血清炎性因子检测及尿培养在经皮肾镜碎石患者术后尿道感染诊断评价

Detection of serum levels of endotoxin and procalcitonin and C reactive protein and urine culture in the diagnosis of urinary tract infection after percutaneous nephrolithotomy

目的探讨血清内毒素、降钙素原(PCT)、C-反应蛋白(CRP)检测及尿培养在经皮肾镜碎石术后尿道感染诊断中临床价值,为经皮肾镜碎石术后尿道感染的诊断提供参考。方法随机选取2014年1月-2015年8月住院的肾结石患者200例,患者于入院时、术后第1天采集外周血5ml,检测血清内毒素、PCT、CRP,术前以膀胱镜采集膀胱内尿液、术中取肾盂尿液进行尿细菌培养,采用全自动微生物鉴定仪进行细菌鉴定;采用SPSS19.0软件对数据进行统计分析。结果术后38例患者发生尿道感染,感染率为19.00%;血清内毒素、PCT及CRP感染组与未感染组患者术后水平及阳性率均较术前升高(P<0.05),但是感染组较未感染组患者升高更明显(P<0.05);感染组与未感染组患者术前中段尿培养阳性率分别为7.89%、6.79%,术中肾盂尿培养阳性率分别为73.68%、1.85%,感染患者肾盂尿培养阳性菌高于未感染患者(P<0.05)。结论血清内毒素、PCT、CRP检测及尿培养在经皮肾镜碎石术后尿道感染诊断中具有较高临床价值,术后检测内毒素、PCT、CRP较术前价值高,术中进行肾盂尿培养较术前尿培养价值高。

OBJECTIVETo investigate the clinical value of serum endotoxin,procalcitonin（PCT）,Creactive protein（CRP）in diagnosis of urinary tract infection in patients with urinary tract infection after percutaneous nephrolithotomy,and to provide reference for the diagnosis of urinary tract infection after percutaneous nephrolithotomy.METHODSA total of 200 cases of patients with renal stones in the hospital were randomly selected from Jan.2014 to Aug.2014.When patients just admitted in hospital and on the first day after they got operation,5ml peripheral blood were collected to detect serum endotoxin,PCT and CRP.Cystoscope was used to collect urine in bladder in preoperative periods;urine in renal pelvis was collected to carry out bacteria culture during operation,Automated microbial identification system was used for bacterial identification.The results were statistically analyzed by software SPSS19.0.RESULTSTotally 38 patients had the postoperative urinary tract infections,with the infection rate19.00%.The levels and positive rates of serum endotoxin,PCT,and CRP of the infection group and the non-in fection group were higher after the surgery than before the surgery（P〈0.05）,which were elevated more significantly in the infection group than in the non-infection group（P〈0.05）.The positive rate of midstream urinec ulture was 7.89%in the infection group before the surgery,6.79%in the non-infection group;the positive rate of culture of renal pelvis urine was 73.68% in the infection group during the surgery,1.85% in the non-infection group;the positive rate of culture of renal pelvis urine was higher in the patients with infections than in the patients without infections（P〈0.05）.CONCLUSIONSerum endotoxin,PCT,CRP detection and urine culture in percutaneous nephrolithotomy has high clinical value in diagnosing postoperative urethral infection.Postoperative detection of bacterial endotoxin,PCT and CRP has much more value than that of the preoperative detection.Intraoperative renal pelvis urine culture has much more value than that of the preoperative perods.