摘要
目的探讨血清干扰素γ(IFN-γ)和甲壳质酶蛋白-40(YKL-40)在经皮肾镜取石术(PCNL)后并发泌尿道感染早期诊断中的价值。方法选取2018年5月—2023年5月北京积水潭医院贵州医院外科诊治的PCNL患者108例作为研究对象,根据术后24 h患者是否发生尿道感染将其分为感染组(n=41)与未感染组(n=67)。采用ELISA法检测并比较2组患者血清IFN-γ、YKL-40水平;Pearson法分析PCNL术后并发泌尿道感染患者血清IFN-γ及YKL-40水平与泌尿道感染指标的相关性;Logistic回归分析PCNL术后并发泌尿道感染的影响因素;受试者工作特征(ROC)曲线评估血清IFN-γ、YKL-40水平对PCNL术后并发泌尿道感染的诊断价值。结果感染组患者手术时间、糖尿病史比例、肾功能不全比例明显高于未感染组[(t(χ^(2))/P=4.356/0.037、5.016/0.025、8.682/0.003)],血清IFN-γ、YKL-40水平明显高于未感染组(t/P=7.276/<0.001、7.161/<0.001)。Pearson相关性分析结果显示,PCNL术后并发泌尿道感染患者血清IFN-γ水平与WBC、CRP、PCT、IL-6、TNF-α水平均呈显著正相关(r/P=0.251/0.025、0.428/0.004、0.584/<0.001、0.632/<0.001、0.374/0.008),YKL-40水平与WBC、CRP、PCT、IL-6、TNF-α水平均呈正相关(r/P=0.603/<0.001、0.459/0.002、0.538/<0.001、0.474/<0.001、0.346/0.019);Logistic回归分析结果显示,IFN-γ和YKL-40水平升高是影响PCNL术后并发泌尿道感染的独立危险因素[OR(95%CI)=1.602(1.175~2.184)、1.665(1.207~2.296)];IFN-γ、YKL-40表达水平及二者联合诊断PCNL术后并发泌尿道感染的曲线下面积(AUC)分别为0.788、0.782、0.877,且二者联合优于各自单独诊断(Z/P=2.114/0.035、2.747/0.006)。结论PCNL术后泌尿道感染患者血清IFN-γ、YKL-40水平明显升高,二者联合检测对PCNL术后并发泌尿道感染有较高的诊断价值。
Objective To explore the value of serum interferon-γ(IFN-γ)and chitinase protein-40(YKL-40)in the early diagnosis of urinary tract infection after percutaneous nephrolithotomy(PCNL).Methods From May 2018 to May 2023,108 patients with PCNL who visited Beijing Jishuitan Hospital Guizhou Hospital were collected as the study subjects.They were separated into an infected group(n=41)and an uninfected group(n=67)based on whether they had urinary tract infection 24 hours after surgery.The clinical data of the two groups were compared;ELISA method was applied to detect and compare serum IFN and YKL-40 levels in two groups;Pearson method was applied to analyze the correlation between serum IFN and YKL-40 levels and indicators of urinary tract infection in patients with urinary tract infection after PCNL;Logistic regression was applied to analyze the influencing factors of urinary tract infections after PCNL;receiver operating characteristic(ROC)curve was applied to evaluate the diagnostic value of serum IFN and YKL-40 levels for urinary tract infections after PCNL.Results The operation time,the proportion of history of diabetes and the proportion of renal insufficiency in the infected group were obviously higher than those in the uninfected group[(t(χ^(2))/P=4.356/0.037,5.016/0.025,8.682/0.003)];the levels of serum IFN and YKL-40 in the infected group were obviously higher than those in the uninfected group(t/P=7.276/<0.001,7.161/<0.001);Pearson correlation analysis showed that there was a positive correlation between serum IFN and YKL-40 levels in patients with urinary tract infection after PCNL(P<0.05);Logistic regression analysis showed that serum IFN-γlevels were positively correlated with WBC and CRP,PCT,IL-6,and TNF-αlevels in patients with urinary tract infections complicated by PCNL(r/P=0.251/0.025,0.428/0.004,0.584/<0.001,0.632/<0.001,0.374/0.008),and YKL-40 levels were positively correlated with WBC and CRP,PCT,IL-6,and TNF-αlevels(r/P=0.603/<0.001,0.459/0.002,0.538/<0.001,0.474/<0.001,0.346/0.019);Logistic regression analysis showed that elevated levels of IFN-γand YKL-40 were independent risk factors affecting the complication of urinary tract infections after PCNL[OR(95%CI)=1.602(1.175-2.184),1.665(1.207-2.296)];ROC curve analysis results showed that the area under the curve(AUC)of serum IFN and YKL-40 levels alone and in combination for the diagnosis of PCNL complicated with urinary tract infections was 0.788,0.782,and 0.877,respectively,the combined diagnostic effect of the two was better than that of single diagnosis(Z/P=2.114/0.035,2.747/0.006).Conclusion The serum levels of IFN-γand YKL-40 in patients with urinary tract infection after PCNL obviously increase,and the combined detection of the two has high diagnostic value for urinary tract infection after PCNL.
作者
何伟
胥丰
王镭播
岑壮顶
He Wei;Xu Feng;Wang Leibo;Cen Zhuangding(Department of Surgery,Beijing Jishuitan Hospital Guizhou Hospital,Guizhou Province,Guiyang 550014,China)
出处
《疑难病杂志》
CAS
2024年第2期212-216,共5页
Chinese Journal of Difficult and Complicated Cases
基金
2023年度贵州省卫生健康委科学技术基金项目(gzwkj2023-373)。
关键词
经皮肾镜取石术
泌尿道感染
血清干扰素γ
甲壳质酶蛋白40
诊断价值
Percutaneous nephrolithotomy
Urinary tract infection
Serum interferon-γ
Chitinase like protein-40
Diagnostic value
