良性前列腺增生患者术后尿源性感染危险因素及血清标志物的早期预测

Risk factors for postoperative urinary infections in patients with benign prostatic hyperplasia and early prediction with serological markers

目的分析良性前列腺增生症(BPH)患者术后尿源性感染发生的危险因素及相关血清标志物的早期预测价值,为医院感染的预防和控制提供研究依据。方法选择2018年10月-2019年12月海南省三亚中心医院收治的156例BPH患者作为研究对象,根据术后是否发生尿源性感染分为感染组和未感染组,单因素及多因素Logistic回归分析BPH患者发生尿源性感染的危险因素,分析患者术后1 d的血清降钙素原(PLT)、C-反应蛋白(CRP)检测诊断感染的临床价值。结果 156例BPH患者中28例患者发生尿源性感染,感染率为17.95%;BPH患者术后尿源性感染的发生与合并糖尿病、术前导尿及留置导尿管时间具有相关性(P<0.05);感染组患者术后1 d的血清PCT(1.81±0.94)ng/ml、CRP(34.07±11.58)mg/L水平均高于未感染组(P<0.05);血清PCT、CRP水平预测BPH术后尿源性感染的曲线下面积(AUC)分别为0.881和0.719,在Cutoff值下,灵敏度和特异度分别为0.750、0.992和0.607、0.727。结论 BPH术后尿源性感染的发生与糖尿病及导尿相关操作有关,尿源性感染患者术后早期可出现PCT、CRP水平的升高,两指标可用于感染的早期预测。

OBJECTIVE To investigate the risk factors for postoperative urinary infections in patients with benign prostatic hyperplasia(BPH)and analyze the value of serological markers in early prediction so as to provide guidance for prevention and control of nosocomial infection.METHODS A total of 156 patients with BPH who were treated in the Sanya Central Hospital from Oct.2018 to Dec.2019 were enrolled in the study and divided into the infection group and the non-infection group according to the status of postoperative urinary tract infection.Univariate analysis and multivariate logistic regression analysis were performed for risk factors for the postoperative urinary tract infection,and the clinical value of serum procalcitonin(PCT)and C-reactive protein(CRP)1 day after surgery in diagnosis of infection was observed.RESULTS Of the 156 patients with BPH,28 had urinary infections,with the infection rate 17.95%.The incidence of postoperative urinary infections in the BPH patients was associated with diabetes mellitus,preoperative urethral catheterization and catheter indwelling time(P<0.05).The levels of serum PCT and CRP of the infection group were respectively(1.81±0.94)ng/ml and(34.07±11.58)mg/L after the surgery for 1 day,significantly higher than those of the non-infection group(P<0.05);the areas under ROC curve(AUC)of the serum PCT and CRP were respectively 0.881 and 0.719 in prediction of the postoperative urinary infection;the sensitivities and specificities were respectively 0.750,0.992 and 0.607,0.727 at Cutoff values.CONCLUSION The incidence of postoperative urinary infection in the BPH patients is associated with the diabetes mellitus and urethral catheterization-related procedures,the levels of PCT and CRP of the patients with urinary infection are elevated at early stage after the surgery,and the two indexes can be used for early prediction of infection.