内毒素、PCT联合NLR对经皮肾镜碎石术后患者尿源性脓毒血症的预测价值

摘要 目的：探讨内毒素、降钙素原（PCT）联合中性粒细胞与淋巴细胞比值（NLR）对经皮肾镜碎石术（PCNL）术后患者发生尿源性脓毒血症的预测价值。方法：选取2020年5月-2023年5月于西安医学院第二附属医院和空军军医大学第一附属医院泌尿外科行PCNL的患者750例作为研究对象。根据尿源性脓毒症发生情况分为尿源性脓毒血症组（n=45）和非脓毒血症组（n=705）。检测PCNL术前血清内毒素、PCT、中性粒细胞与淋巴细胞水平，并计算NLR。对比两组血清内毒素、PCT水平及NLR。采用多因素Logistic回归模型分析PCNL术后患者发生尿源性脓毒血症的影响因素。绘制受试者工作特征（ROC）曲线分析血清内毒素、PCT联合NLR预测PCNL术后患者发生尿源性脓毒血症的临床效能。结果：与非脓毒血症组相比，尿源性脓毒血症组血清内毒素、PCT及NLR更高（P<0.05）。多因素Logistic回归模型分析结果显示，血清内毒素升高、PCT升高、NLR升高、尿白细胞阳性、术前发热及鹿角型结石是PCNL术后患者发生尿源性脓毒血症的独立危险因素（P<0.05）；ROC曲线分析结果显示，血清内毒素、PCT联合NLR检测预测PCNL术后患者发生尿源性脓毒血症的曲线下面积（AUC）为0.913，高于上述各指标单独检测。结论：PCNL术前血清内毒素、PCT和NLR升高可能与术后患者发生尿源性脓毒血症有关。血清内毒素、PCT水平升高、NLR升高、术前发热、尿白细胞阳性、鹿角型结石是PCNL术后患者发生尿源性脓毒血症的危险因素。血清内毒素、PCT联合NLR检测对PCNL术后患者发生尿源性脓毒血症具有较高预测价值。

Predictive Value of Endotoxin, PCT Combined with NLR for Urinary Sepsis in Patients after Percutaneous Nephrolithotomy

ABSTRACT Objective: To investigate the predictive value of endotoxin (Endotoxin), procalcitonin (PCT) combined with neutrophil to lymphocyte ratio (NLR) in predicting urinary sepsis in patients after percutaneous nephrolithotomy (PCNL). Methods: 750 patients who underwent PCNL in the Department of Urology Surgery, The Second Affiliated Hospital of Xi''an Medical College and The First Affiliated Hospital of Air Force Military Medical University from May 2020 to May 2023 were selected as study subjects. Patients were divided into urinary sepsis group(n=45) and non sepsis group(n=705) according to the occurrence of urinary sepsis. The levels of serum Endotoxin, PCT, neutrophils and lymphocytes before PCNL were detected, and NLR was calculated. Serum Endotoxin, PCT levels and NLR were compared in two groups. The factors affecting the risk of urinary sepsis in patients after PCNL were analyzed by multivariate Logistic regression model. The clinical efficacy of serum Endotoxin, PCT combine with NLR in predicting urinary sepsis in patients after PCNL were analyzed by drawn receiver operating characteristic (ROC) curve. Results: Compared with non sepsis group, the serum Endotoxin, PCT and NLR in urinary sepsis group were higher (P<0.05). Multivariate Logistic regression model analysis showed that, elevated serum Endotoxin, elevated PCT, elevated NLR, positive urine white blood cells, preoperative fever and staghorn calculi were independent risk factors for urinary sepsis in patients after PCNL(P<0.05). The results of ROC curve analysis showed that, the area under the curve(AUC) of serum Endotoxin, PCT combine with NLR in predicting urinary sepsis in patients after PCNL was 0.913, which was higher than that of the above indicators alone. Conclusion: The increase of serum Endotoxin, PCT and NLR before PCNL may be relate to the occurrence of urinary sepsis in patients after PCNL. Elevate serum Endotoxin and PCT levels, elevate NLR, preoperative fever, positive urine white blood cells and staghorn calculi are risk factors for urinary sepsis in patients after PCNL. Serum Endotoxin, PCT combine with NLR detection has a high predictive value for urinary sepsis in patients after PCNL.