降钙素原、脂多糖水平与经皮肾镜取石术后早期感染性休克风险的相关性研究

The relationship between serum procalcitonin,lipopolysaccharide concentrations with the risk of early-stage septic shock after percutaneous nephrolithotomy

目的探讨血清降钙素原(PCT)及脂多糖(LPS)水平与经皮肾镜取石术(PCNL)后早期感染性休克的相关性,为PCNL术后早期感染性休克的预防及监测提供参考依据。方法将2014年3月至2018年2月该院泌尿外科确诊为肾结石以及输尿管上段结石,并且治疗方案确定为PCNL术的患者共115例纳入本研究。其中发生早期感染性休克的患者56例(病例组),未发生早期感染性休克的患者59例(对照组)。患者的PCT及LPS水平测定采用免疫发光分析法。结果病例组和对照组血清PCT、LPS水平比较,差异均有统计学意义(P<0.05)。病例组中不同年龄、休克史、肝/肾功能异常情况、严重外伤感染史患者的血清PCT水平比较,差异均有统计学意义(P<0.05);不同年龄、休克史、肝/肾功能异常情况、胰腺功能异常情况、严重外伤感染史患者的血清LPS水平比较,差异均有统计学意义(P<0.05)。血清PCT、LPS水平的相关性分析显示二者呈正相关(rP=0.502,P<0.05);血清PCT、LPS水平并联诊断结果(曲线下面积为0.875,95%CI:0.794~0.956)比血清PCT、LPS水平串联诊断结果(曲线下面积为0.604,95%CI:0.524~0.696)对PCNL术后早期感染性休克的诊断效能更高。结论PCNL术后早期感染性休克与血清PCT、LPS水平升高有关,并联检测血清PCT、LPS水平有助于PCNL术后早期感染性休克的监测并有较高的临床应用价值。

Objective To investigate the relationship between serum concentrations of procalcitonin(PCT),lipopolysaccharide(LPS)and the risk of early-stage septic shock after percutaneous nephrolithotomy(PCNL),and provide reference for the prevention and monitoring of early-stage septic shock after PCNL.Methods From March 2014 to February 2018,115 patients with renal calculi and upper ureteral calculi diagnosed by the urology department in the hospital were enrolled in the study,including 56 patients with early-stage septic shock(case group)and 59 patients without septic shock(control group).The serum concentrations of PCT and LPS were measured by immunoluminescence assay.Results There were significant differences in serum PCT and LPS concentrations between the case group and the control group(P<0.05).There were significant differences in serum PCT concentrations among patients of different ages,with different shock history,abnormal liver/kidney function and severe traumatic infection history(P<0.05);there were significant differences in serum LPS levels among patients of different ages,with different shock history,abnormal liver/kidney function,abnormal pancreatic function and severe traumatic infection history(P<0.05).The correlation analysis of serum PCT and LPS levels showed a positive correlation(r P=0.502,P<0.05);the diagnostic efficiency of serum PCT and LPS tests in parallel(area under curve is 0.875,95%CI:0.794-0.956)were more effective than those in series(area under curve is 0.604,95%CI:0.524-0.696)in the diagnosis of early-stage septic shock after PCNL.Conclusion Early-stage septic shock after PCNL is related to the elevation of serum PCT and LPS concentrations.Parallel detection of serum PCT and LPS concentrations is helpful for monitoring early-stage septic shock after PCNL and has a high clinical value..