输尿管镜碎石术后尿路感染病原学特征及与血清eNOS、Ghrelin水平关系分析

Analysis of the pathogenic characteristics of urinary tract infections after ureteroscopic lithotripsy and their relationship with serum eNOS and Ghrelin levels

目的探究输尿管结石患者血清内皮型一氧化氮合酶(eNOS)、生长激素释放肽(Ghrelin)水平与输尿管镜碎石术后尿路感染的关系及病原学分析。方法选取2020年5月-2023年4月在本院收治的80例输尿管结石患者作为研究对象,根据输尿管结石患者输尿管镜碎石术后是否发生尿路感染,分为感染组(60例)和未感染组(20例),选取同期在我院收治普通泌尿系统疾病的80例患者为对照组,普通泌尿系感染(58例)未感染(22例),并收集尿路感染患者中段尿液进行病原学分析,比较各组血清eNOS、Ghrelin水平。分析尿路感染患者病原学及构成比。受试者工作特征(ROC)曲线分析血清eNOS、Ghrelin水平预测输尿管结石患者输尿管镜碎石术后尿路感染的诊断价值。多因素Logistic回归分析影响输尿管结石患者输尿管镜碎石术后尿路感染的因素。结果尿路感染患者血清eNOS、Ghrelin水平比未感染患者高,差异有统计学意义(P<0.05)。结石组患者血清eNOS、Ghrelin水平比对照组高,差异有统计学意义(P<0.05)。尿路感染患者结石直径比未感染患者大,差异有统计学意义(P<0.05)。培养出20株病原菌,其中革兰阴性菌16株(80%),革兰阳性菌4株(20%)。ROC曲线分析显示,血清eNOS、Ghrelin水平评估输尿管结石患者输尿管镜碎石术后尿路感染的曲线下面积(AUC)分别是0.817(95%CI:0.711~0.923)、0.823(95%CI:0.716~0.929),二者联合检测的AUC为0.916(95%CI:0.857~0.975)。Logistic分析显示,eNOS、Ghrelin是输尿管结石患者输尿管镜碎石术后发生尿路感染的影响因素(P<0.05)。结论输尿管镜碎石术后尿路感染患者血清eNOS、Ghrelin水平升高,二者联合对评估输尿管结石患者输尿管镜碎石术后尿路感染有一定的预测价值。

Objective To investigate the relationship between the levels of serum endothelial nitric oxide synthase(eNOS)and growth hormone releasing peptide(Ghrelin)and urinary tract infection after ureteroscopic lithotripsy in patients with ureteral calculi,and to analyze the etiology.Methods Eighty patients with ureteral calculi admitted to our hospital from May 2020to April 2023were selected as the research objects.According to whether urinary tract infection occurred after ureteroscopic lithotripsy in patients with ureteral calculi,they were divided into infection group(60cases)and noninfection group(20cases).Another 80patients with common urinary system diseases admitted to our hospital during the same period were selected as the control group,including 58patients with common urinary system infections and 22patients without infections.the middle urine of patients with concurrent urinary tract infection was collected for pathogenic analysis,and the levels of eNOS and Ghrelin in serum were compared among each group.The etiology and composition of patients with urinary tract infections were analyzed.Receiver operating characteristic(ROC)curve was applied to analyze the diagnostic value of serum eNOS and Ghrelin levels in predicting urinary tract infections after ureteroscopic lithotripsy in patients with ureteral stones.Multivariate logistic regression was applied to analyze the factors affecting urinary tract infections in patients with ureteral stones after ureteroscopic lithotripsy.Results The serum levels of eNOS and Ghrelin in patients with urinary tract infection were higher than those in non infection patients(P<0.05).The serum levels of eNOS and Ghrelin in ureteral calculi group were higher than those in control group(P<0.05).The diameter of stones in patients with urinary tract infection was larger than patients withnon infection(P<0.05).A total of 20strains of pathogenic bacteria were cultured,including 16strains of Gram negative bacteria(80%)and 4strains of Gram positive bacteria(20%).ROC curve analysis showed that the area under the curve(AUC)of serum eNOS and Ghrelin levels in evaluating urinary tract infection in patients with ureteral calculi after ureteroscopic lithotripsy was 0.817(95%CI:0.711-0.923)and 0.823(95%CI:0.716-0.929),respectively,the AUC of the combined detection of the two was 0.916(95%CI:0.857-0.975).Logistic analysis showed that eNOS and Ghrelin were influencing factors for urinary tract infections in patients with ureteral stones after ureteroscopic lithotripsy(P<0.05).Conclusion The serum levels of eNOS and Ghrelin increase in patients with urinary tract infection after ureteroscopic lithotripsy,and the combination of the two has certain predictive value for evaluating urinary tract infection in patients with ureteroscopic lithotripsy.