肾盂尿培养联合炎症指标对经皮肾镜碎石术后尿路感染的诊断价值

目的探讨经皮肾镜碎石术后,肾盂尿培养联合血清和肽素及IL-6水平对尿路感染的诊断价值。方法选取2015年6月-2018年6月于遵义医科大学附属医院行经皮肾镜碎石术的住院患者201例,根据术后尿路感染情况分为感染组32例及非感染组169例。术前中段尿、术中肾盂尿进行细菌培养,术后第1天采用酶联免疫吸附法检测血清和肽素及白细胞介素-6(Interleukin-6,IL-6)水平,比较上述指标单独及联合对术后尿路感染的诊断价值。结果感染组与非感染组术前中段尿细菌培养阳性率分别为15.63%和14.79%,差异无统计学意义(χ^2=1.218,P=0.270);感染组肾盂细菌培养阳性率为81.25%,高于非感染组的3.55%,差异有统计学意义(χ^2=121.349,P<0.001)。感染组和肽素及IL-6水平高于非感染组,差异有统计学意义(P<0.001)。肾盂尿培养、血清和肽素及IL-6联合诊断PCNL术后尿路感染敏感性为90.65%,特异性为86.44%,AUC为0.873±0.039,高于肾盂尿培养、和肽素、IL-6单独诊断水平(P<0.05)。结论术中肾盂尿培养较术前中段尿培养价值高,且血清和肽素、IL-6及肾盂尿培养联合诊断可提高诊断准确率。

Diagnostic value of bacterial culture of urine in renal pelvis combined with inflammatory index in urinary tract infection after percutaneous nephrolithotripsy

OBJECTIVE To evaluate the value of bacterial culture of urine in renal pelvis combined with copeptin and IL-6 in the diagnosis of urinary tract infection after percutaneous nephrolithotripsy.METHODS Total of 201 hospitalized patients with renal calculi underwent percutaneous nephrolithotomy from June 2015 to June 2018 were recruited.They were divided into the postoperative infection group with 32 cases and the non-infection group with 169 cases according to the severity of bacterial infection.The urine before the operation and the urine in the middle section during the operation were used by bacterial culture.On the first day after the operation,levels of copeptin and IL-6 were detected by ELISA.And the diagnostic efficiency was compared by using the above two indexes alone with in combination of them in the postoperative urinary tract infection.RESULTS The positive rates of urine bacterial culture in the postoperative infection group and the non-infection group were 15.63%and 14.79%,respectively,and there was no significant differences between them(χ^2=1.218,P=0.270).The positive rate of renal pelvis bacterial culture in the postoperative infection group was 81.25%,which was significantly higher than that in the uninfected group of 3.55%(χ^2=121.349,P<0.001).Levels of copeptide and IL-6 in the postoperative infection group and level were significantly higher than that in the non-infection group(P<0.001).The sensitivity of the combination of copeptide,IL-6 and bacterial culture of urine in renal pelvis in the diagnosis of urinary tract infection after PCNL was 90.65%,with the specificity of 86.44%and the AUC of 0.873±0.039,which was significantly higher than the efficacy of renal pelvis,copeptide and IL-6 alone on the urinary tract infection diagnosis(P<0.05).CONCLUSION The value of bacterial culture of intraoperative pyeluria was more valuable than that of preoperative middle urinary,which can improve the diagnostic accuracy in combination of copeptide and IL-6.