经皮肾镜取石术后脓毒血症发生情况及〖JP3〗髓样细胞可溶性触发受体1、超敏C反应〖JP2〗蛋白、中性粒细胞与淋巴细胞比值联合〖JP〗检测的预测价值

doi:10.3969/j.issn.1005-6483.2021.06.019

摘要/Abstract

摘要： 目的：观察经皮肾镜取石术(percutaneous nephrolithotomy，PCNL)术后脓毒血症发生情况及髓样细胞可溶性触发受体1（sTREM1)、超敏C反应蛋白(hsCRP)、中性粒细胞与淋巴细胞比值(NLR)联合检测对其的预测价值。方法：2015年9月～2020年9月本院收治的行PCNL手术治疗病人358例，根据术后是否发生脓毒血症分为脓毒血症组和非脓毒血症，分析PCNL术后脓毒血症发生的影响因素及sTREM1、hsCRP、NLR对PCNL术后脓毒血症发生的预测价值。结果：本组358例病人中有31例PCNL治疗后出现脓毒血症，发生率8.66％。两组性别、结石直径、鹿角形结石、术前sTREM1水平、术前hsCRP水平、术前NLR值及手术时间比较，差异有统计学意义(P<0.05)。sTREM1、NLR的AUC分别为0.886、0.851，显著高于hsCRP的0.647(P<0.05)；将3项指标联合后其AUC高达0.973，显著高于各单一指标(P<0.05)。Logistic回归分析显示，女性、结石直径≥2.5cm、鹿角形结石、术前sTREM1≥1.02μg/L、术前hsCRP≥5.37mg/L、术前NLR≥2.66及手术时间≥90分钟是PCNL术后脓毒血症的独立危险因素(P<0.05)。结论：PCNL术后脓毒血症的发生与多种因素相关，联合sTREM1、hsCRP、NLR指标检测对预测PCNL术后脓毒血症的发生具有重要价值。

关键词: 经皮肾镜取石术, 脓毒血症, 髓样细胞可溶性触发受体1, 超敏C反应蛋白, 中性粒细胞与淋巴细胞比值

Abstract: Objective：To observe the occurrence of sepsis after percutaneous nephrolithotomy(PCNL) and the predictive value of soluble triggering receptor expressed on myeloid cells1(sTREM1) combined with highsensitivity Creactive protein(hsCRP) and neutrophil to lymphocyte ratio(NLR).Methods：A retrospective analysis was performed on the clinical data of 358 PCNL patients admitted to the hospital from September 2015 to September 2020.According to presence or absence of sepsis after PCNL,they were divided into sepsis group and nonsepsis group.The influencing factors of sepsis after PCNL and the predictive value of sTREM1,hsCRP and NLR were analyzed.Results：Among the 358 patients,there were 31 cases(8.66%) with sepsis after PCNL.There were significant differences between the two groups in gender,stone diameter,staghorn stone,preoperative sTREM1,hsCRP and NLR levels,and operation time(P<0.05).AUC values of sTREM1 and NLR were 0.886 and 0.851,significantly higher than that of hsCRP(0.647)(P<0.05).AUC of sTREM1 combined with hsCRP and NLR was as high as 0.973,significantly higher than that of single index(P<0.05).The results of Logistic regression analysis showed that female gender,stone diameter not shorter than 2.5cm,staghorn stone,preoperative sTREM1 level not lower than 1.02 μg/L,preoperative hsCRP level not lower than 5.37 mg/L,preoperative NLR level not lower than 2.66 and operation time not shorter than 90 min were all independent risk factors of sepsis after PCNL(P<0.05).Conclusion：The occurrence of sepsis after PCNL is related to many factors.The combined detection of sTREM1,hsCRP and NLR is of important value for predicting the occurrence of sepsis after PCNL.

Key words: percutaneous nephrolithotomy, sepsis, soluble triggering receptor expressed on myeloid cells11, highsensitivity Creactive protein, Neutrophil to lymphocyte ratio

杨海涛, 谭敦群, 贺德华等. 经皮肾镜取石术后脓毒血症发生情况及〖JP3〗髓样细胞可溶性触发受体1、超敏C反应〖JP2〗蛋白、中性粒细胞与淋巴细胞比值联合〖JP〗检测的预测价值[J]. 临床外科杂志, 2021, 29(6): 565-568.

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