摘要
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32-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.
Abstract
Objective To investigate the value of serum β2 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 pa-tients 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 param-eters(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 Logis-tic stepby-step regression.The value of β2-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 ra-tio,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 of β2-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 that β2-MG,ACTH,cortisol and procalci-tonin 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 of β2-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 lev-els of β2-MG,ACTH,cortisol and procalcitonin in patients with renal injury after ESWL for kidney stones are significantly increased,and the a-bove indicators can be used to predict renal injury in patients with renal stones after ESWL.
维普
万方数据