尿沉渣联合尿标志物诊断肾结石经皮肾镜碎石取石术后肾损伤的临床价值研究

牛忠涛; 刘亚红; 袁宏毅; 郝强; 李东顺; 乔玉华

doi:10.3969/j.issn.1671-2390.2022.04.007

尿沉渣联合尿标志物诊断肾结石经皮肾镜碎石取石术后肾损伤的临床价值研究

Clinical value of urinary sediment plus urinary markers in the diagnosis of renal injury after percutaneous nephrolithotripsy

摘要

摘要: 目的研究尿沉渣联合尿标志物诊断肾结石经皮肾镜碎石取石术后肾损伤的临床价值。方法选取邢台医学高等专科学校第二附属医院于2018年6月至2021年2月期间收治的168例肾结石患者,均接受经皮肾镜碎石取石术,患者检测血、尿生化指标以及尿沉渣镜检。根据术后是否发生肾损伤分为损伤组、未损伤组。采用多因素Logistic回归分析术后肾损伤发生的危险因素,受试者工作特征曲线(receiver operating characteristic,ROC)分析各指标对术后肾损伤的诊断价值。结果损伤组患者术前血肌酐水平(123.76±22.72)μmol/L比(92.62±17.53)μmol/L、尿沉渣评分(0.67±0.17比0.54±0.13)及尿β2-微球蛋白(urinary β2-microglobulin,β2-MG)(156.57±31.59)μg/L比(140.14±29.27)μg/L、中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinaseassociated lipocalin,NGAL)(62.57±10.59)μg/L比(50.14±9.43)μg/L、乳酸脱氢酶(lactic dehydrogenase,LDH)(86.57±15.59)U/L比(76.14±11.27)U/L水平均明显高于未损伤组(P<0.05)。两组患者治疗后尿沉渣评分(2.74±0.56比1.36±0.27)、β2-MG(252.54±44.29)μg/L比(174.57±36.58)μg/L、NGAL(152.54±14.59)μg/L比(64.54±16.59)μg/L、LDH(142.48±21.29)U/L比(94.57±16.58)U/L均呈增加趋势,其中损伤组的变化值均明显高于未损伤组(P<0.001)。Logistic回归分析显示,术前血肌酐、尿沉渣评分、β2-MG、NGAL、LDH(OR=2.540,2.307,1.964,1.702,2.164;95%CI:1.242~5.193,1.223~4.354,1.123~3.434,1.259~2.302,1.216~3.851)是患者术后肾损伤的危险因素(P<0.05)。尿沉渣评分、β2-MG、NGAL、LDH诊断术后肾损伤的曲线下的面积(area under the curve,AUC)分别为0.801,0.827,0.791,0.772(95%CI:0.729~0.873,0.751~0.904,0.705~0.878,0.698~0.846),明显低于联合诊断0.875(95%CI:0.819~0.931),差异有统计学意义(P<0.05)。结论术前尿沉渣评分、尿标志物(β2-MG、NGAL、LDH)与肾结石经皮肾镜碎石取石术后肾损伤存在相关性,联合检测可提高肾损伤的诊断效能。

Abstract: Objective To explore the clinical value of urinary sediment plus urinary markers in the diagnosis of renal injury after percutaneous nephrolithotomy.Methods From June 2018 to February2021,a total of 168 patients with renal calculi were recruited for percutaneous nephrolithotomy. Blood and urinary biochemical parameters were measured and urine sediment microscopic examinations conducted.They were divided into two groups of injury and uninjured according to whether or not renal injury occurred postoperatively. Multivariate Logistic regression was utilized for examining the risk factors of postoperative renal injury. Receiver operating characteristic curve(ROC)was employed for analyzing the diagnostic value of each index for postoperative renal injury.Results The preoperative blood creatinine level(123.76±22.72) μmol/L vs(92.62±17.53) μmol/L,preoperative urinary sediment score(0.67±0.17)vs(0.54±0.13)and urinary β2-microglobulin(β2-MG)(156.57±31.59)μg/L vs(140.14±29.27)μg/L,neutrophil gelatinase associated lipocalin(NGAL)(62.57±10.59)μg/L vs(50.14±9.43)μg/Land lactic dehydrogenase(LDH)(86.57±15.59)U/L vs(76.14±11.27)U/Lwere significantly higher in injury group than those in uninjured group(P<0.05). The preoperative urine sediment scores(2.74±0.56 vs 1.36±0.27),urinary β2-MG(252.54±44.29)μg/L vs(174.57±36.58) μg/L,NGAL(152.54±14.59) μg/L vs(64.54±16.59) μg/L and LDH(142.48±21.29)U/L vs(94.57±16.58)U/Lof two groups showed a rising trend after treatment and the changes of injured group were significantly higher than those of uninjured group(P<0.001). Logistic regression analysis showed that preoperative blood creatinine,urinary sediment score,β2-MG,NGAL and LDH(OR=2.540,2.307,1.964,1.702,2.164;95%CI:1.242-5.193,1.223-4.354,1.123-3.434,1.259-2.302,1.216-3.851)were risk factors for postoperative renal injury(P<0.05). AUC of urinary sediment score,β2-MG,NGAL and LDH for diagnosing postoperative renal injury were 0.801,0.827,0.791 and 0.772(95%CI:0.729-0.873,0.751-0.904,0.705-0.878,0.698-0.846),Each was significantly lower than 0.875 of combined diagnosis(95%CI:0.819-0.931). The differences were statistically significant(P<0.05).Conclusion Preoperative urinary sediment score,urine markers(β2-MG,NGAL & LDH)are correlated with renal injury after percutaneous nephrolithotomy. And combined detection may improve the diagnostic efficiency of renal injury.

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