肾结石患者术后感染的病原菌分布特征及感染的影响因素

Distribution characteristics of pathogens and influencing factors of postoperative infection in patients with kidney stones

目的 分析肾结石患者术后感染的病原菌分布特征及其免疫功能失衡与感染发生的关系。方法 本院2017年1月-2020年12月收治的行PCNL术治疗的肾结石患者386例,依照泌尿系统感染情况分为感染组和未感染组。收集感染组患者的临床标本进行细菌的分离鉴定;采集受试者静脉血,采用ELISA检测血清IL-8、TNF-α水平,采用流式细胞仪检测CD4^(+)、CD8^(+)百分率(%)及CD4^(+)/CD8^(+)值;采用Logistics多元回归模型分析肾结石患者术后感染的影响因素。结果 感染组患者感染的病原菌以革兰阴性菌占比较高,为64.56%,其中以大肠埃希菌多见;感染组和未感染组患者住院时间、糖尿病例数、年龄构成、手术时间和导管留置时间差异均有统计学意义(均P<0.01);感染组患者血IL-8、TNF-α水平和CD4^(+)、CD8^(+)百分率均显著高于未感染组,CD4^(+)/CD8^(+)值显著低于未感染组(均P<0.01)。Logistics回归分析显示,年龄、合并糖尿病、住院时间、留置导管时间、IL-8、TNF-α水平及CD4^(+)百分率均是肾结石患者术后感染发生的独立危险因素(均P<0.01)。结论 肾结石患者术后感染病原菌以革兰阴性菌占比较高,以大肠埃希菌较常见。年龄、合并糖尿病、住院时间、留置导管时间、IL-8、TNF-α水平及CD4^(+)百分率是肾结石患者术后感染发生的独立危险因素,可供临床诊治参考。

Objective To analyze the distribution characteristics of pathogenic bacteria of postoperative infection in patients with kidney stones and the relationship between imbalance of immune function and the occurrence of infection.Methods From January 2017 to December 2020,386 patients with kidney stones who underwent PCNL surgery were treated in our hospital.They were divided into the infected group and the non-infected group according to the urinary system infection.The clinical specimens of patients in the infection group were collected and the bacteria were isolated and identified;The venous blood of the subjects was collected and the serum IL-8 and TNF-α were detected by ELISA.The percentages of CD4^(+) and CD8^(+),and the CD4^(+)/CD8^(+) value were detected by flow cytometry.The logistics multiple regression model was used to analyze the influencing factors of postoperative infection in patients with kidney stones.Results Gram-negative bacteria accounted for 64.56% of the pathogenic bacteria in the infection group.Among them Escherichia coli was more common.The difference in hospitalization time,number of diabetes cases,age composition,operation time and catheter indwelling time between the infected group and the uninfected group was statistically significant(all P<0.01).The serum levels of IL-8,TNF-α and the percentages of CD4^(+) and CD8^(+) in the infected group were significantly higher than those in the uninfected group,and the CD4^(+)/CD8^(+) value in the infected group was significantly lower than that in the uninfected group(all P<0.01).The logistics regression analysis showed that age composition,complication of diabetes mellitus,length of hospitalization time,catheter indwelling time,IL-8,TNF-α levels,and CD4^(+) percentage were all independent risk factors for postoperative infection in patients with kidney stones(all P<0.01).Conclusion Gram-negative bacteria account for a high proportion of postoperative infection pathogens in patients with kidney stones,and Escherichia coli is more common.Age composition,complication of diabetes mellitus,length of hospitalization time,catheter indwelling time,IL-8 and TNF-α levels,and CD4^(+) percentage are independent risk factors for postoperative infection in patients with kidney stones,which can be used as a reference for clinical diagnosis and treatment.