血清Sestrin2、CXCL10、HBD-3联合检测对肾结石患者术后并发尿源性脓毒血症的预测价值-东南大学学报医学版

血清Sestrin2、CXCL10、HBD-3联合检测对肾结石患者术后并发尿源性脓毒血症的预测价值

单位：1. 石家庄医学高等专科学校附属医院泌尿外科, 河北石家庄 050000;
2. 邢台市中心医院肾病科, 河北邢台 054000

关键词：应激诱导蛋白2 CXC趋化因子配体10 β-防御素-3 肾结石尿源性脓毒血症预测

分类号：R699.2

出版年·卷·期（页码）：2025·44·第五期（731-738）

摘要：

目的:探讨血清应激诱导蛋白2(Sestrin2)、CXC趋化因子配体10(CXCL10)、β-防御素-3(HBD-3)联合检测预测肾结石患者术后并发尿源性脓毒血症的价值。方法:选取邢台市中心医院2022年10月至2024年10月行经皮肾镜取石术(PCNL)治疗的183例肾结石患者为研究对象,根据肾结石患者术后7 d内是否发生尿源性脓毒血症,将183例肾结石患者分为脓毒血症组42例和非脓毒血症组141例。采用ELISA法检测肾结石患者术后2 h血清Sestrin2、CXCL10、HBD-3水平;采用多因素Logistic回归分析肾结石患者PCNL术后发生尿源性脓毒血症的影响因素;采用ROC曲线评估Sestrin2、CXCL10、HBD-3水平预测尿源性脓毒血症发生的价值;采用Kaplan-Meier生存曲线分析Sestrin2、CXCL10、HBD-3水平与患者术后28 d生存率的关系。结果:脓毒血症组患者结石大小≥3 cm、鹿角结石、术后结石培养阳性的比例高于非脓毒血症组患者(P＜0.05)。脓毒血症组患者血清Sestrin2、HBD-3水平显著低于非脓毒血症组患者,CXCL10水平显著高于非脓毒血症组患者(P＜0.05)。结石大小≥3 cm、结石形态为鹿角结石、术后结石培养阳性及CXCL10为肾结石患者PCNL术后发生尿源性脓毒血症的危险因素,Sestrin2、HBD-3为保护因素(P＜0.05)。Sestrin2、CXCL10、HBD-3水平预测尿源性脓毒血症发生的AUC分别为0.845、0.835、0.841,三者联合预测尿源性脓毒血症发生的AUC为0.929,优于Sestrin2(Z=2.308,P＜0.05)、CXCL10(Z=2.184,P＜0.05)、HBD-3(Z=2.129,P＜0.05)单独预测的AUC。Sestrin2、HBD-3低表达,CXCL10高表达患者术后28 d生存率显著低于Sestrin2、HBD-3高表达,CXCL10低表达患者(logrank=18.164、14.678、15.142,P＜0.001)。结论:Sestrin2、HBD-3在肾结石PCNL术后并发尿源性脓毒血症患者血清中下调表达,CXCL10上调表达,术后结石培养阳性及CXCL10为肾结石患者PCNL术后发生尿源性脓毒血症的危险因素,Sestrin2、HBD-3为保护因素,三者联合预测肾结石患者术后并发尿源性脓毒血症的临床价值较高。

Objective: To explore the value of combined detection of serum Sestrin2, CXC chemokine ligand 10(CXCL10), and human beta-defensin 3(HBD-3) in predicting postoperative urosepsis in patients with kidney stones. Methods: A total of 183 patients with kidney stones who underwent percutaneous nephrolithotomy(PCNL) from October 2022 to October 2024 were used as the study subjects. Based on whether urosepsis occurred within 7 days after surgery, the 183 patients with kidney stones were divided into the sepsis group with 42 cases and the non-sepsis group with 141 cases. ELISA method was used to detect the serum Sestrin2, CXCL10, and HBD-3 in patients with kidney stones at 2 h after surgery. Multivariate Logistic regression was used to analyze the influencing factors of postoperative urosepsis in patients with kidney stones undergoing PCNL. ROC curve was used to evaluate the value of Sestrin2, CXCL10, and HBD-3 in predicting the occurrence of urosepsis. Kaplan-Meier survival curve was used to analyze the relationship between Sestrin2, CXCL10, HBD-3 and the 28 d postoperative survival rate. Results: The proportions of patients with stones measuring ≥3 cm, beaded stones, and positive postoperative stone culture were significantly higher in the sepsis group than those in the non-sepsis group(P<0.05). Additionally, serum levels of Sestrin2 and HBD-3 were markedly lower in the sepsis group than those in the non-sepsis group, whereas the level of CXCL10 was significantly elevated in the sepsis group than that in the non-sepsis group(P<0.05). The stone size ≥3 cm, the stone shape of staghorn stones, positive postoperative stone culture, and CXCL10 were risk factors for postoperative urosepsis in patients with kidney stones undergoing PCNL, while Sestrin2 and HBD-3 were protective factors(P<0.05). The AUC of Sestrin2, CXCL10, and HBD-3 in predicting the occurrence of urosepsis was 0.845, 0.835, and 0.841, respectively. The AUC of the combined prediction of three factors for the occurrence of urosepsis was 0.929, which was better than that of single prediction of Sestrin2(Z=2.308, P<0.05), CXCL10(Z=2.184, P<0.05), and HBD-3(Z=2.129, P<0.05). The 28 d survival rates of patients with low expression of Sestrin2, HBD-3, and high expression of CXCL10 were manifestly lower than those of patients with high expression of Sestrin2, HBD-3, and low expression of CXCL10(logrank=18.164, 14.678, 15.142, P<0.001). Conclusion: Sestrin2 and HBD-3 are downregulated in the serum of patients with urosepsis after PCNL for kidney stones, while CXCL10 is upregulated. Positive postoperative stone culture and CXCL10 are risk factors for urosepsis after PCNL in patients with kidney stones. Sestrin2 and HBD-3 are protective factors. The combination of the three has high clinical value in predicting postoperative urosepsis in patients with kidney stones.

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