经皮肾镜碎石术后感染性休克的早期预警指标探究及其与多器官功能障碍的相关性

Early-warning indexes of septic shock after percutaneous nephrolithotomy and their correlation with multiple organ dysfunction

目的:研究DD、ALB、CHE、TNT对经皮肾镜碎石术(PCNL)后感染性休克的早期预警价值及其与多器官功能障碍综合征(MODS)的相关性。方法:选择发生PCNL术后感染性休克的患者作为观察组研究对象、术后未发生感染的患者作为对照组研究对象,测定DD、ALB、CHE、TNT及IL-17、IL-10、Foxp3、RORγt。结果:观察组CHE、ALB均显著低于对照组,DD、TNT均显著高于对照组;观察组中发生MODS患者的CHE、ALB低于未发生MODS的患者,DD、TNT高于未发生MODS的患者且MODS累及脏器数目越多,CHE、ALB越低,DD、TNT越高;观察组血清中IL-17、IL-10的含量以及外周血中Foxp3、RORγt的mRNA含量显著高于对照组;观察组中发生MODS患者血清中IL-17、IL-10的含量以及外周血中Foxp3、RORγt的mRNA含量高于未发生MODS的患者且MODS累及脏器数目越多,血清中IL-17、IL-10的含量以及外周血中Foxp3、RORγt的mRNA含量越高;CHE、ALB与IL-17、IL-10、Foxp3、RORγt呈负相关,DD、TNT与IL-17、IL-10、Foxp3、RORγt呈正相关。结论:DD、ALB、CHE、TNT是PCNL术后感染性休克及MODS的早期预警指标,与MODS的严重程度及全身炎症反应综合征、代偿性抗炎反应综合征密切相关。

Objective： To study the early-warning value of DD, ALB, CHE and TNT for septic shock after percutane- ous nephrolithotomy （PCNL） and their correlation with multiple organ dysfunction syndrome （MODS）. Methods： Patients with septic shock after PCNL were selected as observation group, patients without postoperative infection were selected as con- trol group, and then the DD, ALB, CHE and TNT as well as IL-17, IL-10, Foxp3 and RORγt were determined. Results： CHE and ALB of observation group were significantly lower than those of control group while DD and TNT were significantlyhigher than those of control group. CHE and ALB of observation group with MODS were lower than those of patients without MODS, DD and TNT were higher than those of patients without MODS, and the more the number of viscera that MODS in- volved, the lower the CHE and ALB, and the higher the DD and TNT; IL-17 and IL-10 levels in serum as well as Foxp3 and RORγt mRNA levels in peripheral blood of observation group were significantly higher than those of control group. IL-17 and IL-10 levels in serum as well as Foxp3 and RORγt mRNA levels in peripheral blood of observation group of patients with MODS were significantly higher than those of patients without MOD, and the more the number of viscera that MODS in- volved, the higher the IL-17 and IL-10 levels in serum as well as Foxp3 and RORγt mRNA levels in peripheral blood. CHE and ALB were negatively correlated with IL-17, IL-10, Foxp3 and RORγt while DD and TNT were positively correlated with IL- 17, IL-10, Foxp3 and RORγt. Conclusion： DD, ALB, CHE and TNT are the early-warning indexes of septic shock and MODS after PCNL, and they are closely related to MODS severity as well as systemic inflammatory response syndrome and compensa- tory anti-inflammatory response syndrome.