血清降钙素原、C反应蛋白/白蛋白比值联合尿白细胞酯酶对复杂性肾结石患者经皮肾镜碎石术后发生尿路感染的预测价值分析

Value of Serum Procalcitonin,C-Reactive Protein/Albumin Ratio Combined with Urinary Leukocyte Esterase in Predicting Urinary Tract Infection after Percutaneous Nephrolithotomy in Patients with Complex Renal Calculi

目的:探讨血清降钙素原(PCT)、C反应蛋白(CRP)/白蛋白(ALB)比值联合尿白细胞酯酶(LEU)对复杂性肾结石患者经皮肾镜碎石术(PCNL)后发生尿路感染的预测价值。方法:选择2015年3月-2021年6月我院收治的128例行PCNL的复杂性肾结石患者作为观察对象,术后定期随访,统计尿路感染情况,根据是否发生术后尿路感染分为尿路感染组和非尿路感染组。比较两组PCT水平、LEU,CRP/ALB比值及其他临床资料。采用多因素Logistic回归分析术后尿路感染的危险因素,绘制受试者工作特征(ROC)曲线,分析PCT、CRP/ALB比值、LEU单独以及联合检测预测术后尿路感染的价值。结果:尿路感染组的血清PCT、CRP/ALB高于非尿路感染组(P<0.05)。尿路感染组的LEU呈阳性,而非尿路感染组的LEU呈阴性。两组在既往泌尿道手术史、手术时间、导尿管留置时间、住院时间、术前尿路感染、结石负荷、使用>3种抗菌药物、合并肾功能障碍、术中通道类型、术前血糖水平方面对比有统计学差异(P<0.05)。既往泌尿道手术史、手术时间≧100 min、导尿管留置时间?7 d、术前尿路感染、结石负荷≧1000 mm^(2)、术前血糖水平高、合并肾功能障碍是复杂性肾结石患者PCNL后发生尿路感染的危险因素(P<0.05)。PCT、CRP/ALB、LEU单独预测PCNL后尿路感染的曲线下面积(AUC)分别为0.712(0.476~0.944)、0.686(0.436~0.931)、0.836(0.753~0.918),三者联合预测PCNL后尿路感染的AUC为0.879(0.785~0.972),均高于PCT、CRP/ALB、LEU单独预测。结论:复杂性肾结石患者PCNL后发生尿路感染的影响因素较多,包括导尿管留置时间、住院时间、结石负荷等,且PCNL后发生尿路感染患者PCT、CRP/ALB比值偏高,LEU呈阳性,三者可能作为PCNL后发生尿路感染的生物标记物。

Objective: To investigate the value of serum procalcitonin(PCT), C-reactive protein(CRP)/albumin(ALB) ratio combined with urinary leukocyte esterase(LEU) in predicting urinary tract infection after percutaneous nephrolithotomy(PCNL) in patients with complex renal calculi. Methods: 128 patients with complex kidney stones who were treated by PCNL in our hospital from March 2015 to June 2021 were selected as the observation object. They were followed up regularly after operation to count the situation of urinary tract infection. They were divided into urinary tract infection group and non urinary tract infection group according to whether postoperative urinary tract infection occurred. PCT level, LEU, CRP/ALB ratio and other clinical data were compared between the two groups. Multivariate Logistic regression was used to analyze the risk factors of postoperative urinary tract infection, draw the receiver operating characteristic(ROC) curve, and analyze the value of PCT, CRP/ALB ratio, LEU alone and combined detection in predicting postoperative urinary tract infection. Results: The serum PCT and CRP/ALB in urinary tract infection group were higher than those in non urinary tract infection group(P<0.05). LEU was positive in the urinary tract infection group, but negative in the non urinary tract infection group. There were significant differences between the two groups in the history of previous urinary tract surgery, operation time,indwelling time of urinary catheter, length of hospital stay, preoperative urinary tract infection, stone load, use of > 3 antibiotics, renal dysfunction, intraoperative channel type and preoperative blood glucose level(P<0.05). Previous urinary tract surgery history, operation time ≥100 min, indwelling time of urinary catheter ≥7 d, preoperative urinary tract infection, stone load ≥1000 mm^(2), high preoperative blood glucose level and renal dysfunction were the risk factors of urinary tract infection after PCNL in patients with complex renal calculi(P<0.05). The area under the curve(AUC) of PCT, CRP/ALB and LEU alone in predicting urinary tract infection after PCNL were 0.712(0.476~0.944), 0.686(0.436~0.931)and 0.836(0.753~0.918)respectively. The AUC of PCT, CRP/ALB and Leu combined in predicting urinary tract infection after PCNL was 0.879(0.785~0.972), which were higher than those predicted by PCT, CRP/ALB and Leu alone. Conclusion There are many influencing factors of urinary tract infection in patients with complex renal calculi after PCNL,including indwelling time of urinary catheter, length of hospital stay, stone load, etc. in patients with urinary tract infection after PCNL,the ratio of PCT and CRP/ALB is high, and LEU is positive. These three may be used as biomarkers of urinary tract infection after PCNL.