肾结石患者肠道菌群改变与PNUL术后复发的关系探讨-东南大学学报医学版

肾结石患者肠道菌群改变与PNUL术后复发的关系探讨

单位：湖南省中西医结合医院(湖南省中医药研究院附属医院) 泌尿外科, 湖南长沙 410006

分类号：R692.4

出版年·卷·期（页码）：2025·44·第六期（953-959）

摘要：

目的: 探讨肾结石患者肠道菌群改变与经皮肾镜超声碎石术(PNUL)术后复发的关系。方法: 选取2020年4月至2022年11月本院收治的269例行PNUL治疗的肾结石患者作为研究对象,于手术前后通过特殊培养基培养检测肠道菌群分布情况。另根据PNUL术后随访1年期间复发情况,将研究对象进一步分为复发组(n=45)和未复发组(n=224)。比较患者肠道菌群分布情况,并采用多因素Logistic回归分析法分析肾结石患者PNUL术后复发的影响因素。结果: 肾结石患者术后乳酸杆菌、双歧杆菌、草酸杆菌的数量较术前升高(P＜0.05),大肠埃希菌的数量较术前降低(P＜0.05);术后两组双歧杆菌、草酸杆菌、乳酸杆菌的数量均较术前升高(P＜0.05),大肠埃希菌的数量则较术前降低(P＜0.05),且复发组术后双歧杆菌、草酸杆菌、乳酸杆菌的数量低于未复发组(P＜0.05),大肠埃希菌的数量高于未复发组(P＜0.05);复发组年龄＞70岁、术前尿常规白细胞“+++”、术后合并泌尿系感染占比均高于未复发组(P＜0.05);多因素Logistic回归分析显示,术后肠道乳酸杆菌、双歧杆菌、草酸杆菌是肾结石患者PNUL术后复发的保护因素(P＜0.05),术后大肠埃希菌以及年龄＞70岁、术前尿常规白细胞“+++”、术后合并泌尿系感染则是危险因素(P＜0.05)。结论: 肾结石患者肠道菌群失调,且术后肠道乳酸杆菌、双歧杆菌、草酸杆菌、大肠埃希菌变化均与患者PNUL术后肾结石的发生有关,临床可采取针对性的防治措施调整肠道菌群失调,以减少肾结石的复发。

Objective: To investigate the relationship between the changes of intestinal flora in patients with renal calculi and the recurrence after percutaneous nephrolithotomy ultrasonic lithotripsy(PNUL). Methods: A total of 269 patients with renal calculi treated with PNUL in our hospital from April 2020 to November 2022 were selected as the research objects, and the distribution of intestinal flora was detected by culturing in special media before and after operation. According to the recurrence during the 1 year follow-up after PNUL, the subjects were further divided into the recurrence group(n=45) and the non-recurrence group(n=224). The distribution of intestinal flora in patients was compared, and the influencing factors of recurrence after PNUL in patients with renal calculi was analyzed by multivariate Logistic regression analysis. Results: The numbers of Lactobacillus, Bifidobacterium and Oxalobacter in patients with renal calculi after operation were higher than those before operation(P<0.05), but the number of Escherichia coli was lower than that before operation(P<0.05). The numbers of Lactobacillus, Bifidobacterium and Oxalobacter in the two groups after operation were higher than those before operation(P<0.05), but the number of Escherichia coli was lower than that before operation(P<0.05). The numbers of Lactobacillus, Bifidobacterium and Oxalobacter in the recurrence group after operation were lower than those in the non-recurrence group(P<0.05), while the number of Escherichia coli was higher than that in the non-recurrence group(P<0.05). The proportion of age >70 years old, preoperative urine routine white blood cell ‘+++’ and postoperative urinary tract infection in the recurrence group were higher than those in the non-recurrence group(P<0.05). The multivariate Logistic regression analysis showed that postoperative intestinal Lactobacillus, Bifidobacterium and Oxalobacter were protective factors for recurrence after PNUL in patients with renal calculi, and postoperative Escherichia coli, age >70 years old, preoperative urine routine white blood cells ‘+++’ and postoperative urinary tract infection were risk factors(P<0.05). Conclusion: Patients with renal calculi has intestinal flora imbalance, and the changes of postoperative intestinal Lactobacillus, Bifidobacterium, Oxalobacter and Escherichia coli are related to the occurrence of renal calculi after PNUL, and targeted prevention and treatment measures can be taken to adjust the imbalance of intestinal flora, in order to reduce the recurrence of renal calculi.

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