微创医学

目的探讨肝素结合蛋白（HBP）、白蛋白（ALB）及CD4+T细胞在HIV/AIDS患者上尿路结石术后并发尿脓毒血症的早期诊断价值。方法回顾性分析102例HIV/AIDS合并上尿路结石患者，行微创技术碎石后，其中并发尿脓毒血症（观察组）31例，未并发尿脓毒血症（对照组）71例。比较两组患者的临床资料，分析上尿路结石术后发生尿脓毒血症的影响因素，评估HBP、ALB、CD4+T细胞计数单独检测及三指标联合检测对HIV/AIDS患者上尿路结石术后发生尿脓毒血症的预测价值。结果纳入102例患者中，术后有31例（30.4%）患者出现尿脓毒血症（观察组），71例未出现尿脓毒血症（对照组）。两组患者的性别、结石部位、尿培养阳性率及尿亚硝酸盐阳性率差异均有统计学意义（均P<0.05）。术后6 h，观察组HBP水平高于对照组，ALB及CD4+T细胞水平均低于对照组（均P<0.05）。多因素Logistic回归分析结果显示，性别、术前尿培养阳性、亚硝酸盐阳性、术后HBP水平增高、ALB水平降低、CD4+T细胞计数减少均为HIV/AIDS合并上尿路结石患者术后并发尿脓毒血症的独立危险因素（均P<0.05）。截断值HBP为13.5 pg/mL、ALB为33.05 g/L、CD4+T细胞计数246个/μL时，诊断尿脓毒血症的ROC曲线下面积分别为0.990、0.887、0.851；HBP、ALB及CD4+T细胞计数联合检测的曲线下面积为0.994（95%CI：0.000～1.000，灵敏度100.00%，特异度95.77%），联合检测具有更高的灵敏度和阴性预测值。结论 HBP、ALB及CD4+T细胞计数可作为预测HIV/AIDS合并上尿路结石患者术后并发尿脓毒血症的可靠指标，联合检测具有更高的预测价值。

Objective To investigate the early diagnostic value of heparin-binding protein (HBP), albumin (ALB) and CD4+T cells in urosepsis after upper urinary tract calculus surgery in HIV/AIDS patients. Methods A retrospective analysis of 102 HIV/AIDS patients with upper urinary tract calculus. After minimally invasive lithotripsy, 31 cases were complicated with urosepsis (observation group) and 71 cases were not complicated with urosepsis (control group). To compare the clinical data of the two groups of patients, analyze the influencing factors of urosepsis after upper urinary tract calculus surgery, and evaluate the predictive value of separate detection of HBP, ALB, CD4+T cell count and combined detection of the above three indicators for urosepsis after upper urinary tract calculus surgery in HIV / AIDS patients. Results Among the 102 patients, 31 patients (30.4%) had urosepsis after surgery (observation group), and 71 patients did not have urosepsis (control group). There were statistically significant differences in gender, stone location, urine culture positivity rate, and urine nitrite positivity rate between the two groups of patients (all P<0.05). At 6 hours after surgery, the level of HBP in the observation group was higher than that in the control group, and the levels of ALB and CD4+T cells were lower than those in the control group (all P<0.05). The result of multivariate Logistic regression analysis showed that gender, positive preoperative urine culture, positive nitrite, increased postoperative HBP level, decreased ALB level, and decreased CD4+T cell count were independent risk factors for urosepsis after surgery in HIV/AIDS patients with upper urinary tract calculus (all P<0.05). When the cut-off values of HBP was 13.5 pg/mL, ALB was 33.05 g/L and CD4+T cell count was 246 cells/μL, the area under the ROC curve for the diagnosis of urosepsis was 0.990, 0.887 and 0.851, respectively; and the area under the curve of the combined detection of HBP, ALB and CD4+T cell count was 0.994 (95%CI: 0.000—1.000, sensitivity 100.00%, specificity 95.77%), and the combined detection had higher sensitivity and negative predictive value. Conclusion HBP, ALB and CD4+T cell count can be used as reliable indicators to predict urosepsis in patients with HIV/AIDS complicated with upper urinary tract calculus after surgery, and the combined detection has higher predictive value.