摘要
目的:探讨输尿管镜钬激光碎石术(UHLL)后尿路感染(UTI)的影响因素以及对成纤维生长因子(FGF)23/Klotho通路的影响.方法:回顾性分析2021年8月至2023年8月我院泌尿外科收治的行UHLL治疗的输尿管结石患者120例,根据是否发生尿路感染(UTI)分为未发生UTI组(n=101)和UTI组(n=19).ELISA检测血清FGF23和Klotho水平;多因素Logistic回归分析UHLL后发生UTI的影响因素.结果:输尿管结石患者UHLL后UTI发生率为15.83%(19/120).发生UTI组合并糖尿病、结石直径≥2 cm、术前未使用抗菌药物、肾积水以及手术时间≥60 min的占比显著高于未发生UTI组(χ2=5.003、11.027、5.885、6.564、6.621,P<0.05).多因素Logistic回归分析显示,结石直径(OR=2.518)、术前抗菌药物使用情况(OR=1.835)、肾积水(OR=2.026)、手术时间(OR=2.104)为UHLL后发生TUI的影响因素(P<0.05).术后发生UTI组血清FGF23、PCT及IL-6水平高于未发生UTI组(t=7.617、31.489、11.053,P<0.05)、Klotho低于未发生UTI组(t=9.483,P<0.05).发生UTI组术后血清FGF23、PCT及IL-6水平较术前升高(t=5.590、14.555、6.660,P<0.05),Klotho较术前降低(t=6.950,P<0.05).结论:结石直径、术前抗菌药物使用情况、肾积水、手术时间为UHLL后发生TUI的影响因素,且UHLL后UTI的发生伴FGF 23/Klotho通路改变.
Abstract
Objective:To investigate the influencing factors of urinary tract infection(UTI)following uretero-scopic holmium laser lithotripsy(UHLL)and its impact on the fibroblast growth factor(FGF)23/Klotho pathway.Methods:A retrospective analysis was conducted on 120 patients with ureteral calculi who underwent Ureteroscopic Holmium Laser Lithotripsy(UHLL)treatment at the Department of Urology in our hospital between August 2021 and August 2023.The patients were categorized into two groups based on the presence or absence of urinary tract in-fection(UTI):a non-UTI group(n=101)and a UTI group(n=19).ELISA was applied to detect serum FGF23 and Klotho levels;Multivariate logistic regression analysis was applied to analyze the influencing factors of UTI after UHLL.Results:The incidence of UTI after UHLL in patients with ureteral calculi was 15.83%(19/120).The pro-portions of diabetes,stone diameter≥2 cm,no use of antibiotics before operation,hydronephrosis and operation time≥60 min in UTI group were obviously higher than those in non UTI group(χ2=5.003,11.027,5.885,6.564,6.621,P<0.05).Multivariate logistic regression analysis showed that stone diameter(OR=2.518),preoperative use of antibiotics(OR=1.835),hydronephrosis(OR=2.026),and operative time(OR=2.104)were the influenc-ing factors for TUI after UHLL(P<0.05).The serum levels of FGF23,PCT,and IL-6 in postoperative UTI group were higher than those in the non UTI group(t=7.617,31.489,11.053,P<0.05),and Klotho was lower than that in the non UTI group(t=9.483,P<0.05).The serum levels of FGF23,PCT,and IL-6 in the UTI group after operation were higher than those before operation(t=5.590,14.555,6.660,P<0.05),while Klotho was lower than that before operation(t=6.950,P<0.05).Conclusion:The diameter of stones,preoperative use of antibiotics,hy-dronephrosis,and operative time are the influencing factors for the occurrence of TUI after UHLL,Moreover,the oc-currence of UTI after UHLL is accompanied by changes in the FGF23/Klotho pathway.
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