血清β2-MG、ACTH及降钙素原水平预测肾结石患者ESWL术后肾损伤的价值

Value of serumβ2-MG,ACTH and procalcitonin levels in predicting renal injury after ESWL in patients with renal calculi

目的探讨血清β2微球蛋白(β2-MG)、促肾上腺皮质激素(ACTH)及降钙素原水平预测肾结石患者体外冲击波碎石术(ESWL)后肾损伤的价值。方法前瞻性选取2021年6月至2023年6月青岛市第五人民医院收治的100例肾结石患者作为研究对象。患者均行ESWL,对患者进行术后7 d随访,根据是否发生肾损伤分为发生组(n=8)与未发生组(n=92)。收集患者基线资料,包括性别、年龄、体重指数、肾损伤史、吸烟、饮酒、结石直径、结石位置、结石数量、手术时间,检测实验室指标(甘油三酯、总胆固醇、β2-MG、ATCH、皮质醇、降钙素原)。比较两组基线资料及实验室指标;采用非条件Logistic逐步回归分析肾结石患者ESWL术后发生肾损伤的危险因素;通过受试者操作特征(ROC)曲线分析β2-MG、ACTH、皮质醇、降钙素原预测肾结石患者ESWL术后肾损伤的价值。结果两组性别构成比、年龄、体重指数、肾损伤史、吸烟、饮酒、结石直径、结石位置、结石数量、手术时间、甘油三酯、总胆固醇组间比较,差异均无统计学意义(P>0.05);发生组β2-MG、ACTH、皮质醇、降钙素原水平分别为(3.45±0.89)mg/L、(36.29±6.08)ng/L、(139.06±19.74)μg/L、(2.92±0.95)ng/mL,均显著高于未发生组[(2.31±0.72)mg/L、(26.71±5.02)ng/L、(121.15±16.93)μg/L、(1.48±0.41)ng/mL],差异均有统计学意义(P<0.05)。多因素Logistic回归分析结果显示,β2-MG、ACTH、皮质醇、降钙素原是肾结石患者ESWL术后发生肾损伤的危险因素(P<0.05)。ROC曲线分析结果显示,β2-MG、ACTH、皮质醇、降钙素原预测肾结石患者ESWL术后肾损伤发生的曲线下面积分别为0.819、0.933、0.834、0.838,敏感度分别为0.875、0.875、0.750、0.750,且P<0.05。结论肾结石ESWL术后发生肾损伤的患者β2-MG、ACTH、皮质醇、降钙素原水平显著上升,以上指标可用于预测肾结石患者ESWL术后发生肾损伤。

Objective To investigate the value of serumβ2 microglobulin(β2-MG),adrenocorticotropin(ACTH)and procalcitonin levels in predicting renal injury after extracorporeal shock wave lithotripsis(ESWL)in patients with renal calculi.Methods A total of 100 patients with renal calculi admitted to Qingdao Fifth People's Hospital from June 2021 to June 2023 were prospectively selected as the study object.All patients underwent ESWL and were followed up 7 days after surgery.According to whether kidney injury occurred,the patients were divided into the occurrence group(n=8)and the non-occurrence group(n=92).Baseline data were collected,including gender,age,body mass index,kidney injury history,smoking,alcohol consumption,stone diameter,stone location,stone number,operation time,and laboratory parameters(triglyceride,total cholesterol,β2-MG,ATCH,cortisol,and procalcitonin)were detected.Baseline data and laboratory indicators were compared between the two groups.The risk factors of kidney injury after ESWL in patients with renal calculi were analyzed by unconditional Logistic stepby-step regression.The value ofβ2-MG,ACTH,cortisol and procalcitonin in predicting renal injury in patients with renal calculi after ESWL was analyzed using receiver operating characteristic(ROC)curve.Results There were no statistically significant differences in gender ratio,age,BMI,history of kidney injury,smoking,drinking,stone diameter,stone location,stone number,operation time,triglyceride and total cholesterol between the two groups(P>0.05).The levels ofβ2-MG,ACTH,cortisol and procalcitonin in the occurrence group were(3.45±0.89)mg/L,(36.29±6.08)ng/L,(139.06±19.74)μg/L,(2.92±0.95)ng/mL,respectively,which were significantly higher than those in the non-occurrence group[(2.31±0.72)mg/L,(26.71±5.02)ng/L,(121.15±16.93)μg/L,(1.48±0.41)ng/mL],and the differences were statistically significant(P<0.05).Multivariate Logistic regression analysis showed thatβ2-MG,ACTH,cortisol and procalcitonin were the risk factors for renal injury in patients with renal calculi after ESWL(P<0.05).ROC curve analysis showed that the area under the curve ofβ2-MG,ACTH,cortisol and procalcitonin in predicting the occurrence of kidney injury after ESWL in renal calculi patients was 0.819,0.933,0.834 and 0.838,and the sensitivity was 0.875,0.875,0.750 and 0.750,respectively,and P<0.05.Conclusion The levels ofβ2-MG,ACTH,cortisol and procalcitonin in patients with renal injury after ESWL for kidney stones are significantly increased,and the above indicators can be used to predict renal injury in patients with renal stones after ESWL.