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中华腔镜泌尿外科杂志(电子版)

中华腔镜泌尿外科杂志(电子版) ›› 2023, Vol. 17 ›› Issue (05) : 476 -480. doi: 10.3877/cma.j.issn.1674-3253.2023.05.010

临床研究

炎症介质谱联合降钙素原在尿源性脓毒血症中的诊断价值
伍学成, 李远伟†(), 袁武雄, 王建松, 石泳中, 卢强, 李卓, 陈佳, 刘哲, 滕伊漓, 高智勇   
  1. 410005　长沙，湖南省人民医院（湖南师范大学附属第一医院）泌尿外科
  • 收稿日期:2023-02-06 出版日期:2023-10-01
  • 通信作者: 李远伟

Diagnostic value of inflammatory mediators profile combined with procalcitonin in urogenic sepsis

Xuecheng Wu, Yuanwei Li†(), Wuxiong Yuan, Jiansong Wang, Yongzhong Shi, Qiang Lu, Zhuo Li, Jia Chen, Zhe Liu, Yili Teng, Zhiyong Gao   

  1. Hunan Provincial People's Hospital (the First Affiliated Hospital of Hunan Normal University), Changsha 410005, China
  • Received:2023-02-06 Published:2023-10-01
  • Corresponding author: Yuanwei Li
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引用本文：

伍学成, 李远伟, 袁武雄, 王建松, 石泳中, 卢强, 李卓, 陈佳, 刘哲, 滕伊漓, 高智勇. 炎症介质谱联合降钙素原在尿源性脓毒血症中的诊断价值[J]. 中华腔镜泌尿外科杂志(电子版), 2023, 17(05): 476-480.

Xuecheng Wu, Yuanwei Li, Wuxiong Yuan, Jiansong Wang, Yongzhong Shi, Qiang Lu, Zhuo Li, Jia Chen, Zhe Liu, Yili Teng, Zhiyong Gao. Diagnostic value of inflammatory mediators profile combined with procalcitonin in urogenic sepsis[J]. Chinese Journal of Endourology(Electronic Edition), 2023, 17(05): 476-480.

目的

评估炎症介质谱联合降钙素原在输尿管结石并发尿源性脓毒血症中的诊断价值。

方法

收集湖南省人民医院2017年6月至2022年6月行炎症因子试剂盒检测的160例输尿管结石患者临床资料，研究组66例（输尿管结石术后发生尿源性脓毒血症患者），对照组94例（输尿管结石术后未发生尿源性脓毒血症患者）。分析两组患者的临床资料、围手术期生化指标的差异，采用多因素Logistic回归分析引起尿源性脓毒血症的相关危险因素。

结果

研究组术前血浆中IL-4、IL-6、IL-10、TFN-α、IFN-γ、CRP、PCT指标明显高于对照组，两组之间差异有统计学意义（P<0.05）；研究组术后血浆中炎症介质谱、CRP、PCT指标均高于对照组，两组之间差异有统计学意义（P<0.05）。多因素Logistic回归分析显示：术前PCT和IL-6升高是输尿管结石术后尿源性脓毒血症的危险因素。

结论

IL-6和PCT升高是输尿管结石术后发生尿源性脓毒血症的重要预测指标。

关键词: 炎症介质谱, 降钙素原, 尿源性脓毒血症, 输尿管结石
Objective

To assess the diagnostic value of inflammatory mediator profile combined with procalcitonin in the perioperative period of ureteric stones complicated by urogenic sepsis.

Methods

Clinical data of 160 patients with ureteral stones who underwent inflammatory cytokine kit testing admitted to Hunan Provincial People's Hospital between June 2017 and June 2022 were collected, 66 patients in the study group (patients with ureteral stones who developed urogenic sepsis after surgery) and 94 patients in the control group (patients who did not develop urogenic sepsis after ureteral stones). The differences in clinical data and perioperative biochemical indexes between the two groups were analyzed, and the risk factors causing urogenic sepsis were analyzed by multifactorial logistic regression.

Results

The preoperative plasma indices of IL-4, IL-6, IL-10, TFN-α, IFN-γ, CRP, and PCT in the study group were significantly higher than those in the control group, with significant differences between the two groups (P<0.05); the postoperative plasma indices of inflammatory mediator profile, CRP, and PCT in the study group were higher than those in the control group, with significant differences between the two groups (P<0.05). Multi-factor logistic regression analysis showed that elevated preoperative PCT and IL-6 were risk factors for ureteric sepsis after ureterolithotomy.

Conclusions

IL-6 and PCT were significant predictors of urogenic sepsis that would occur after ureteral stone surgery.

Key words: Inflammatory mediators spectrum, Procalcitonin, Urogenic sepsis, Ureteral calculi
表1 输尿管结石术后脓毒血症（研究组）与非脓毒血症（对照组）患者术前术后血清指标对比[M(Q)]
指标 术前 Z值 P值 术后 Z值 P值
对照组(n=94) 研究组(n=66) 对照组(n=94) 研究组(n=66)
IL-2(ng/L) 0.09(0.01，0.55) 0.01(0.01，5.45) -0.562 0.574 1.79(0.23，8.07)# 10.75(3.40，14.65)# -2.214 0.027*
IL-4(ng/L) 0.36(0.01，1.35) 0.62(0.34，8.65) -2.868 0.004* 2.86(0.36，14.54)# 13.09(7.83，22.40)# -2.406 0.016*
IL-6(ng/L) 2.85(1.36，16.35) 35.17(19.86，66.44) -2.128 0.036* 18.68(7.72，54.93)# 227.30(62.74，560.62)# -5.124 <0.001*
IL-10(ng/L) 2.11(1.43，4.01) 4.23(2.27，9.18) -2.762 0.006* 6.37(2.19，14.10)# 14.22(10.12，61.52)# -3.929 <0.001*
TNF-α(ng/L) 0.03(0.01，1.51) 1.77(0.48，3.74) -2.879 0.004* 1.56(0.27，5.67)# 6.70(3.65，14.18)# -3.036 0.002*
IFN-γ(ng/L) 0.46(0.01，1.22) 0.86(0.44，9.02) -2.636 0.008* 2.85(0.58，20.01)# 22.21(6.36，48.37)# -3.018 0.003*
CRP(mg/L) 3.13(3.13，17.80) 16.00(5.00，79.45) -2.681 0.007* 12.40(4.44，53.25)# 93.00(36.50，142.00)# -4.457 <0.001*
PCT(ng/mL) 0.05(0.05，0.09) 0.28(0.05，1.17) -2.966 0.003* 0.12(0.05，0.66)# 1.99(1.25，20.50)# -6.371 <0.001*
表2 多因素的Logistics回归分析输尿管结石术后发生尿源性脓毒血症的危险因素
术前指标 B值 S.E Wald P值 OR值 95%CI
PCT 0.125 0.059 4.554 0.033 1.133 0.760~1.210
IL-6 0.095 0.013 4.474 0.034 1.100 1.011~1.148
图1 术前IL6、降钙素原和两指标联合诊断尿源性脓毒血症的ROC曲线
表3 术前IL6、降钙素原和两指标联合评价尿源性脓毒血症的诊断效能
指标 AUC 标准误 P值 95%CI 截断值
术前IL-6 0.9190 0.0347 <0.001 0.820~0.972 29.357
术前降钙素原 0.8460 0.0491 <0.001 0.736~0.936 0.238
联合检测 0.9214 0.0500 <0.001 0.901~0.986 -
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