输尿管结石并发尿脓毒血症的预测与治疗研究

Prediction and treatment of ureteral calculi complicated with urinary sepsis

目的评估输尿管结石合并泌尿系感染疾病进展的危险因素;评估尿脓毒血症的预警因子的意义;对比各种治疗方案的效果。方法选取北京市仁和医院2014年1月至2018年5月诊治的73例输尿管结石合并泌尿系感染患者作为研究对象。其中明确诊断尿脓毒血症患者21例为研究组,经单纯抗感染未进展的患者52例为对照组。研究组中有10例为治疗过程中进展为尿脓毒血症患者,将该10例患者称为进展组。分别比较其治疗前后血清降钙素原(PCT),C反应蛋白(CRP)水平,比较其预警效果;观察三组患者细菌培养阳性率区别;比较各组患者结石大小及合并糖尿病比例。结果全部患者中,女性患者比例较高(84.9%),但尿脓毒血症的发病率(29.0%)与男性(27.3%)比较,差异无统计学意义(P=0.09)。研究组和进展组的尿细菌培养阳性率与对照组均无差别,差异均无统计学意义(均P>0.05)。疾病不同程度进展与结石的大小差异无统计学意义(P>0.05)。但研究组和进展组中糖尿病患者比例明显高于对照组患者,差异具有统计学意义(P<0.01)。治疗前研究组和进展组的PCT水平明显高于对照组,研究组中CRP水平明显高于对照组患者,差异均具有统计学意义(均P<0.01),但进展组中CRP水平与对照组比较,差异无统计学意义(P>0.05);治疗后,各观察组PCT与CRP水平与对照组比较,差异均无统计学意义(均P>0.05)。经过积极抗感染治疗或同时于早期联合手术解除梗阻治疗后,所有病例均治愈,无严重并发症或死亡发生。结论PCT可作为输尿管结石合并泌尿系感染早期诊断的重要指标广泛应用,应用最微创的手段早期解除梗阻是治疗的关键。

Objective To evaluate the deteriorating risk factors of urinary tract infection complicated with ureteral calculi,evaluate the significance of urine sepsis warning factors,and compare the effects of various therapeutic regimen.Methods 73 patients with urinary tract infections complicated with ureteral calculi in Beijing Renhe Hospital between January 2014 and May 2018 were selected,including 21 patients with sepsis as the observation group and 52 cases who did not progress after anti-infection treatment as control group.10 patients deteriorated to sepsis after anti-infection treatment in observation group were called as progress group.The Procalcitonin(PCT)and C-reactive protein(CRP)levels before and after the treatment were compared,and their early warning effect was compared.The difference in positive rate of germiculture between each groups was observed and the calculous size and proportion of diabetes mellitus in patients between groups was compared.Results Female made up a high percentage(84.9%)in all the patients.The incidence rate of urinary sepsis was 29.0%in female and 27.3%in male,with no statistically significant differences(P=0.09).There were no statistically significant differences in the urine bacteria culture positive rate between the observation group/progress group and the control group(all P>0.05).The progress of the disease had no obvious relation with the size of stones(P>0.05).The proportions of patients with diabetes in the observation group and progress group were obviously higher than that of control group(P<0.01).Before treatment,the PCT level of observation group and progress group was obviously higher than that of control group and the CRP levels of observation group were significantly higher than those in control group,all with statistically significant differences(all P<0.01),but no statistically significant difference in the CRP levels was found between the progress group and the control group(P>0.05).After treatment,there were no statistically significant differences in both PCT and CRP level between observation/progress group and the control group(all P>0.05).All cases were cured,and there were no serious complications or death occurred,after active anti-infection treatment or at the same time removing obstruction by surgical method in the early time.Conclusions PCT can be widely used as an important index in the early diagnosis of ureteral calculi complicated with urinary tract infection.It is the key to treat the early obstruction by using the most minimal invasive method.