输尿管硬镜碎石术后留置输尿管支架管致尿源性感染发生的多因素回顾性分析

Risk factors for urinary infection in patients with ureteral stents after ureteroscopic lithotripsy

目的探索输尿管硬镜碎石术后留置输尿管支架管患者尿源性感染发生的主要危险因素。方法收集2018年7月—2019年12月在同济大学附属上海市第十人民医院接受输尿管硬镜碎石术、术后留置输尿管支架管二次入院取管时尿检白细胞阳性的患者共158例,根据取管后转归情况及尿培养结果分为导管相关性白细胞组和尿源性感染组。回顾性分析尿源性感染发生的相关危险因素并进行Logistic分析,通过构建受试者工作曲线并计算曲线下面积评价危险因素的预测能力。结果尿源性感染组患者女性所占比例(51.5%)、带管平均时间(48.94±22.39)d、尿白细胞酯酶、中性粒细胞-淋巴细胞比值(3.58%±1.74%)均显著高于导管相关性白细胞组;血红细胞[(3.90±0.36)×10^(12)/L]、血红蛋白[(118.73±10.82)g/L]、红细胞比积(35.93%±6.77%)、淋巴细胞[(1.57±0.63)×10^(9)/L],显著低于导管相关性白细胞组,差异具有统计学意义(P<0.05)。Logistic回归分析显示,NLR、尿白细胞酯酶和带管时间是输尿管支架管置入术后尿源性感染发生的独立危险因素。结论中性粒细胞-淋巴细胞比值、尿白细胞酯酶和带管时间和是输尿管硬镜碎石术后留置输尿管支架患者尿源性感染发生的独立危险因素,可作为预测尿源性感染发生的新型指标。

Objective To explore the risk factors of urinary infection in patients with ureteral stents after ureteroscopic lithotripsy.Methods Patients with ureteral stents after ureteroscopic lithotripsy were admitted in our institution for removal of ureteral stents between July 2018 and December 2019.Before stent removal the urinary leukocytes(WBC)were detected in 158 patients,according to urine culture results and the change in urine WBC after removing the ureteral stents,33 cases(16 males and 17 females)were confirmed as urinary tract infection and 125 cases(94 males and 31 females)were confirmed as stent-related WBC.The risk factors of urinary infection were analyzed with multivariate logistic regression.Results In urinary infection group,the proportion of female(51.5%),duration of stent placement[(48.94±22.39)days],urinary leukocyte esterase and NLR(neutrophil-lymphocyte ratio)(3.58%±1.74%)were higher than those in stent-related WBC group;while the red blood cells[(3.90±0.36)×10^(12)/L)],hemoglobin[(118.73±10.82)g/L],hematocrit(35.93%±6.77%)and lymphocyte[(1.57±0.63)×10^(9)/L]in urinary infection group were lower than those in stent-related leukocyte group(all P<0.05).Multivariate logistic regression analysis revealed that urinary leukocyte esterase,duration of stent placement and NLR were independent predictors of urinary infection in patients with ureteral stent.Conclusion The elevated urinary leukocyte esterase,the longer duration of stent placement and the increased NLR aree independent risk factors of urinary infection in patients with ureteral stent after ureteroscopic lithotripsy.