Preoperative CL-11，Urinary Nitrite，U-HBP，and Their Correlation with Postoperative Urinary Sepsis in Patients with Kidney Stones and Their Predictive Significance
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摘要:
目的 分析术前胶原凝集素-11（CL-11）、尿亚硝酸盐、尿肝素结合蛋白（U-HBP）与肾结石术后并发尿源性脓毒症（US）的相关性，并探讨其对术后并发US的预测价值及其预警意义。 方法 选取2021年9月至2023年6月昆明医科大学第二附属医院190例肾结石患者，根据微创经皮肾镜取石术后7 d是否并发US分为US组（n = 30）和无US组（n = 160）。比较两组基线资料及术前CL-11、尿亚硝酸盐、U-HBP。分析术前CL-11、尿亚硝酸盐、U-HBP与术后并发US的关系。评价术前CL-11、尿亚硝酸盐、U-HBP对术后并发US的预测效能。 结果 US组CL-11、尿亚硝酸盐阳性占比、U-HBP分别为（313.68±38.73）ng/mL、46.67%、（157.82±41.61）ng/mL，高于无US组的（234.00±41.25）ng/mL、12.50%、（128.59±36.38）ng/mL（P < 0.05）；Logistic回归分析显示，术前CL-11、尿亚硝酸盐、U-HBP是并发US的影响因素；术前CL-11、尿亚硝酸盐、U-HBP预测术后并发US的AUC依次为0.797、0.624、0.826，联合预测术后并发US的AUC为0.923，敏感度、特异度分别为90.00%和88.75%。 结论 肾结石术后并发US患者尿亚硝酸盐阳性占比、CL-11、U-HBP水平升高，且与术后并发US呈正相关，其对术后并发US具有一定预测价值，联合检测其水平的预测效能更优，可能作为术后并发US的预警标志物，为临床制定防控措施提供参考。 Abstract:Objective To analyze the correlation of preoperative collagen lectin-11 （CL-11）, urinary nitrite, and urinary heparin-binding protein （U-HBP） with postoperative urinary sepsis （US） in patients with kidney stones, and to explore their predictive value and warning significance for postoperative US. Methods A total of 190 patients with kidney stones who underwent minimally invasive percutaneous nephrolithotomy at the Second Affiliated Hospital of Kunming Medical University from September 2021 to June 2023 were selected.According to whether they developed US within 7 days after surgery, they were divided into the US group （n = 30） and the non-US group （n = 160）. Baseline data and preoperative levels CL-11, urinary nitrite and U-HBP were compared between the two groups. The correlation between preoperative CL-11, urinary nitrite, U-HBP and postoperative US was analyzed. The predictive efficacy of preoperative CL-11, urinary nitrite, and U-HBP for postoperative US was evaluated. Results The positive rates of CL-11, urinary nitrite, and U-HBP in the US group were （313.68±38.73） ng/mL, 46.67% and （157.82±41.61） ng/mL, respectively, which were higher than those in the non-US group at （234.00±41.25） ng/mL, 12.50%, and （128.59±36.38） ng/mL （P < 0.05）.Logistic regression analysis indicated that preoperative CL-11, urinary nitrite, and U-HBP were influencing factors for the occurrence of US. The area under the curve （AUC） for predicting postoperative US was 0.797 for CL-11, 0.624 for urinary nitrite, and 0.826 for U-HBP, while the combined AUC for predicting postoperative US was 0.923, with a sensitivity of 90.00% and specificity of 88.75%. Conclusion Patients with postoperative US following kidney stone surgery exhibited elevated levels of urinary nitrite, CL-11, and U-HBP, which were positively correlated with the occurrence of postoperative US. These markers have certain predictive value for postoperative US, and their combined detection offers superior predictive efficacy, potentially serving as warning biomarkers for postoperative US, thereby providing a reference for clinical prevention and control measures. -
Key words:
- Kidney stone /
- Urinary sepsis /
- Collagen agglutinin-11 /
- Urinary nitrite /
- Urinary heparin-binding protein /
- Warning
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图 1 术前CL-11、尿亚硝酸盐、U-HBP预测术后并发US的ROC曲线
Figure 1. ROC curve of preoperative CL-11，urinary nitrite and U-HBP predicting postoperative complications of US
图 2 术前CL-11、尿亚硝酸盐联合U-HBP预测术后并发US的ROC曲线
Figure 2. ROC curve of preoperative CL-11 and urinary nitrite combined with U-HBP in predicting postoperative US complications
表 1 两组基线资料比较
Table 1. Comparison of baseline data between the two groups
资料 US组
（n = 30）无US组
（n = 160）t P 年龄（岁） 46.88 ± 11.03 44.95 ± 12.18 0.808 0.420 性别 0.181 0.671 男 21（70.00） 118（73.75） 女 9（30.00） 42（26.25） 体质量指数
（kg/m²）24.81 ± 0.72 24.94 ± 0.95 0.712 0.478 糖尿病 8（26.67） 20（12.50） 4.035 0.045* 高血压 5（16.67） 21（13.13） 0.268 0.604 冠心病 2（6.67） 14（8.75） 0.142 0.706 结石位置 0.067 0.796 左侧 18（60.00） 100（62.50） 右侧 12（40.00） 60（37.50） 结石长径（cm） 0.077 0.782 ≤2.5 17（56.67） 95（59.38） > 2.5 13（43.33） 65（40.63） 结石数 0.054 0.817 单发 16（53.33） 89（55.63） 多发 14（46.67） 71（44.38） 通道数 0.294 0.588 单 28（93.33） 153（95.63） 多 2（6.67） 7（4.38） 手术时间（min） 118.55 ± 27.30 99.78 ± 30.51 3.141 0.002* 术前肌酐
（μmol/L）93.64 ± 18.28 89.59 ± 22.04 0.947 0.345 术前尿白细胞 0.223 0.636 正常 23（76.67） 116（72.50） 升高 7（23.33） 44（27.50） 感染性结石成分 0.016 0.900 无 26（86.67） 140（87.50） 有 4（13.33） 20（12.50） 术前抗菌药物 0.254 0.614 无 15（50.00） 72（45.00） 有 15（50.00） 88（55.00） *P < 0.05。 
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表 2 两组术前CL-11、尿亚硝酸盐、U-HBP比较[（$ \bar x \pm s $）/n（%）]
Table 2. Comparison of preoperative CL-11，urinary nitrite，and U-HBP between two groups [（$ \bar x \pm s $）/n （%）]
组别 n CL-11（ng/mL） 尿亚硝酸盐阳性 U-HBP（ng/mL） US组 30 313.68 ± 38.73 14（46.67） 157.82 ± 41.61 无US组 160 234.00 ± 41.25 20（12.50） 128.59 ± 36.38 t 9.799 20.072 3.946 P < 0.001* < 0.001* < 0.001* *P < 0.001。
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表 3 术前CL-11、尿亚硝酸盐、U-HBP与术后并发的Logistic回归分析
Table 3. Logistic regression analysis of CL-11，urinary nitrite，and U-HBP before surgery and postoperative complications
变量 B SB Wald/χ2 OR 95%CI P 术前CL-11 0.710 0.283 6.294 2.034 1.322～6.311 0.024* 尿亚硝酸盐 1.136 0.302 14.139 3.113 1.864～10.457 0.005* U-HBP 0.495 0.205 5.823 1.640 1.274～4.436 0.045* *P < 0.05。
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表 4 术前CL-11、尿亚硝酸盐、U-HBP预测术后并发US的价值
Table 4. Value of preoperative CL-11，urinary nitrite and U-HBP in predicting postoperative US complications
指标 AUC 95%CI cut-off 敏感度（%） 特异度（%） P CL-11 0.797 0.733～0.852 300.31 80.00 77.50 < 0.001* 尿亚硝酸盐 0.624 0.551～0.693 阳性 46.67 78.12 < 0.001* U-HBP 0.826 0.764～0.877 126.50 80.00 75.00 < 0.001* *P < 0.001。
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[1] Deng X L,Xie D H,Huang X,et al. Suctioning flexible ureteroscopy with automatic control of renal pelvic pressure versus mini PCNL for the treatment of 2-3-cm kidney stones in patients with a solitary kidney[J]. Urol Int,2022,106(12):1293-1297. doi: 10.1159/000521373 [2] Choudhury S,Kasim A,Pal D K. Supine PCNL in autosomal dominant polycystic kidney disease[J]. Urologia,2023,90(1):123-129. doi: 10.1177/03915603221091082 [3] Amier Y,Zhang Y,Zhang J,et al. Analysis of preoperative risk factors for postoperative urosepsis after mini-Percutaneous nephrolithotomy in patients with large kidney stones[J]. J Endourol,2022,36(3):292-297. doi: 10.1089/end.2021.0406 [4] Howard M C,Nauser C L,Farrar C A,et al. l-Fucose prevention of renal ischaemia/reperfusion injury in mice[J]. FASEB J,2020,34(1):822-834. doi: 10.1096/fj.201901582R [5] Papava V,Didbaridze T,Zaalishvili Z,et al. The role of urinary nitrite in predicting bacterial resistance in urine culture analysis among patients with uncomplicated urinary tract infection[J]. Cureus,2022,14(6):e26032-e26042. [6] Tang J,Yuan H,Wu YL,et al. The predictive value of heparin-binding protein and D-Dimer in patients with sepsis[J]. Int J Gen Med,2023,16(6):2295-2303. [7] Kunwar A K,Upadhyaya A M,Tiwari K,et al. Thoracic complications in supracostal percutaneous nephrolithotomy[J]. J Nepal Health Res Counc,2022,20(2):361-365. doi: 10.33314/jnhrc.v20i02.3950 [8] Wagenlehner F M,Lichtenstern C,Rolfes C,et al. Diagnosis and management for urosepsis[J]. Int J Urol,2013,20(10):963-70. doi: 10.1111/iju.12200 [9] Alexander R T. Kidney stones,hypercalciuria,and recent insights into proximal tubule calcium reabsorption[J]. Curr Opin Nephrol Hypertens,2023,32(4):359-365. [10] 于佳,杨元强,肖荣. 大型肾结石行微创经皮肾镜取石术后发生尿源性脓毒症的预测模型构建[J]. 国际泌尿系统杂志,2023,43(6):964-968 doi: 10.3760/cma.j.cn431460-20220414-00248 [11] Howard M C,Nauser C L,Vizitiu D A,et al. Fucose as a new therapeutic target in renal transplantation[J]. Pediatr Nephrol,2021,36(5):1065-1073. doi: 10.1007/s00467-020-04588-2 [12] Fanelli G,Romano M,Lombardi G,et al. Soluble collectin 11 (CL-11) acts as an immunosuppressive molecule potentially used by stem cell-derived retinal epithelial cells to modulate T cell response[J]. Cells,2023,12(13):1805-1815. doi: 10.3390/cells12131805 [13] Wu K Y,Cao B,Chen W B,et al. Collectin 11 has a pivotal role in host defense against kidney and bladder infection in mice[J]. Kidney Int,2024,105(3):524-539. doi: 10.1016/j.kint.2023.11.031 [14] Gong K J,Xia M,Wang Y Q,et al. Importance of glycosylation in the interaction of Tamm-Horsfall protein with collectin-11 and acute kidney injury[J]. J Cell Mol Med,2020,24(6):3572-3581. doi: 10.1111/jcmm.15046 [15] Li X C,Zhuge Z B,Carvalho L R R A,et al. Inorganic nitrate and nitrite ameliorate kidney fibrosis by restoring lipid metabolism via dual regulation of AMP-activated protein kinase and the AKT-PGC1α pathway[J]. Redox Biol,2022,51(1):102266-102276. [16] Méndez-Espinola B M,Gallardo-Aravena E. Diagnosis of urinary tract infection in infants under 3 months with fever without a source: Reliability of urinalysis and urine culture[J]. Bol Med Hosp Infant Mex,2023,80(5):288-295. [17] Liang T,Schibeci Oraa S,Rebollo Rodríguez N,et al. Predicting urinary tract infections with interval likelihood ratios[J]. Pediatrics,2021,147(1):e5008-e5018. [18] Olinder J,Stjernqvist MJ,Lindén A,et al. Hepcidin,in contrast to heparin binding protein,does not portend acute kidney injury in patients with community acquired septic shock[J]. PLoS One,2024,19(5):e0299257-e0299265. doi: 10.1371/journal.pone.0299257 [19] Zhou L L,Chen J J,Mu G H,et al. Heparin-binding protein (HBP) worsens the severity of pancreatic necrosis via up-regulated M1 macrophages activation in acute pancreatitis mouse models[J]. Bioengineered,2021,12(2):11978-11986. doi: 10.1080/21655979.2021.2011018 [20] 谭德敏,陈军,张敏. 脓毒症患者血清HBP与器官损伤严重程度和临床结局的相关性研究[J]. 临床急诊杂志,2022,23(6):412-418. [21] Gu J,Liu J,Hong Y,et al. Nomogram for predicting risk factor of urosepsis in patients with diabetes after percutaneous nephrolithotomy[J]. BMC Anesthesiol,2022,22(1):87-97. doi: 10.1186/s12871-022-01629-1 [22] 应建新,尹国红,季士本. 经皮肾镜取石术后患者发生尿路感染预警模型的建立[J]. 现代泌尿外科杂志,2021,26(12):1042-1046. doi: 10.3969/j.issn.1009-8291.2021.12.012 [23] 蔡高平,杨成,杨旭凯,等. 经皮肾镜碎石术后尿脓毒血症发生的独立危险因素预测模型研究[J]. 微创泌尿外科杂志,2020,9(5):330-336. [24] 甘伟胜,零云,陈武强,等. 血浆胶原凝集素-11对复杂性上尿路感染相关尿脓毒症的预测作用[J]. 中华医院感染学杂志,2022,32(20):3093-3097. [25] 严超,王树声,段迪程,等. 术前尿培养阴性患者微创经皮肾镜碎石取石术后发生尿脓毒症的危险因素[J]. 现代泌尿外科杂志,2023,28(1):42-45. doi: 10.3969/j.issn.1009-8291.2023.01.010 [26] 尹飞挺,张健,孙洪芹. 尿U-HBP、NGAL、U-NIT对糖尿病合并无症状性菌尿患者的诊断及疗效预测价值[J]. 临床与病理杂志,2022,42(6):1328-1334. doi: 10.3978/j.issn.2095-6959.2022.06.010 [27] 赵媛,刘晶,宁欣. 动态监测老年重症肺炎患者IL-6、HBP、CRP水平对并发脓毒症的预测价值[J]. 河北医药,2023,45(11):1628-1631. doi: 10.3969/j.issn.1002-7386.2023.11.005 [28] 陈俊,邵俊,马爱闻. 联合检测外周血TIRAP、FOXO3a、HBP预测脓毒症患者近期预后的价值及意义[J]. 中国急救复苏与灾害医学杂志,2024,19(3):340-345. -
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