经皮肾镜取石术后2h检测IL-6在尿源性脓毒症诊治和改善预后中的价值

The value of IL-6 in the diagnosis,treatment and prognostic improvement of urosepsis at 2 hours after percutaneous nephrolithotomy

目的探讨经皮肾镜取石术后2 h检测白细胞介素-6(IL-6)在尿源性脓毒症早期诊断、治疗和改善预后中的价值。方法回顾性分析2019年1月至2021年6月山东第一医科大学附属省立医院收治的25例经皮肾镜取石术后发生尿源性脓毒症患者的病例资料,男6例,女19例。年龄(55.4±11.6)岁。伴高血压病10例,糖尿病11例,肾积水14例。结石负荷>353 mm28例。术前脓尿22例,尿亚硝酸盐阳性12例,尿细菌培养阳性18例。根据术后2 h是否检测IL-6将患者分为试验组和对照组。试验组以术后2 h IL-6>1000 pg/ml作为诊断尿源性脓毒症标准,指导术后的抗感染治疗。比较两组的手术时间、术后脓毒症确诊时间、尿源性脓毒症严重程度(严重脓毒症和感染性休克例数)、术后住院时间。结果试验组13例,男4例,女9例;年龄(52.4±12.2)岁;伴高血压病6例,糖尿病5例,肾积水9例;结石负荷>353 mm25例;术前脓尿12例,尿亚硝酸盐阳性7例,尿细菌培养阳性10例。对照组12例,男2例,女10例;年龄(58.7±10.5)岁;伴高血压病4例,糖尿病6例,肾积水5例;结石负荷>353 mm23例;术前脓尿10例,亚硝酸盐阳性5例,尿细菌培养阳性8例。两组一般资料比较差异均无统计学意义(P>0.05)。试验组和对照组的手术时间分别为(100.8±27.8)min和(88.3±39.3)min,差异无统计学意义(P=0.645)。试验组术后2 h IL-6为(6824.4±1473.3)pg/ml。试验组和对照组术后脓毒症确诊时间分别为(3.6±2.0)h和(6.0±3.0)h(P=0.023),术后住院时间分别为(6.1±1.6)d和(8.2±2.3)d(P=0.014),严重脓毒症和感染性休克患者分别为3例和8例(P=0.047),差异均有统计学意义。结论通过检测经皮肾镜取石术后2 h内IL-6可早期诊断尿源性脓毒症,降低术后尿源性脓毒症的严重程度,缩短术后住院时间,改善患者预后。

Objective To explore the value of IL-6 in the diagnosis,treatment and improving prognosis of urosepsis at 2 hours after percutaneous nephrolithotomy.Methods Twenty-five patients with urosepsis undergoing percutaneous nephrolithotomy in the Shandong Provincial Hospital Affiliated to Shandong First Medical University from January 2019 to June 2021 were analyzed retrospectively,including 6 males and 19 females,aged(55.4±11.6)years,and there were 10 cases with hypertension,11 cases with diabetes and 14 cases with hydronephrosis.There were 10 cases with Stone volume>353mm2,22 cases with pyuria,12 cases with positive nitrite and 18 cases with positive urine culture before operation.Among them,13 patients were classified into experimental group with the test of IL-6 at 2 hours after operation and 12 patients were classified into control group without the test of IL-6 at 2 hours after operation.IL-6>1000 pg/ml at 2 hours after operation as the standard for diagnosis of urosepsis was used to guide the anti-infective treatment after percutaneous nephrolithotomy.The operation time,severity of urinary sepsis(severe sepsis and septic shock),diagnostic time of urosepsis after operation,and hospital stay after operation were compared between the two groups.Results There were 13 patients including 9 females with average age of(52.4±12.2)years in the experimental group,and there were 6 cases with hypertension,5 cases with diabetes and 9 cases with hydronephrosis,5 cases with stone volume>353mm2,12 cases with pyuria,7 cases with positive nitrite and 10 cases with positive urine culture before operation.There were 12 patients including 10 females with average age of(58.7±10.5)years in the control group,and there were 4 cases with hypertension,6 cases with diabetes,5 cases with hydronephrosis,3 cases with stone volume>353mm2,10 cases with pyuria,5 cases with positive nitrite,and 8 cases with positive urine culture before operation.There was no significant difference between the two groups in terms of gender(P=0.645),average age(P=0.182),hypertension(P=0.688),diabetes(P=0.695),hydronephrosis(P=0.238),stone volume>353 mm2(P=0.673),pyuria(P=0.593),positive nitrite(P=0.695),and positive urine culture(P=0.673).There was not significant difference in the general clinical data of gender,age,hypertension,diabetes,stone burden,hydronephrosis,pyuria,positive nitrite and positive urine culture between the two groups(P>0.05).The mean value of IL-6 in the test group was(6824.4±1473.3)pg/ml.The operative time of the experimental group with(100.8±27.8)minutes was longer than that of the control group with(88.3±39.3)minutes,but the difference between the two groups was not statistically significant(P=0.645).The diagnostic time of urosepsis after operation in the test group with(3.6±2.0)hours was shorter than that in the control group with(6.0±3.0)hours,and the difference between the two groups was statistically significant(P=0.023).The postoperative hospital stay in the test group with(6.1±1.6)days was shorter than that in the control group with(8.2±2.3)days,and the difference between the two groups was statistically significant(P=0.014).Three patients with severe sepsis and septic shock in the test group,which were less than that of eight patients with severe sepsis and septic shock in the control group,and the difference between the two groups was statistically significant(P=0.047).Conclusion The detection of IL-6 at 2 hours after percutaneous nephrolithotomy can early diagnose urosepsis,reduce the severity of postoperative urosepsis,shorten the postoperative hospital stay,and improve the prognosis.