文章摘要
张志刚,侯皓中,郑 亮,贾 磊,张龙龙.内毒素、PCT联合NLR对经皮肾镜碎石术后患者尿源性脓毒血症的预测价值[J].,2023,(24):4781-4785
内毒素、PCT联合NLR对经皮肾镜碎石术后患者尿源性脓毒血症的预测价值
Predictive Value of Endotoxin, PCT Combined with NLR for Urinary Sepsis in Patients after Percutaneous Nephrolithotomy
投稿时间:2023-07-08  修订日期:2023-07-31
DOI:10.13241/j.cnki.pmb.2023.24.036
中文关键词: 经皮肾镜碎石术  尿源性脓毒血症  内毒素  PCT  NLR  影响因素  预测价值
英文关键词: Percutaneous nephrolithotomy  Urinary sepsis  Endotoxin  PCT  NLR  Influencing factors  Predictive value
基金项目:陕西省创新能力支撑计划项目(S2020-ZC-PT-0036)
作者单位E-mail
张志刚 西安医学院第二附属医院泌尿外科 陕西 西安 710038 shitou202301@163.com 
侯皓中 空军军医大学第一附属医院泌尿外科 陕西 西安 710032  
郑 亮 西安医学院第二附属医院泌尿外科 陕西 西安 710038  
贾 磊 西安医学院第二附属医院泌尿外科 陕西 西安 710038  
张龙龙 空军军医大学第一附属医院泌尿外科 陕西 西安 710032  
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中文摘要:
      摘要 目的:探讨内毒素、降钙素原(PCT)联合中性粒细胞与淋巴细胞比值(NLR)对经皮肾镜碎石术(PCNL)术后患者发生尿源性脓毒血症的预测价值。方法:选取2020年5月-2023年5月于西安医学院第二附属医院和空军军医大学第一附属医院泌尿外科行PCNL的患者750例作为研究对象。根据尿源性脓毒症发生情况分为尿源性脓毒血症组(n=45)和非脓毒血症组(n=705)。检测PCNL术前血清内毒素、PCT、中性粒细胞与淋巴细胞水平,并计算NLR。对比两组血清内毒素、PCT水平及NLR。采用多因素Logistic回归模型分析PCNL术后患者发生尿源性脓毒血症的影响因素。绘制受试者工作特征(ROC)曲线分析血清内毒素、PCT联合NLR预测PCNL术后患者发生尿源性脓毒血症的临床效能。结果:与非脓毒血症组相比,尿源性脓毒血症组血清内毒素、PCT及NLR更高(P<0.05)。多因素Logistic回归模型分析结果显示,血清内毒素升高、PCT升高、NLR升高、尿白细胞阳性、术前发热及鹿角型结石是PCNL术后患者发生尿源性脓毒血症的独立危险因素(P<0.05);ROC曲线分析结果显示,血清内毒素、PCT联合NLR检测预测PCNL术后患者发生尿源性脓毒血症的曲线下面积(AUC)为0.913,高于上述各指标单独检测。结论:PCNL术前血清内毒素、PCT和NLR升高可能与术后患者发生尿源性脓毒血症有关。血清内毒素、PCT水平升高、NLR升高、术前发热、尿白细胞阳性、鹿角型结石是PCNL术后患者发生尿源性脓毒血症的危险因素。血清内毒素、PCT联合NLR检测对PCNL术后患者发生尿源性脓毒血症具有较高预测价值。
英文摘要:
      ABSTRACT Objective: To investigate the predictive value of endotoxin (Endotoxin), procalcitonin (PCT) combined with neutrophil to lymphocyte ratio (NLR) in predicting urinary sepsis in patients after percutaneous nephrolithotomy (PCNL). Methods: 750 patients who underwent PCNL in the Department of Urology Surgery, The Second Affiliated Hospital of Xi'an Medical College and The First Affiliated Hospital of Air Force Military Medical University from May 2020 to May 2023 were selected as study subjects. Patients were divided into urinary sepsis group(n=45) and non sepsis group(n=705) according to the occurrence of urinary sepsis. The levels of serum Endotoxin, PCT, neutrophils and lymphocytes before PCNL were detected, and NLR was calculated. Serum Endotoxin, PCT levels and NLR were compared in two groups. The factors affecting the risk of urinary sepsis in patients after PCNL were analyzed by multivariate Logistic regression model. The clinical efficacy of serum Endotoxin, PCT combine with NLR in predicting urinary sepsis in patients after PCNL were analyzed by drawn receiver operating characteristic (ROC) curve. Results: Compared with non sepsis group, the serum Endotoxin, PCT and NLR in urinary sepsis group were higher (P<0.05). Multivariate Logistic regression model analysis showed that, elevated serum Endotoxin, elevated PCT, elevated NLR, positive urine white blood cells, preoperative fever and staghorn calculi were independent risk factors for urinary sepsis in patients after PCNL(P<0.05). The results of ROC curve analysis showed that, the area under the curve(AUC) of serum Endotoxin, PCT combine with NLR in predicting urinary sepsis in patients after PCNL was 0.913, which was higher than that of the above indicators alone. Conclusion: The increase of serum Endotoxin, PCT and NLR before PCNL may be relate to the occurrence of urinary sepsis in patients after PCNL. Elevate serum Endotoxin and PCT levels, elevate NLR, preoperative fever, positive urine white blood cells and staghorn calculi are risk factors for urinary sepsis in patients after PCNL. Serum Endotoxin, PCT combine with NLR detection has a high predictive value for urinary sepsis in patients after PCNL.
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