输尿管结石患者术后泌尿系统真菌感染的危险因素及BG、GM的回顾性分析  

Risk factors for postoperative fungal infections in the urinary system of patients with ureteral stones and the predictive value of BG and GM

作　　者：刘美玲 王兰英 朱勇[3] 贺梦琴 LIU Meiling;WANG Lanying;ZHU Yong;HE Mengqin(Department of Urology,Huazhong University of Science and Technology Tongji Medical College Affiliated Liyuan Hospital,Wuhan 430077,China;Department of Public Health,Huazhong University of Science and Technology Tongji Medical College Affiliated Liyuan Hospital,Wuhan 430077,China;Department of General Surgery,Hubei Provincial Hospital of Traditional Chinese Medicine,Wuhan 430070,China;Disinfection Supply Center,Huazhong University of Science and Technology Tongji Medical College Affiliated Liyuan Hospital,Wuhan 430077,China)

机构地区：[1]华中科技大学同济医学院附属梨园医院泌尿外科,武汉430077 [2]华中科技大学同济医学院附属梨园医院公共卫生科,武汉430077 [3]湖北省中医院普外科,武汉430070 [4]华中科技大学同济医学院附属梨园医院消毒供应中心,武汉430077

出　　处：《中国真菌学杂志》2024年第5期440-445,共6页Chinese Journal of Mycology

基　　金：湖北省卫生健康委员会科研项目(WJ2019F163)。

摘　　要：目的探讨输尿管结石患者术后泌尿系统真菌感染特点和危险因素,以及术后(1,3)-β-D葡聚糖(1,3 beta-D-glucan,BG)、半乳甘露聚糖(galactomannan,GM)对真菌感染的预测价值。方法回顾性收集华中科技大学同济医学院附属梨园医院2022年4月—2024年1月期间216例输尿管结石患者资料,根据术后泌尿系统真菌感染情况分为感染组52例和未感染组164例。采用酶联免疫吸附法检测BG水平,采用双抗体夹心法检测GM水平;采用logistic回归分析进行多因素分析;绘制受试者工作特征(receiver operating characteristic,ROC)曲线分析术后指标BG、GM水平对输尿管结石患者术后泌尿系统真菌感染的预测价值。结果52例术后泌尿系统真菌感染患者中,共分离出63株病原真菌,其中以白念珠菌最为常见,占比50.79%。感染组输尿管结石患者术后血清BG、GM水平及糖尿病比例、手术时间≥60 min比例、导尿管留置时间≥3 d比例高于未感染组患者(P<0.05)。多因素logistic回归分析结果显示,导尿管留置时间(OR=2.949)、术后BG(OR=2.693)、术后GM(OR=2.518)均是输尿管结石患者术后泌尿系统真菌感染的独立危险因素(P<0.05)。术后BG、GM水平预测曲线下面积(area under curve,AUC)分别为0.853、0.841,低于联合AUC为0.941(Z=2.695、2.830,P<0.05)。结论导尿管留置时间、术后BG、术后GM是影响输尿管结石患者术后泌尿系统真菌感染的独立危险因素,且术后BG、术后GM对真菌感染有重要预测价值,可针对性进行干预治疗。Objective To explore the characteristics and risk factors of postoperative fungal infections in the urinary system of patients with ureteral stones,and the predictive value of postoperative 1,3 beta-D-glucan(BG)and galactomannan(GM)for fungal infections.Methods A retrospective collection of data was conducted on 216 patients with ureteral stones from April 2022 to January 2024.According to the postoperative fungal infection in the urinary system,they were separated into an infected group of 52 cases and an uninfected group of 164 cases.Enzyme linked immunosorbent assay(ELISA)method was applied to detect BG level.Double antibody sandwich method was applied to detect GM level.Logistic regression analysis was applied to conduct multivariate analysis.Receiver operating characteristic(ROC)curve was plotted to analyze the predictive value of postoperative indicators BG and GM levels for postoperative fungal infections in the urinary system of patients with ureteral stones.Results Among 52 postoperative patients with fungal infections in the urinary system,a total of 63 strains of pathogenic fungi were isolated,among which Candida albicans was the most common,accounting for 50.79%.The levels of serum BG and GM,the ratio of diabetes,the proportion of operation time≥60 min,and the ratio of catheter retention time≥3 d in the infected group were higher than those in the uninfected group(P<0.05).Multivariate logistic regression reveled that indwelling catheter time(OR=2.949),postoperative BG(OR=2.693),and postoperative GM(OR=2.518)were all independent risk factors for postoperative fungal infections in the urinary system in patients with ureteral stones(P<0.05).The AUCs of postoperative BG and GM levels were 0.853 and 0.841,respectively,which was lower than the combined AUC,0.941(Z=2.695 and 2.830,P<0.05).Conclusion Urinary catheter retention time,postoperative BG,and postoperative GM are independent risk factors affecting postoperative fungal infection in the urinary system of patients with ureteral stones.Postoperative

关 键 词：输尿管结石 泌尿系统 真菌感染 危险因素 (1 3)-β-D葡聚糖 半乳甘露聚糖 

分 类 号：R519[医药卫生—内科学] R691.3[医药卫生—临床医学]