输尿管镜碎石术后血清炎症因子动态变化对尿源性感染的预测价值

Value of dynamic change of serum inflammatory factors in prediction of urinary infection in patients undergoing ureteral lithotripsy

目的探究输尿管镜碎石术后血清炎症因子动态变化对尿源性感染的预测价值。方法回顾性分析2019年1月-2021年5月在绍兴文理学院附属医院行输尿管镜碎石术的608例患者,根据是否发生尿源性感染分为感染组122例和未感染组486例,收集患者临床资料;采集感染组患者尿液进行病原菌分离鉴定;术前1 d、术后24 h和术后3 d,检测患者血清白细胞介素(IL)-6、IL-8、肿瘤坏死因子(TNF-α)水平,降钙素原(PCT)和C-反应蛋白(CRP)水平。受试者工作特征(ROC)曲线分析炎症因子谱的早期预测价值。结果感染组患者白蛋白水平低于未感染组,24 h尿微量白蛋白、血肌酐(Scr)和尿素氮(BUN)水平高于未感染组(P<0.05);感染组感染主要病原菌为大肠埃希菌、铜绿假单胞菌和肺炎克雷伯菌;术前1 d、术后24 h和术后3 d,感染组IL-6、TNF-α、IL-8、CRP和PCT水平均高于未感染组(P<0.05)。术后24 h,两组患者炎症因子水平均较术前升高,术后3 d下降(P<0.05)。IL-6、TNF-α、IL-8、PCT、CRP及联合预测的曲线下面积(AUC)分别为0.810、0.799、0.826、0.820、0.762和0.910。结论临床可以通过炎症因子动态变化对输尿管镜碎石术患者术后尿源性感染并发症进行早期预测。

OBJECTIVE To explore the value of dynamic change of serum inflammatory factors in prediction of urinary infection in patients undergoing ureteral lithotripsy.METHODS A total of 608 patients who underwent ureteral lithotripsy in Affiliated Hospital of Shaoxing University of Arts and Sciences from Jan 2019 to May 2021 were enrolled in the study and were divided into the infection group with 122 cases and the no infection group with 486 cases according to the status of urinary infection.The clinical data were collected from the patients.The urine specimens were collected from the patients,the pathogens were isolated and identified.The levels of interleukin(IL)-6,IL-8,tumor necrosis factor-α(TNF-α),procalcitonin(PCT)and C-reactive protein(CRP)were detected 1 day before the surgery and after the surgery for 24 hours and 3 days.The early prediction values of the serum inflammatory factors were analyzed by means of receiver operating characteristic(ROC)curve.RESULTS The albumin level of the infection group was lower than that of the no infection group;the levels of 24-hour microalbuminuria,serum creatinine(Scr)and urea nitrogen(BUN)of the infection group were higher than those of the no infection group(P<0.05).Escherichia coli,Pseudomonas aeruginosa and Klebsiella pneumoniae were the major species of pathogens isolated from the patients of the infection group.The levels of IL-6,TNF-α,IL-8,CRP and PCT of the infection group were higher than those of the no infection group 1 day before the surgery and after the surgery for 24 hours and 3 days(P<0.05).The levels of serum inflammatory factors of the two groups were elevated after the surgery for 24 hours and were reduced after the surgery for 3 days(P<0.05).The areas under curves(AUCs)of IL-6,TNF-α,IL-8,PCT,CRP and the joint detection were respectively 0.810,0.799,0.826,0.820,0.762 and 0.910.CONCLUSION The dynamic change of inflammatory factors may facilitate the early prediction of postoperative urinary infection in the patients undergoing ureteral lithotripsy.