C-反应蛋白是输尿管结石伴上尿路感染外科引流时机选择的重要影响因素

CRP is an important factor affecting the timing of surgical drainage of ureteral calculi with upper urinary tract infection

目的分析输尿管结石伴感染患者的引流时机。方法回顾性分析2018年1月-2020年1月于上海交通大学医学院附属仁济医院收治的输尿管结石伴感染患者117例,根据治疗方式不同分为手术引流组和非手术引流组。对两组患者的年龄、性别、结石侧别、体温峰值、发病时间、白细胞(WBC)计数、C-反应蛋白(CRP)等各项临床指标进行比较分析。并应用ROC曲线确定引流的最佳临界点。结果患者的年龄、峰值体温、WBC计数和CRP水平是手术引流的影响因素(P<0.05),回归分析发现CRP(P<0.001)、年龄(P=0.003)、WBC计数(P=0.014)是手术引流的独立危险因素。CRP、年龄、白细胞计数的ROC曲线下面积分别为0.923、0.601、0.796。CRP的理想临界点为29.87 mg/L(敏感度为79.4%,特异度为90.0%)。进行多指标结合并通过logistic回归模型生成预测概率后,CRP仍显示出明显的临床预测优势。结论输尿管结石伴感染需及时诊断和治疗,在急诊处置时需积极行抗感染治疗,应根据CRP水平选择是否行外科引流。

Objective To explore the timing of surgical drainage for ureteral calculi with upper urinary tract infection.Methods Clinical data of 117 cases of ureteral calculi with upper urinary tract infection treated in our hospital during Jan.2018 and Jan.2020 were retrospectively analyzed.According to different treatment methods,the patients were divided into surgical drainage group and non-surgical drainage group.The patients age,gender,side of calculi,peak body temperature,time of onset,white blood cell(WBC)count,C-reactive protein(CRP)and other clinical indicators were compared between the two groups.The cutoff value of surgical drainage was determined with receiver operator characteristic(ROC)curve.Results The patients age,peak body temperature,WBC count and CRP level were the influencing factors of surgical drainage(P<0.05).Regression analysis showed that CRP(P<0.001),age(P=0.003)and WBC count(P=0.014)were independent risk factors for surgical drainage.The area under the ROC curve(AUC)of CRP,age,and WBC count were 0.923,0.601,and 0.796,respectively.The cutoff value of CRP was 29.87 mg/L(sensitivity 79.4%,specificity 90.0%).Logistic regression model showed CRP was a significant clinical predictor.Conclusion Ureteral calculi with upper urinary tract infection need to be diagnosed and treated in time.Positive anti-infection should be performed during emergency treatment,and surgical drainage could be selected according to the value of CRP.