摘要
目的探讨上尿路结石术后患者发生泌尿系统感染的危险因素及血清降钙素原(PCT)对泌尿系统感染预测价值。方法选取2023年1月至2025年2月收治的200例上尿路结石患者作为研究对象,均接受手术治疗,术后7 d内根据病原学培养结果分为感染组、未感染组,统计两组临床资料,多因素Logistic回归分析上尿路结石术后患者发生泌尿系统感染的影响因素,比较两组血清PCT、肿瘤坏死因子-α(TNF-α)及诱骗受体3(DcR3)水平,分析血清PCT、TNF-α及DcR3水平对上尿路结石术后患者发生泌尿系统感染的预测价值。结果200例患者中52例发生泌尿系统感染,感染发生率为26.00%,其中革兰阴性菌占比较高,大肠埃希菌为优势菌株,对诺氟沙星、氨苄西林高度耐药;感染组血清PCT、TNF-α及DcR3水平高于未感染组(P<0.05);糖尿病、结石直径、尿路梗阻、肾积水、术前应用抗菌药物种类、术前抗菌药物使用时间、血清PCT、TNF-α及DcR3水平是上尿路结石术后患者发生泌尿系统感染的危险因素(P<0.01)。传统预测方案:糖尿病、结石直径、尿路梗阻、肾积水、术前应用抗菌药物种类、术前应用抗菌药物使用时间联合预测上尿路结石患者发生感染的曲线下面积(AUC)为0.856;新型预测方案:血清PCT、TNF-α及DcR3水平联合预测的AUC为0.927。新型预测方案联合预测的AUC明显大于传统预测方案(P<0.05)。结论上尿路结石术后患者发生泌尿系统感染的危险因素为糖尿病、结石直径、尿路梗阻、肾积水、术前应用抗菌药物种类、术前抗菌药物使用时间、血清PCT、TNF-α及DcR3水平,临床医师应重点关注。血清PCT、TNF-α及DcR3水平对患者发生泌尿系统感染联合预测价值较高。
Objective To investigate the risk factors for urinary tract infection(UTI)in patients with upper urinary tract calculi(UUTC)after operation and the predictive value of serum procalcitonin(PCT)for UTI.Methods A total of 200 patients with UUTC admitted from January 2023 to February 2025 were selected as the research subjects.All patients received surgical treatment.Within 7 d after operation,they were divided into infection group and non-infection group according to the results of etiological culture.The clinical data of the two groups were statistically analyzed.Multivariate logistic regression was used to analyze the influencing factors of UTI in patients with UUTC after operation.The levels of serum PCT,tumor necrosis factor-α(TNF-α)and decoy receptor 3(DcR3)were compared between the two groups.The predictive value of serum PCT,TNF-αand DcR3 levels for UTI in patients after surgery for UUTC was analyzed.Results Among the 200 patients,52 had UTI,with an infection rate of 26.00%.Gram-negative bacteria accounted for a relatively high proportion,and Escherichia coli was the dominant strain,which was highly resistant to Norfloxacin and Ampicillin.The levels of serum PCT,TNF-αand DcR3 in the infection group were higher than those in the non-infection group(P<0.05).Diabetes,stone diameter,urinary tract obstruction,hydronephrosis,type of preoperative antimicrobial agents used,duration of preoperative antimicrobial agent use,serum PCT,TNF-αand DcR3 levels were risk factors for UTI in patients after UUTC operation(P<0.05).For the traditional prediction scheme,the area under the curve(AUC)of diabetes,stone diameter,urinary tract obstruction,hydronephrosis,type of preoperative antimicrobial agents used,and duration of preoperative antimicrobial agent use in combination to predict infection in patients with UUTC was 0.856.For the new prediction scheme,the AUC of combined prediction of serum PCT,TNF-αand DcR3 levels was 0.927.The AUC of the combination of the new prediction scheme for prediction was significantly greater than that of the traditional prediction scheme(P<0.05).Conclusion The risk factors of UTI in patients with UUTC after operation are diabetes mellitus,stone diameter,urinary tract obstruction,hydronephrosis,type of preoperative antimicrobial agents used,duration of preoperative antimicrobial agent use,serum PCT,TNF-αand DcR3 levels,which warrant attention of clinicians.The combined predictive value of serum PCT,TNF-αand DcR3 levels is higher in patients with UTI.
作者
刘庆
马赛骅
吴磊彬
LIU Qing;MA Saihua;WU Leibin(The Third Department of Surgery,Qidong Hospital of Traditional Chinese Medicine,Qidong,Jiangsu 226200,China)
出处
《临床误诊误治》
2025年第24期96-104,共9页
Clinical Misdiagnosis & Mistherapy
基金
南通市卫生健康委员会科研课题(MS2023125)
江苏省卫生健康发展研究中心2021年度开放课题立项课题(JSHD2021061)。
关键词
上尿路结石
感染
危险因素
血清降钙素原
肿瘤坏死因子-Α
诱骗受体3
受试者工作特征曲线
upper urinary tract calculi
infection
risk factors
serum procalcitonin
tumor necrosis factor-α
decoy receptor 3
receiver operating characteristic curve
