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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