输尿管软镜碎石术患者手术前后血清ET-1 PGE_(2) PGF_(2α)水平变化及意义

Changes and Significance of Serum ET-1 PGE_(2) and PGF_(2α)Levels in Patients Before and After Flexible Ureteroscopic Lithotripsy

目的:探讨输尿管软镜碎石术(FURL)患者手术前后血清内皮素-1(ET-1)、前列腺素E2(PGE_(2))、前列腺素F2α(PGF_(2α))水平变化及意义。方法:选取2017年2月至2019年12月期间在我院住院治疗的268例泌尿系结石患者作为研究对象,均行FURL治疗,观察患者术后1周内有无全身炎症反应综合征(SIRS)发生以及手术前后血清ET-1、PGE_(2)、PGF_(2α)水平,并采用单因素、多因素和ROC曲线分析FURL患者术后血清ET-1、PGE_(2)、PGF_(2α)水平与SIRS发生的关系。结果:术后1周内,有24例患者出现SIRS,发生率为8.96%,为SIRS组;244例患者未出现SIRS,占比91.04%,为无SIRS组;SIRS组和无SIRS组患者术后血清ET-1、PGE_(2)、PGF_(2α)水平均高于术前(P<0.05);且SIRS组手术前后血清ET-1、PGE_(2)、PGF_(2α)水平差值均高于无SIRS组(P<0.05)。单因素分析结果显示,SIRS组与无SIRS组在性别、合并糖尿病、手术时间、术后ET-1水平、术后PGE_(2)水平、术后PGF_(2α)水平和尿路感染方面存在明显差异(P<0.05);多因素回归分析结果显示,手术时间≥120min、尿路感染、术后ET-1水平≥81.33ng/L、术后PGE_(2)水平≥254.23pg/mL和术后PGF_(2α)水平≥117.56ng/mL是FURL患者发生SIRS的独立预测因素;ROC曲线分析结果显示,血清中ET-1、PGE_(2)、PGF_(2α)水平联合预测SIRS的ROC曲线下面积高于以上三个指标单独预测SIRS的ROC曲线下面积(P<0.05)。结论:FURL患者血清ET-1、PGE_(2)、PGF_(2α)水平在手术后均出现升高,且在并发SIRS患者血清中呈较高表达,血清三项指标联合检测对于临床上预测FURL患者术后有无SIRS的发生具有较好的应用价值。

Objective:To explore the changes and significance of serum endothelin-1(ET-1),prostaglandin E_(2)(PGE_(2))and prostaglandin F_(2α)(PGF_(2α))levels in patients before and after flexible ureteroscopic lithotripsy(FURL).Methods:A total of 268 patients with urinary calculi who were treated in the hospital from February 2017 to December 2019 were enrolled as the research subjects.All patients underwent FURL.The occurrence of systemic inflammatory response syndrome(SIRS)within 1 week after surgery,as well as levels of serum ET-1,PGE_(2)and PGF_(2α)before and after surgery were observed.The relationship between serum ET-1,PGE_(2),PGF_(2α)levels and the occurrence of SIRS was analyzed by univariate,multivariate and ROC curves analysis.Results:Among the 268 patients,there were 24 cases(8.96%)with SIRS(SIRS group)and 244 cases(91.04%)without SIRS(non-SIRS group)within 1 week after surgery.The difference of serum ET-1,PGE_(2),PGF_(2α)before and after operation in SIRS group was higher than that in non-SIRS group(P<0.05).The results of univariate analysis showed that there were significant differences in gender,diabetes,operation time,postoperative levels of serum ET-1,PGE_(2)and PGF_(2α),and urinary tract infection between the two groups(P<0.05).The results of multivariate regression analysis showed that operation time not shorter than 120 min,urinary tract infection,postoperative ET-1 level not lower than 81.33 ng/L,PGE_(2)not lower than 254.23 pg/mL and PGF_(2α)not lower than 117.56 ng/mL were independent predictors of SIRS.The results of ROC curve analysis showed that the area under the ROC curve(AUC)of serum ET-1 combined with PGE_(2)and PGF_(2α)for predicting SIRS was higher than that of them alone(P<0.05).Conclusion:The levels of serum ET-1,PGE_(2)and PGF_(2α)are increased in patients after FURL,which are highly expressed in patients with SIRS.The combined detection of three indexes is of application value in clinically predicting SIRS.