输尿管软镜碎石术后尿路感染的危险因素及血清IL-8、TNF-α、CD4^+CD8^+T细胞研究

Risk factors for postoperative urinary tract infection in flexible ureteroscopic lithotripsy patients and changes of serum IL-8,TNF-αand CD4^+CD8^+T cells

目的分析输尿管软镜碎石术后尿路感染的相关危险因素及血清IL-8,TNF-α,CD4^+CD8^+T细胞的变化。方法选取2017年1月-2019年3月武汉市中西医结合医院(武汉市第一医院)384例行输尿管软镜碎石患者作为研究对象,根据术后是否发生尿路感染分为感染组与未感染组,其中感染组患者35例,未感染组349例;对输尿管软镜碎石术后尿路感染病原菌进行鉴定;采用Logistic回归分析对输尿管软镜碎石术后尿路感染患者的年龄、合并糖尿病、结石大小、手术时间、留置尿管时间、住院时间等资料进行分析;采用酶联免疫吸附法(Enzyme-linked immunosorbent assay,ELISA)检测血清白细胞介素-8(Interleukin-8,IL-8)、肿瘤坏死因子-α(Tumor necrosis factor-α,TNF-α)、CD4^+、CD8^+、CD4^+/CD8^+水平变化。结果384例输尿管软镜碎石术后35例尿路感染患者,尿路感染发生率为9.11%,共分离出47株病原菌,革兰阴性菌30株占63.83%,革兰阳性菌16株占34.04%,真菌1株占2.13%;单因素分析结果显示,感染组与未感染组患者在年龄、合并糖尿病、结石大小、留置尿管时间、住院时间方面,比较差异均有统计学意义;Logistic回归分析结果显示,年龄≥61岁、合并糖尿病、结石大小≥3 cm、留置尿管时间≥7 d、住院时间≥14 d为输尿管软镜碎石术后发生尿路感染的危险因素(P<0.05);与术前比较,两组患者血清IL-8、TNF-α、CD4^+、CD8^+、CD4^+/CD8^+水平均升高,且感染组水平较未感染高,差异均有统计学意义(P<0.05)。结论年龄、合并糖尿病、结石大小、留置尿管时间、住院时间均是影响输尿管软镜碎石术后发生尿路感染的独立危险因素;针对以上危险因素临床应采取积极措施,预防感染发生风险。

OBJECTIVE To investigate the related risk factors for postoperative urinary tract infection in flexible ureteroscopic lithotripsy patients and observe the changes of IL-8,TNF-αand CD4^+CD8^+T cells.METHODS A total of 384 patients who underwent flexible ureteroscopic lithotripsy in Wuhan Integrated Traditional Chinese and Western Medicine Hospital(Wuhan First Hospital)from Jan 2017 to Mar 2019 were recruited as the study objects and divided into the infection group and the non-infection group according to the status of postoperative urinary tract infection:the infection group with 35 cases and the non-infection group with 349 cases.The pathogens causing the postoperative urinary tract infection in the flexible ureteroscopic lithotripsy patients were identified,the logistic regression analysis was performed for the data of the patients with postoperative urinary tract infection,including age,complication with diabetes mellitus,size of stone,operation duration,time of urinary catheter indwelling and length of hospital stay.The levels of serum interleukin-8(IL-8),tumor necrosis factor-α(TNF-α),CD4^+,CD8^+and CD4^+/CD8^+were detected by using enzyme-linked immunosorbent assay(ELISA).RESULTS Of the 384 patients who underwent the flexible ureteroscopic lithotripsy,35 had postoperative urinary tract infection,with the incidence rate 9.11%.Totally 47 strains of pathogens were isolated,30(63.83%)of which were gram-negative bacteria,16(34.04%)were gram-positive bacteria,and 1(2.13%)was fungus.The result of univariate analysis showed that there were significant differences in the age,complication with diabetes mellitus,size of stone,time of urinary catheter indwelling and length of hospital stay between the infection group and the non-infection group.The result of logistic regression analysis indicated that the no less than 61 years of age,complication with diabetes mellitus,size of stone no less than 3 cm,time of urinary catheter indwelling no less than 7 days and length of hospital stay no less than 14 days were the risk factors for the postoperative urinary tract infection in the flexible ureteroscopic lithotripsy patients(P<0.05).The levels of serum IL-8,TNF-α,CD4^+,CD8^+and CD4^+/CD8^+of the two groups of patients were higher after the surgery than before the surgery,and the levels of above indexes of the infection group were higher than those of the non-infection group,and there were significant differences(P<0.05).CONCLUSION The age,complication with diabetes mellitus,size of stone,time of urinary catheter indwelling and length of hospital stay are the independent risk factors for the postoperative urinary tract infection in the flexible ureteroscopic lithotripsy patients.It is necessary to take targeted measures according to the risk factors so as to prevent the infection.