the two groups,levels of serum procalcitonin(PCT)and C-reactive protein(CRP)before and at 6 h,12 h,and 24 h after surgery were analyzed.Urine IL-6 and STAT3 levels were detected by enzyme-linked immunosorbent assay.The receiver operating characteristic curve(ROC)was used to analyze the predictive value of each index for the poor prognosis of patients.RESULTS A total of 76 strains of pathogens were detected in the urine culture of the 70 patients in the infection group,including 50 gram-negative bacteria(65.79%),and 26 were gram-positive bacteria(34.21%).The detection rate of Escherichia coli was the highest,accounting for 25.00%.There was no significant difference of the levels of IL-6,STAT3,CRP and PCT between the two groups before surgery.Levels of serum CRP,PCT,urine IL-6 and STAT3 in the infection group 6 h,12 h,and 24 h after surgery were significantly higher than those in the non-infected group(P<0.05).Serum CRP,PCT and urine IL-6 and STAT levels in patients with lower urinary tract infection was significantly higher than those with the upper urinary tract infection(P<0.05).ROC analysis showed that the area under the curves of single blood CRP,PCT,urine IL-6,and STAT3 used to predict the poor prognosis of PCNL patients with urinary tract infection were 0.743,0.765,0.840,0.821,respectively;when the four indicators were combined,the area under the curve was 0.897,which were significant(P<0.05).CONCLUSION Urinary tract infection after PCNL is accompanied by activation of IL-6/SITA3 signaling pathway.The high levels of IL-6 and STAT3 in urine can predict the poor prognosis of patients.