【摘要】 目的 探讨术前血清Toll样受体4(TLR4)/核转录因子-κB(NF-κB)与尿白细胞酯酶（ULE）对输尿管软镜钬激光碎石术（F-URS）后尿路感染的联合预测价值。方法 选取自贡市第四人民医院2023年1月至2024年5月收治的上尿路结石患者300例作为研究对象进行前瞻性研究，所有患者均行F-URS术治疗，根据术后是否发生尿路感染分为感染组（46例）与无感染组（254例），比较两组基线资料，术前血清TLR4、NF-κB水平，ULE阳性率。采用Pearson相关系数分析术前血清TLR4、NF-κB、ULE与常规炎症指标[白细胞计数（WBC）、C反应蛋白（CRP）、降钙素原（PCT）]的相关性；Logistic回归分析术前血清TLR4、NF-κB、ULE与尿路感染的关系；受试者工作特征（ROC）曲线及曲线下面积（AUC）评价术前血清TLR4、NF-κB、ULE及常规炎症指标对尿路感染的预测价值。结果 感染组年龄，既往结石手术史比例，术前WBC、CRP、PCT水平高于无感染组（P<0.05）；感染组术前血清TLR4、NF-κB水平高于无感染组，ULE阳性率低于无感染组（P<0.05）;ULE阳性患者术前血清TLR4、NF-κB水平高于ULE阴性患者（P<0.05）;Logistic回归分析，年龄、既往结石手术史、术前血清TLR4、NF-κB、ULE是F-URS术后尿路感染的独立影响因素（P<0.05）；之后校正年龄、既往结石手术史，结果显示术前血清TLR4、NF-κB、ULE仍是F-URS术后尿路感染的独立影响因素（P<0.05）;ROC曲线分析，术前血清TLR4、NF-κB、ULE预测F-URS术后尿路感染的AUC为0.778、0.763、0.751，略高于常规炎症指标WBC、CRP、PCT的AUC(0.726、0.735、0.725)；之后构建术前血清TLR4、NF-κB、ULE联合预测模型，获取术前血清TLR4、NF-κB与ULE联合预测F-URS术后尿路感染的AUC为0.921，较各指标单独预测价值显著提升（Z=3.621、3.805、4.033,P均<0.001）。结论 术前血清TLR4/NF-κB联合ULE能较为可靠地预测F-URS术后尿路感染风险，可帮助临床采取科学的防治措施。更多还原

【Abstract】 Objective To explore the combined predictive value of preoperative serum Toll-like receptor 4(TLR4)/nuclear factor-kappa B(NF-κB) and urinary leukocyte esterase(ULE) for urinary tract infection(UTI) after flexible ureteroscopic holmium laser lithotripsy(F-URS). Methods A prospective study was conducted on 300 patients with upper urinary tract calculi admitted to Zigong Fourth People’s Hospital from January 2023 to May 2024. All patients underwent F-URS. According to the occurrence of postoperative UTI, patients were divided into the infection group(46 cases) and the non-infection group(254 cases). Baseline data, preoperative serum levels of TLR4 and NF-κB, and positive rate of ULE were compared between the two groups. Pearson correlation coefficient was used to analyze the correlations between preoperative serum TLR4, NF-κB, ULE and conventional inflammatory indicators [white blood cell count(WBC), C-reactive protein(CRP), procalcitonin(PCT)]. Logistic regression analysis was performed to explore the relationship between preoperative serum TLR4, NF-κB, ULE and postoperative UTI. Receiver operating characteristic(ROC) curve and area under the curve(AUC) were used to evaluate the predictive value of preoperative serum TLR4, NF-κB, ULE and conventional inflammatory indicators for postoperative UTI. Results The infection group had higher age, higher proportion of previous stone surgery history, and higher preoperative levels of WBC, CRP and PCT than the non-infection group(all P<0.05). Preoperative serum levels of TLR4 and NF-κB in the infection group were higher than those in the non-infection group, and positive rate of ULE were lower than those in the non-infection group(all P<0.05). Patients with positive ULE had higher preoperative serum levels of TLR4 and NF-κB than those with negative ULE(all P<0.05). Logistic regression analysis showed that age, previous stone surgery history, preoperative serum TLR4, NF-κB and ULE were independent influencing factors for postoperative UTI after F-URS(all P<0.05). After adjusting for age and previous stone surgery history, preoperative serum TLR4, NF-κB and ULE remained independent influencing factors for postoperative UTI after F-URS(all P<0.05). ROC curve analysis showed that the AUCs of preoperative serum TLR4, NF-κB and ULE for predicting postoperative UTI after F-URS were 0.778, 0.763 and 0.751, respectively, which were slightly higher than those of conventional inflammatory indicators WBC, CRP and PCT(0.726,0.735 and 0.725). Subsequently, a combined prediction model of preoperative serum TLR4, NF-κB and ULE was constructed. The AUC of the combined prediction of preoperative serum TLR4, NF-κB and ULE for postoperative UTI after F-URS was 0.921, which was significantly higher than the predictive value of each indicator alone(Z=3.621,3.805,4.033, all P<0.001). Conclusion Preoperative serum TLR4/NF-κB combined with ULE can reliably predict the risk of UTI after F-URS, which can help clinicians take scientific prevention and treatment measures.更多还原