结石CT值结合IPS、Toll样受体预测PCNL后尿源性脓毒血症的价值-《中国医学物理学杂志》

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Title:: Predictive value of calculi CT value combined with IPS and Toll-like receptor for urinary sepsis after PCNL

文章编号:: 1005-202X（2024）12-1558-05

作者:: 王敏; 窦全亮; 张一凡; 徐郑; 南京市第一医院泌尿外科，江苏南京 210019

Author(s):: WANG Min; DOU Quanliang; ZHANG Yifan; XU Zheng; Department of Urology, Nanjing First Hospital, Nanjing 210019, China

关键词:: 尿源性脓毒血症; 经皮肾镜碎石取石术; 结石CT值; 感染可能性评分; Toll样受体

Keywords:: Keywords: urinary sepsis percutaneous nephrolithotomy calculi CT value infection possibility score Toll-like receptor

分类号:: R459.7

DOI:: DOI:10.3969/j.issn.1005-202X.2024.12.014

文献标志码:: A

摘要:: 目的：探讨结石CT值、感染可能性评分（IPS）及外周血单个核细胞Toll样受体（TLR） mRNA水平预测经皮肾镜碎石取石术（PCNL）后发生尿源性脓毒血症的价值。方法：选取实施PCNL手术后并发尿源性脓毒血症患者43例作为脓毒症组，另外按照倾向性评分选择与之匹配的PCNL手术后未发生脓毒血症患者105例作为对照组，比较两组术后结石CT值、IPS、外周血单个核细胞TLR mRNA水平，并分别绘制受试者工作特征曲线（ROC）分析各项指标预测PCNL后尿源性脓毒血症发生的价值。结果：脓毒症组结石CT值、IPS评分、TLR2 mRNA、TLR4 mRNA水平均显著高于对照组（P<0.05）；脓毒症组患者的结石直径≥2.0 cm患者占比、鹿角形结石患者占比、术后中性粒细胞与淋巴细胞计数比值、术后降钙素原均显著高于对照组，脓毒症组术后白蛋白低于对照组，差异均有统计学意义（P<0.05）；结石CT值、IPS、TLR2 mRNA、TLR4 mRNA及4项指标联合应用预测PCNL后尿源性脓毒血症发生的ROC曲线下面积AUC值分别为0.669、0.794、0.710、0.584、0.907。结论：肾结石接受PCNL手术后结石CT值、IPS、TLR2 mRNA、TLR4 mRNA升高与尿源性脓毒血症发生关系密切，综合考虑4项指标对于临床上预测尿源性脓毒血症有较高价值。

Abstract:: Abstract: Objective To investigate the value of calculi CT value, infection possibility score (IPS), and Toll-like receptor (TLR) mRNA level of peripheral blood mononuclear cells in predicting urinary sepsis after percutaneous nephrolithotomy (PCNL). Methods Forty-three patients with urinary sepsis after PCNL were selected as sepsis group, while 105 patients without sepsis after PCNL were selected as control group according to propensity score. The postoperative calculi CT value, IPS and TLR mRNA level of peripheral blood mononuclear cells were compared between two groups, and receiver operating characteristic (ROC) curve was drawn to analyze the value of each index in predicting urinary sepsis after PCNL. Results The calculi CT value, IPS, TLR2 mRNA and TLR4 mRNA levels in sepsis group were significantly higher than those in control group (P<0.05). Compared with control group, sepsis group had higher proportion of stone diameter ≥ 2.0 cm, proportion of staghorn stone, postoperative ratio of neutrophil to lymphocyte and postoperative procalcitonin, but lower postoperative albumin, with statistical differences (P<0.05). The area under ROC curve of calculi CT value, IPS, TLR2 mRNA, TLR4 mRNA and the combination of the 4 indexes to predict urinary sepsis after PCNL were 0.669, 0.794, 0.710, 0.584 and 0.907, respectively. Conclusion The increases of calculi CT value, IPS, TLR2 mRNA and TLR4 mRNA after PCNL are associated with urinary sepsis. A comprehensive consideration of these 4 indicators is of high value for predicting urinary sepsis in clinic.

《中国医学物理学杂志》[ISSN:1005-202X/CN:44-1351/R]

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