摘要
目的 研究输尿管结石患者在输尿管软镜碎石术(RIRS)后发生全身炎症反应患者体内早期单核细胞人类白细胞DR抗原(mHLA-DR)、可溶性髓样细胞触发受体-1(sTREM-1)的表达及其发生全身炎症反应的危险因素。方法 回顾性分析2020年1月至2022年1月石家庄市第三医院收治140例输尿管结石患者的临床资料,根据患者RIRS术后是否发生全身炎症反应,分为发生组(16例)与未发生组(124例)。收集患者一般资料,包括性别、年龄、体重指数、有无高血压、有无糖尿病、有无结石手术史、美国麻醉师协会(ASA)分级、手术时间、术后有无结石残留、mHLA-DR水平、sTREM-1水平、术前有无DJ管留置,通过受试者工作特征(ROC)分析mHLA-DR、sTREM-1预测术后发生全身炎症反应的价值,通过多因素Logistic回归分析明确输尿管结石患者术后发生全身炎症性反应的危险因素。结果 发生组中糖尿病、术后结石残留患者比率及手术时间、mHLA-DR、sTREM-1水平分别为43.75%、37.50%、(79.95±22.24) min、(0.79±0.28)%、(607.64±170.34) pg/mL,显著高于未发生组[17.74%、16.13%、(69.13±19.51) min、(0.79±0.28)%、(172.48±44.25) pg/mL],差异均有统计学意义(P<0.05)。经ROC分析证实手术时间、mHLA-DR、sTREM-1能够用于术后发生全身炎症反应的预测,曲线下面积为0.672、0.700、0.712,均有较好预测价值(P<0.05)。经多因素Logistic回归分析证实,糖尿病、手术时间≥79 min、术后有结石残留、mHLA-DR≥0.535%、sTREM-1≥332.110 pg/mL是输尿管结石患者术后发生全身炎症反应的危险因素(P<0.05)。结论 输尿管结石RIRS术后全身炎症反应患者mHLA-DR、sTREM-1水平表达呈升高状态,对mHLA-DR、sTREM-1水平进行测定可以判断术后是否会发生全身炎症反应。糖尿病、手术时间≥79 min、术后有结石残留、mHLA-DR≥0.535%、sTREM-1≥332.110 pg/mL与输尿管结石患者术后发生全身炎症反应有紧密关系,对于这些患者需要密切关注。
Objective To study the expression levels of early monocyte human leukocyte DR antigen(mHLA-DR) and soluble triggering receptor expressed on myeloid cells 1(sTREM-1) in patients with ureteral calculi who developed systemic inflammation after retrograde intrarenal surgery(RIRS) and risk factors of systemic inflammatory reaction. Methods The clinical data of 140 patients with ureteral calculi admitted to Shijiazhuang Third Hospital from January 2020 to January 2022 were retrospectively analyzed. According to whether systemic inflammatory reaction occurred after RIRS, the patients were divided into the occurrence group(16 cases) and the non-occurrence group(124 cases). General data of the patients, including gender, age, body mass index, hypertension, diabetes, history of calculi surgery, American Society of Anesthesiology(ASA) classification, operation time, postoperative calculi residue, mHLA-DR level, sTREM-1 level and preoperative DJ tube indplacement were collected, the value of mHLA-DR and sTREM-1 in predicting postoperative systemic inflammatory reactions was analyzed by receiver operating characteristic(ROC), and the risk factors of postoperative systemic inflammatory reactions in patients with ureteral stones were determined by multivariate Logistic regression analysis. Results The proportion of patients with diabetes, postoperative stone residual, operation time, mHLA-DR and sTREM-1 levels in the occurrence group were 43.75%, 37.50%,(79.95±22.24) min,(0.79±0.28)%,(607.64±170.34) pg/mL,which were significantly higher than those in the non-occurrence group[17.74%, 16.13%,(69.13±19.51) min,(0.79±0.28)%,(172.48±44.25) pg/mL], the differences were statistically significant(P<0.05). ROC analysis confirmed that operation time, mHLA-DR and sTREM-1 could be used to predict systemic inflammatory reaction after operation, and the areas under the curve were 0.672, 0.700 and 0.712, all had good predictive value(P<0.05). Multivariate Logistic regression analysis confirmed that diabetes mellitus, operation time ≥79 min, postoperative stone residue, mHLA-DR≥0.535%, sTREM-1 ≥332.110 pg/mL were risk factors for postoperative systemic inflammatory reaction in patients with ureteral calculi(P<0.05). Conclusion The expression of mHLA-DR and sTREM-1 in patients with systemic inflammatory reaction after the operation of RIRS for ureteral calculi was elevated. The determination of mHLA-DR and sTREM-1 levels can determine whether there will be systemic inflammatory reaction after the operation. Diabetes mellitus, operation time ≥79 min, postoperative stone residual, mHLA-DR ≥0.535%, sTREM-1≥332.110 pg/mL are closely related to postoperative systemic inflammatory reaction in patients with ureteral calculi, and these patients need to pay close attention to.
作者
马志强
左岩
张翼
MA Zhi-qiang;ZUO Yan;ZHANG Yi(Department of Urinary Surgery,Shijiazhuang Third Hospital,Shijiazhuang Hebei 050000,China)
出处
《临床和实验医学杂志》
2023年第1期38-42,共5页
Journal of Clinical and Experimental Medicine
基金
河北省卫生和计划生育委员会科研基金项目(编号:20170992)。
关键词
输尿管结石
软镜碎石术
全身炎症反应
单核细胞人类白细胞DR抗原
可溶性髓样细胞触发受体-1
Ureteral calculi
Retrograde intrarenal surgery
Systemic inflammatory response
Monocyte human leukocyte DR antigen
Soluble triggering receptor expressed on myeloid cells 1
