外周血单个核细胞TLR2 mRNA和TLR4 mRNA对泌尿系结石患者术后并发尿源性脓毒血症的诊断效能

Diagnostic efficacy of TLR2 mRNA and TLR4 mRNA in peripheral blood mononuclear cells in patients with urinary calculi complicated by postoperative urosepsis

目的探讨外周血单个核细胞Toll样受体(TLR)2 mRNA和TLR4 mRNA诊断泌尿系结石患者术后并发尿源性脓毒血症的效能。方法选取2019年1月至2021年4月延安大学咸阳医院收治的59例泌尿系结石术后并发尿源性脓毒血症患者(观察组)、59例泌尿系结石术后单纯泌尿系感染患者(对照B组)、59例泌尿系结石术后无泌尿系感染患者(对照A组)进行前瞻性研究。比较三组患者的经典炎症标志物[血清降钙素原(PCT)、C-反应蛋白(CRP)、白细胞(WBC)]和TLR2 mRNA、TLR4 mRNA水平,采用Spearman相关法分析TLR2 mRNA、TLR4 mRNA与经典炎症标志物的相关性,采用多因素Logistic回归分析泌尿系结石术后并发尿源性脓毒血症的影响因素,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析TLR2 mRNA、TLR4 mRNA诊断术后并发尿源性脓毒血症的效能,并比较观察组不同病情(普通尿源性脓毒血症、严重尿源性脓毒血症、感染性休克)患者PCT、CRP、WBC、TLR2 mRNA、TLR4 mRNA表达水平。结果观察组患者的PCT、CRP、WBC、TLR2 mRNA、TLR4 mRNA明显高于对照B组、对照A组,且对照B组高于对照A组,差异均有统计学意义(P<0.05);经Spearman分析结果显示,TLR2 mRNA、TLR4 mRNA与PCT、CRP、WBC呈正相关(P<0.05);多因素Logistic回归分析结果显示,PCT、CRP、WBC、TLR2 mRNA、TLR4 mRNA均是并发尿源性脓毒血症的相关影响因素(P<0.05);经ROC分析结果显示,TLR4 mRNA、TLR2 mRNA诊断并发尿源性脓毒血症的AUC均>0.8,分别为0.838(95%CI:0.759~0.900)、0.829(95%CI:0.748~0.892);感染性休克患者的PCT、CRP、WBC、TLR2 mRNA、TLR4 mRNA分别为(10.69±1.35)μg/L、(55.03±11.82)mg/L、(18.94±4.38)×109/L、10.46±1.57、7.63±1.15,明显高于严重尿源性脓毒血症患者[(6.15±1.22)μg/L、(38.22±8.64)mg/L、(14.82±3.25)×109/L、5.76±1.18、4.26±1.05]和普通尿源性脓毒血症患者[(3.64±1.03)μg/L、(25.14±4.84)mg/L、(12.01±2.76)×109/L、3.59±1.03、2.11±0.98],且严重尿源性脓毒血症患者高于普通尿源性脓毒血症患者,差异均有统计学意义(P<0.05)。结论泌尿系结石术后并发尿源性脓毒血症患者存在TLR2 mRNA、TLR4 mRNA升高现象,早期检测上述指标可为临床诊断、病情程度评估提供循证指导。

Objective To investigate the efficacy of Toll-like receptor(TLR)2 mRNA and TLR4 mRNA peripheral blood mononuclear cells in the diagnosis of postoperative urosepsis in patients with urinary calculi.Methods Fifty-nine patients of urinary tract calculi complicated with postoperative urosepsis(observation group),59 patients complicated with simple urinary tract infection(control group B),and 59 patients without urinary tract infection after urolithiasis(control group A)from Xianyang Hospital of Yan'an University between January 2019 and April 2021 were selected and prospectively studied.The classical inflammatory markers[serum procalcitonin(PCT),C-reactive protein(CRP),white blood cells(WBC)],TLR2 mRNA,TLR4 mRNA levels of the three groups were compared.Spearman correlation method was used to analyze the correlation between TLR2 mRNA,TLR4 mRNA and classical inflammatory markers.Multivariate logistic regression analysis was used to analyze the influencing factors of postoperative urosepsis after urinary calculi surgery.Receiver operating characteristic curve(ROC)and area under the curve(AUC)were used to analyze the efficacy of TLR2 mRNA and TLR4 mRNA in diagnosing postoperative urosepsis.The expression levels of PCT,CRP,WBC,TLR2 mRNA,and TLR4 mRNA were compared among patients with different conditions(common urinary sepsis,severe urinary sepsis,septic shock)in the observation group.Results The levels of PCT,CRP,WBC,TLR2 mRNA,and TLR4 mRNA in the observation group were significantly higher than those in the control group B and A,and the levels in control group B were higher than those in control group A,with statistically significant differences(P<0.05).Spearman analysis showed that TLR2 mRNA and TLR4 mRNA were positively correlated with PCT,CRP,and WBC(P<0.05).The results of multivariate logistic regression analysis showed that PCT,CRP,WBC,TLR2 mRNA,and TLR4 mRNA were all related influencing factors of postoperative urosepsis(P<0.05).The results of ROC analysis showed that the AUCs of TLR4 mRNA and TLR2 mRNA in the diagnosis of postoperative urosepsis were all>0.8,which were 0.838(95%CI:0.759-0.900)and 0.829(95%CI:0.748-0.892),respectively.The levels of PCT,CRP,WBC,TLR2 mRNA,and TLR4 mRNA in patients with septic shock were(10.69±1.35)μg/L,(55.03±11.82)mg/L,(18.94±4.38)×109/L,10.46±1.57,7.63±1.15,which were significantly higher than(6.15±1.22)μg/L,(38.22±8.64)mg/L,(14.82±3.25)×109/L,5.76±1.18,4.26±1.05 in patients with severe urinary sepsis and(3.64±1.03)μg/L,(25.14±4.84)mg/L,(12.01±2.76)×109/L,3.59±1.03,2.11±0.98 in patients with common urinary sepsis patients,and the level in patients with severe urinary sepsis were higher than those in patients with common urinary sepsis,with statistically significant differences(P<0.05).Conclusion TLR2 mRNA and TLR4 mRNA are elevated in patients with urinary calculi complicated by postoperative urosepsis.Early detection of these indicators can provide evidence-based guidance for clinical diagnosis and disease severity assessment.