输尿管镜碎石术后感染病原菌与危险因素及感染相关指标水平的预测价值  

Investigation of pathogens,risk factors and prediction value of infection-related indexes on the infection after ureteroscopic lithotripsy

作　　者：陈怀安[1] 刘硕[1] 王哲[1] 苏军涛 张潮[1] 苗文隆[1] 李凤岐[1] HEN Huai-an;LIU Shuo;WANG Zhe;SU Jun-tao;ZHANG Chao;MIAO Wen-long;LI Feng-qi(First Affiliated Hospital of Hebei North University,Zhangjiakou,Hebei o75oo0,China)

机构地区：[1]河北北方学院附属第一医院泌尿外科,河北张家口075000

出　　处：《中华医院感染学杂志》2024年第8期1191-1195,共5页Chinese Journal of Nosocomiology

基　　金：河北省卫生健康委员会2021年度医学科学研究课题计划(20211529);张家口市科学技术局2023年市级科技计划财政资助项目(2311040D)。

摘　　要：目的探讨输尿管镜碎石术后感染的病原学特点、相关因素及肝素结合蛋白(HBP)、β2-微球蛋白(β2-MG)、C-反应蛋白(CRP)水平的预测价值。方法回顾性分析256例2020年2月-2023年2月河北北方学院附属第一医院收治的行输尿管镜碎石术患者临床资料,根据术后感染分为感染组和未感染组(52例/204例)。统计输尿管镜碎石术后感染的病原菌分布特点;采用Logistic分析法分析输尿管镜碎石术后感染的相关因素;采用酶联免疫吸附实验、乳胶免疫比浊法、化学发光法分别检测HBP、β2-MG、CRP水平;比较两组HBP、β2-MG、CRP水平;采用受试者工作特征(ROC)曲线分析HBP、β2-MG、CRP对输尿管镜碎石术后感染的诊断价值。结果输尿管镜碎石术后感染发生率为20.31%(52/256),革兰阴性菌为主;Logistic回归分析结果显示,输尿管镜碎石术后感染的相关因素包括年龄、手术时间、有糖尿病史、导管留置时间(P<0.05);感染组β2-MG、CRP水平较未感染组高(P<0.05),HBP≥0.05ng/ml患者占比较未感染组高(P<0.05);HBP、β2-MG、CRP联合检测诊断输尿管镜碎石术后感染的AUC高于各项单独检测(P<0.05),敏感度和特异度为75.00%,93.60%。结论输尿管镜碎石术后感染发生率较高,多为革兰阴性菌感染,且与患者年龄、手术时间、糖尿病史、导管留置时间相关。输尿管镜碎石术后感染HBP、β2-MG、CRP呈高表达;HBP、β2-MG、CRP联合检测有助于诊断输尿管镜碎石术后感染。OBJECTIVE To investigate the etiological characteristics and related factors of the infection after uret-eroscopic lithotripsy and the predictive value of heparin-binding protein(HBP),β2-microglobulin(β2-MG)and C-reactive protein(CRP)levels on it.METHODS Clinical data of 256 patients undergoing ureteroscopic lithotripsis admitted to the First Affiliated Hospital of Hebei North University from Feb 2020 to Feb 2023 were retrospective-ly collected.They were divided into the infected group(52 cases)and uninfected group(204 cases)according to whether postoperative infection occurred.The distribution of pathogenic bacteria after ureteroscopic lithotripsy was analyzed.Multivariate logistic analysis was used to analyze the related factors of infection after ureteroscopic litho-tripsy.The levels of HBP,β2-MG and CRP were determined by enzyme-linked immunosorbent assay,latex im-munoturbidimetry and chemiluminescence,respectively.The levels of HBP,β2-MG and CRP were compared be-tween the two groups.Receiver operating characteristic curve(ROC)was used to analyze the diagnostic value of HBP,β2-MG and CRP on infection after ureteroscopic lithotripsis.RESULTS The incidence of infection after uret-eroscopic lithotripsy was 20.31%(52/256),mainly gram-negative bacteria.Multivariate logistic regression analy-sis showed that the relevant factors for the infection after ureteroscopic lithotripsy included age,operation time,history of diabetes,and catheter retention time(P<0.05).The levels of[32-MG and CRP in the infected group were higher than those in the non-infected group(P<0.05),and the proportion of patients with HBP≥0.05 ng/ml was higher in the non-infected group(P<0.05).The AUC value of HBP,β2-MG and CRP combined detection in the diagnosis of postoperative infection after ureteroscopic lithotripsis was higher than that of each single detec-tion(P<0.05)],and the sensitivity and specificity were 75.00%and 93.60%,respectively.CONCLUSION The in-cidence of infection after ureteroscopic lithotripsy is high,and the main patho

关 键 词：输尿管结石 输尿管镜碎石术 感染 病原菌 危险因素 肝素结合蛋白 Β2-微球蛋白 C-反应蛋白 

分 类 号：R619.3[医药卫生—外科学]