外周血T淋巴细胞亚群联合尿培养用于诊断PNCL术后尿路感染的临床价值  

Clinical value of peripheral blood T lymphocyte subsets combined with urine culture in the diagnosis of urinary tract infection after percutaneous nephrolithotomy

作　　者：刘振民 郑兵[1] 陈新凤[1] 张伟[1] 张骥 吴翔 张勇 江杰[1] 施春梅[1] 朱华[1] LIU Zhenmin;ZHENG Bing;CHEN Xinfeng;ZHANG Wei;ZHANG Ji;WU Xiang;ZHANG Yong;JIANG Jie;SHI Chunmei;ZHU Hua(Department of Urology, Nantong First People's Hospital, Nantong 226001, Jiangsu, China)

机构地区：[1]南通市第一人民医院泌尿外科,江苏南通226001

出　　处：《西部医学》2022年第2期250-254,共5页Medical Journal of West China

基　　金：江苏省科技项目(BE2017682)。

摘　　要：目的探讨外周血T淋巴细胞亚群联合尿培养用于诊断经皮肾镜碎石术(PCNL)后尿路感染的临床价值。方法纳入2012年1月~2019年12月在本院行PCNL治疗的患者220例,根据患者术后1个月内是否发生尿路感染,分为感染组(48例)和未感染组(172例)。记录患者年龄、体质量指数(BMI)、术前尿白细胞数、结石大小、术前是否行体外冲击波碎石、术前是否行排石药物治疗、肾积水、手术时长、术后输尿管导管留置时长、是否合并糖尿病、是否合并高血压等临床特征;于术后第3天,采用VITEK 2 Compact检测尿细菌及流式细胞术检测外周血T淋巴细胞亚群(CD3^(+)、CD4^(+)、CD8^(+)和CD4^(+)/CD8^(+))水平;Logistic回归分析影响患者术后尿路感染的危险因素。对比T淋巴细胞亚群和尿培养对PCNL术后尿路感染发生的预测价值。结果感染组与未感染组年龄>50岁、术前尿白细胞>2个/HP、术前行体外冲击波碎石、肾积水、结石大小和术后输尿管导管留置时长比较差异有统计学意义(P<0.05),年龄、术后尿白细胞>2个/HP、术前行体外冲击波碎石、肾积水和术后输尿管导管置留时长均为影响PCNL术后尿路感染的危险因素(P<0.05);感染组术后尿培养44例呈阳性,4例呈阴性,未感染组术后尿培养34例呈阳性,138例呈阴性,两组比较差异有统计学意义(P<0.05);感染组血清CD4^(+)和CD4^(+)/CD8^(+)水平明显低于未感染组(P<0.05);CD3^(+)、CD4^(+)、CD8^(+)、CD4^(+)/CD8^(+)、尿培养及联合预测尿路感染的AUC分别为0.565、0.620、0.531、0.777、0.859、0.956。结论外周血T淋巴细胞亚群联合尿培养用于诊断经PCNL术后尿路感染,具有预测价值。Objective To analyze the clinical value of peripheral blood T lymphocyte subsets combined with urine culture in the diagnosis of urinary tract infection after percutaneous nephrolithotomy(PCNL).Methods A total of 220 patients undergoing PCNL in the hospital were analyzed between January 2012 and December 2019.According to presence or absence of urinary tract infection within 1 month after surgery,they were divided into infection group(48 cases)and non-infection group(172 cases).The clinical data[age,body mass index(BMI),preoperative white blood cell count,size of stones,preoperative extracorporeal shock wave lithotripsy,medication for stone clearance,hydronephrosis,operation time,postoperative ureteral indwelling time,diabetes,hypertension]of patients were recorded.At 3d after surgery,urinary bacteria were detected by VITEK 2 Compact.The levels of peripheral blood T lymphocyte subsets(CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+))were detected by flow cytometry.The risk factors affecting postoperative urinary tract infection were analyzed by Logistic regression analysis.The predictive value of T lymphocyte subsets and urine culture for urinary tract infection after PCNL was compared.Results Age,postoperative urinary white blood cells count over 2/HP,preoperative extracorporeal shock wave lithotripsy,hydronephrosis and postoperative long ureteral indwelling time(OR=1.852,P=0.045)were risk factors affecting urinary tract infection after PCNL(P<0.05).In infection group,there were 44 cases with positive urine culture results and 4 cases with negative.In non-infection group,there were 34 cases with positive urine culture results and 138 cases with negative.The levels of serum CD4^(+)and CD4^(+)/CD8^(+)in infection group were significantly lower than those in non-infection group.AUC values of CD3^(+),CD4^(+),CD8^(+),CD4^(+)/CD8^(+),urine culture and their combination for predicting urinary tract infection were 0.565,0.620,0.531,0.777,0.859 and 0.956,respectively.Conclusion Peripheral blood T lymphocyte subsets combined with

关 键 词：联合培养 尿路感染 临床价值 T淋巴细胞 

分 类 号：R691.3[医药卫生—泌尿科学]