摘要
目的 探讨CT值联合炎症指标在肾输尿管结石术后引发尿源性脓毒血症中的预测作用.方法 选取2020年1月至2023年1月在江苏省无锡市惠山区第三人民医院接受经输尿管镜取石术的700例肾输尿管结石患者作为研究对象,根据患者术后是否出现尿源性脓毒血症被分为尿源性脓毒血症组(n=53)与非尿源性脓毒血症组(n=647).收集患者的一般资料和术前结石CT影像CT值,术后2 h内检测白细胞计数(white blood cell count,WBC)、降钙素原(procalcitonin,PCT)、白细胞介素-6(interleukin-6,IL-6)、白蛋白(albumin,ALB)、C 反应蛋白(C-reactive protein,CRP)、血小板计数(platelet count,PLT)、凝血酶原时间(prothrombin time,PT)、活化部分凝血活酶时间(activated partial thromboplastin time,APTT)、体温、血压.采用logistic回归分析法分析肾和输尿管结石术后发生尿源性脓毒血症的独立预后指标,并通过受试者工作特征(receiver operating characteristic,ROC)曲线评估CT值、PCT、CRP及三者联合预测对尿源性脓毒血症预测的效能.结果 两组性别、年龄、结石大小、手术时间、高血压等一般资料比较,差异无统计学意义(P＞0.05);单因素分析结果显示,尿源性脓毒血症组CT值、WBC、PCT、CRP指标均高于非尿源性脓毒血症组,差异有统计学意义(P＜0.05);IL-6、ALB、PT、APTT、合并高血压例数比较,差异无统计学意义(P＞0.05);多因素logistic回归分析结果显示,肾输尿管结石术后并发尿源性脓毒血症的独立危险因素为CT值、PCT、CRP、血小板计数及体温;ROC曲线分析显示,CT值、PCT、CRP及其联合预测肾输尿管结石术后尿源性脓毒血症的曲线下面积分别为0.793、0.781、0.815和0.946,以CT值、PCT和CRP的联合预测效能最高(灵敏度为88.7％,特异度为90.4％).结论 CT值联合炎症指标对肾输尿管结石术后的尿源性脓毒血症早期预测具有重要参考价值.
Abstract
Objective To explore the predictive value of CT values combined with inflammatory indicators for urosepsis after kidney stone surgery.Methods A total of 700 patients with renal ureteral stones who underwent percutaneous nephrolithotomy in the Third People's Hospital of Huishan District,Wuxi City,Jiangsu Province from January 2020 to January 2023 were selected.Based on the occurrence of postoperative urosepsis,patients were divided into urosepsis group(53 cases)and non-urosepsis group(647 cases).General data and preoperative stone CT values of the patients were collected.Within 2 hours post-surgery,the white blood cell count(WBC),procalcitonin(PCT),interleukin-6(IL-6),albumin(ALB),C-reactive protein(CRP),platelet count(PLT),prothrombin time(PT),activated partial thromboplastin time(APTT),body temperature,and blood pressure were tested.A logistic regression model was used to analyze the independent predictive factors of urosepsis after renal ureteral lithotripsy,and the receiver operating characteristic(ROC)curve was used to evaluate the prediction efficacy of CT values,PCT,CRP,and their combined prediction for urosepsis.Results There were no significant differences in gender,age,stone size,operation time,hypertension and other general data between the two groups(P＞0.05).Univariate variance analysis showed statistically significant differences between the two groups in CT values,WBC,PCT,CRP,PLT,and body temperature(P＜0.05),with higher values of CT,WBC,PCT,and CRP in the urosepsis group.There were no statistically significant differences in IL-6,ALB,PT,APTT,and the number of combined hypertension cases(P＞0.05).Multivariate logistic regression analysis revealed that CT values,PCT,CRP,platelet count,and body temperature were independent risk factors for urosepsis after renal ureteral lithotripsy.The ROC curve analysis showed that the areas under the curve for CT values,PCT,CRP,and their combined prediction were 0.793,0.781,0.815,and 0.946,respectively.The combined predictive efficacy of CT values,PCT,and CRP was the highest(sensitivity:88.7％,specificity:90.4％).Conclusion The combined prediction of CT values and inflammatory indicators has significant reference value for early prediction of urosepsis after kidney stone surgery.
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