经皮肾镜微创取石术后尿路感染危险因素及血清HMGB1、TLR4、NF-κB水平

Risk factors for postoperative urinary tract infection in minimally invasive percutaneous nephrolithotomy patients and impact on serum HMGB1,TLR4 and NF-κB

目的探讨经皮肾镜微创取石术(PNCL)后尿路感染危险因素及对血清高迁移率族蛋白B1(HMGB1)、Toll样受体4(TLR4)及核转录因子-κB(Nuclear transcription factor,NF-κB)水平的影响。方法选择焦作市人民医院泌尿外科2017年5月-2019年5月收治的上尿路结石行PCNL患者110例作为研究对象,根据其术后是否发生尿路感染分为感染组19例和未感染组91例。收集感染患者中段尿标本进行病原菌培养与鉴定;采用电子病历收集患者临床资料,单因素及多因素Logistic回归分析患者PNCL术后尿路感染的危险因素;采用酶联免疫吸附法(ELISA)检测血清中HMGB1、TLR4及NF-κB水平。结果19例感染患者共分离出病原菌23株,其中革兰阴性菌15株,占65.22%,革兰阳性菌8株,占34.78%,大肠埃希菌检出率最高,共9株,占39.13%;单因素分析结果显示,性别、术前STONE评分、合并基础性疾病比较差异无统计学意义,年龄、既往泌尿道手术史、手术时间、术前尿WBC计数、导尿管留置时间、住院时间比较差异有统计学意义(P<0.05);多因素Logistic回归分析结果,年龄、既往泌尿道手术史、手术时间、术前尿培养结果、术前尿WBC计数、导尿管留置时间、住院时间是PNCL术后发生尿路感染的危险因素(P<0.05);感染组患者血清HMGB1、TLR4、NF-κB水平高于未感染组患者(P<0.05)。结论年龄、既往泌尿道手术史、手术时间、术前尿培养结果、术前尿WBC计数、导尿管留置时间、住院时间是PNCL术后尿路感染的危险因素,在临床中应进行针对性预防,加强监测,其感染机制可能与HMGB1、TLR4、NF-κB通路改变有关,有待进一步研究。

OBJECTIVE To explore the risk factors for postoperative urinary tract infection in the patients undergoing percutaneous nephrolithotomy(PNCL) and observe the effects on serum high mobility group protein B1(HMGB1), Toll-like receptor 4(TLR4) and nuclear transcription factor-κB(NF-κB). METHODS A total of 110 patients with upper urinary tract calculi who underwent PCNL in urology department of Jiaozuo People′s Hospital from May 2017 to May 2019 were recruited as the study subjects and divided into the infection group with 19 cases and the non-infection group with 91 cases according to the status of postoperative urinary tract infection.The midstream urine specimens were collected from the patients with infection for culture of pathogens, the clinical data of the patients were collected through electronic medical record, univariate analysis and multivariate logistic regression analysis were performed for the risk factors for postoperative urinary tract infection in the PNCL patients, and the levels of serum HMGB1, TLR4 and NF-κB were detected by means of enzyme-linked immunosorbent assay(ELISA). RESULTS Totally 23 strains of pathogens were isolated from 19 patients with infection, 15(65.22%) of which were gram-negative bacteria, and 8(34.78%) were gram-positive bacteria;Escherichia coli was dominant among the isolated pathogens, accounting for 39.13%(9 strains).Univariate analysis showed that there were no significant differences in the gender, preoperative STONE score and complication with underlying diseases(P>0.05), but there were significant differences in the age, previous urinary tract surgery history, operation duration, preoperative urine WBC, urinary catheter indwelling time and length of hospital stay(P<0.05).Multivariate logistic regression analysis indicated that the age, previous urinary tract surgery history, operation duration, result of preoperative urine culture, preoperative urine WBC, urinary catheter indwelling time and length of hospital stay were the risk factors for the postoperative urinary tract infection in the PNCL patients(P<0.05).The levels of serum HMGB1, TLR4 and NF-κB of the infection group were significantly higher than those of the non-infection group(P<0.05). CONCLUSION The age, previous urinary tract surgery history, operation duration, result of preoperative urine culture, preoperative urine WBC, urinary catheter indwelling time and length of hospital stay are the risk factors for the postoperative urinary tract infection in the PNCL patients. It is necessary for the hospital to take targeted prevention measures and strengthen the monitoring;its infection mechanisms may be related to the changes of HMGB1, TLR4 and Nf-κB pathways, which need to be further studied.