前列腺增生伴尿路感染患者病原菌分布血清降钙素原尿白细胞酯酶及红细胞形态变化的临床意义

Changes and significance of serum procalcitonin,urinary leukocyte esterase and erythrocyte morphology in patients with benign prostatic hyperplasia and urinary tract infection

目的探讨前列腺增生(BPH)伴尿路感染患者病原菌分布情况和血清降钙素原(PCT)、尿白细胞酯酶(LEU)及红细胞形态变化及意义。方法选取2021年6月至2022年12月在江西省于都县中医院收治的BPH患者90例作为BPH组,根据尿细菌培养是否伴有尿路感染将其分为感染组(26例)和未感染组(64例);另同期选取健康体检人员90名作为对照组。分析感染组患者病原菌分布情况。比较各组血清PCT和红细胞形态相关指标[红细胞刚性指数(IR)、红细胞变形指数(DI)]水平,采用受试者工作特征曲线分析上述指标对BPH伴尿路感染的诊断效能;检测尿LEU,以尿细菌培养的尿路感染为金标准,采用Kappa一致性分析尿LEU对尿路感染的诊断效能。结果26例尿路感染患者共检出病原菌48株,其中革兰阴性菌占56%(27/48),以大肠埃希菌和肺炎克雷伯菌为主,革兰阳性菌占35%(17/48),以屎肠球菌和表皮葡萄球菌为主,真菌占8%(4/48),且有11例患者同时合并2种细菌感染。感染组、未感染组患者血清PCT水平分别为(3.95±0.78)ng/ml、(1.34±0.35)ng/ml,高于对照组(0.26±0.06)ng/ml,IR、DI水平分别为(1.90±0.48)、(3.63±0.72)、(0.31±0.08)、(0.47±0.12),均低于对照组(5.29±1.24)、(0.61±0.17)(P<0.05),且相较于未感染组,感染组患者血清PCT水平更高,IR和DI水平更低(P<0.05)。血清PCT、IR和DI水平诊断BPH伴尿路感染的曲线下面积分别为0.780、0.767和0.781(P均<0.05)。尿LEU阳性(感染)19例,其诊断BPH伴尿路感染的敏感度、特异度、准确率、阳性预测值、阴性预测值和Kappa值分别为73.08%、92.19%、86.67%、79.17%、89.39%和0.668。结论BPH伴尿路感染患者的主要致病菌为革兰阴性菌,血清PCT水平呈异常升高,IR和DI水平呈异常降低,尿LEU呈阳性,临床可通过检测血清PCT、尿LEU、IR和DI水平来辅助诊断BPH伴尿路感染。

Objective To investigate the distribution of pathogenic bacteria and the changes and significance of serum calcitonin(PCT),urinary leukocyte esterase(LEU)and erythrocyte morphology in patients with benign prostatic hyperplasia(BPH)and urinary tract infection.Methods Ninety BPH patients admitted to Yudu County Traditional Chinese Medicine Hospital from June 2021 to December 2022 were selected as the BPH group,and they were divided into an infected group(n=26)and an uninfected group(n=64)based on whether they were accompanied by urinary tract infections,and 90 health examination personnel were randomly selected during the same period as the control group.The distribution of pathogenic bacteria among patients in the infection group were analyzed.Comparing the levels of serum PCT and erythrocyte morphology related indicators[index of rigidity(IR),deformability index(DI)]in each group,and analyzing the diagnostic efficacy of the above indicators for BPH with urinary tract infection using the receiver operating characteristic(ROC)curve.The urinary LEU levels was detected,and urinary tract infections cultured with urinary bacteria was taken as the gold standard,and the diagnostic efficacy of urinary LEU on urinary tract infection was analyzed using the Kappa concordance.Results A total of 48 strains of pathogenic bacteria were detected in 26 patients with urinary tract infection,of which 56%were Gram negative bacteria,with mainly Escherichia coli and Klebsiella pneumoniae,35%were Gram positive bacteria,with mainly Enterococcus and Staphylococcus epidermidis,and 8%were fungi,and there were 11 patients with a combination of 2 bacterial infections at the same time.The serum PCT levels of patients in the infected and uninfected groups were significantly higher than those in the control group,and the levels of IR and DI were significantly lower than the control group(P<0.05).Moreover,compared to the uninfected group,the patients in the infected group had higher serum PCT levels and lower IR and DI levels(P<0.05).The AUC of BPH with urinary tract infection diagnosed by serum PCT,IR,and DI levels were 0.780,0.767,and 0.781,respectively(P<0.05).Nineteen cases were positive for urinary LEU,with sensitivity,specificity,accuracy,positive predictive value,negative predictive value,and Kappa value of 73.08%、92.19%、86.67%、79.17%、89.39%and 0.668,respectively.Conclusion The main pathogenic bacteria in patients with BPH accompanied by urinary tract infection are Gram negative bacteria,with abnormally high serum PCT levels,abnormally low IR and DI levels,and positive urine LEU.Clinical diagnosis of BPH accompanied by urinary tract infection can be assisted by detecting serum PCT,urine LEU,IR and DI levels.