目的分析复杂性肾结石术后感染的相关危险因素及其与微小RNA（miRNA）-451、miRNA-218表达及磷脂酰肌醇-3（PI3K）/蛋白激酶B信号作用通道（Akt）蛋白通路表达的关系。
方法选取宁波市第四医院于2021年3月至2024年3月收治的复杂性结石患者213例为研究对象，均行经皮肾镜碎石取石术（PCNL），记录患者术后感染发生情况。采用实时荧光定量PCR法（qRT-PCR）测定血清miRNA-145和miRNA-218表达；采用Western Blot法测定PI3K和Akt蛋白表达。多因素logistic回归分析复杂性肾结石术后感染危险因素；比较复杂性肾结石术后感染组与无感染组血清miRNA-145和miRNA-218表达、PI3K和Akt蛋白灰度值；Pearson分析miRNA-145、miRNA-218、PI3K和Akt表达与术后感染相关性。
结果复杂性结石患者213例中，PCNL术后发生感染患者46例，占21.60%；未发生感染患者167例，占78.40%。两组性别、年龄、合并高血压、合并冠心病和吸烟史比较，差异无统计学意义（ P > 0.05）；感染组结石直径 ≥ 3 cm占比［78.26%（36/46）］高于无感染组［47.31%（79/167）］，合并糖尿病占比［30.43%（14/46）］高于无感染组［10.79%（18/167）］，中重度肾积水占比［89.13%（41/46）］高于无感染组［68.86%（115/167）］，手术时间 ≥ 60 min占比［86.96%（40/46）］高于无感染组［61.68%（103/167）］，术后留置导尿管 ≥ 7 d占比［69.57%（32/46）］高于无感染组［23.95%（40/167）］（ χ 2=13.91、10.91、7.55、10.44、33.53，均 P < 0.05）。结石直径 ≥ 3 cm、合并糖尿病、中重度肾积水、手术时间 ≥ 60 min及术后留置导尿管 ≥ 7 d等为影响复杂性肾结石术后感染独立危险因素（ OR=7.192、4.870、5.089、12.988、9.007）。感染组血清miRNA-145相对表达量（1.37±0.38）和miRNA-218相对表达量（0.76±0.21），均低于无感染组的（2.86±0.62）和（1.97±0.38）（ t=15.50、20.71，均 P < 0.001）。感染组PI3K蛋白表达灰度值（1.23±0.31）和Akt蛋白表达灰度值（0.98±0.23），均高于无感染组的（0.68±0.20）和（0.42±0.12）（ t=14.49、22.36，均 P < 0.001）。采用Pearson分析miRNA-145、miRNA-218与术后感染呈负相关，PI3K和Akt表达与术后感染呈正相关（ r=-0.57、-0.48、0.62、0.59，均 P < 0.001）。
结论复杂性肾结石术后感染受多因素影响，其中结石直径、合并糖尿病、肾积水程度、手术时间和术后留置导尿管时间为其独立危险因素；且术后感染患者miRNA-145和miRNA-218低表达，而PI3K和Akt蛋白高表达。
ObjectiveTo analyze the risk factors for infection after surgery for complex kidney stones and to investigate their correlation with the expressions of microRNA (miRNA)-451 and miRNA-218, as well as the phosphoinositide 3-kinase (PI3K)/protein kinase B (Akt) signaling pathway.
MethodsA total of 213 patients with complex kidney stones who were admitted to Ningbo Fourth Hospital from March 2021 to March 2024 were included in this study. All patients underwent percutaneous nephrolithotomy (PCNL), and the occurrence of postoperative infections was recorded. The expression levels of serum miRNA-145 and miRNA-218 were measured using quantitative real-time PCR (qRT-PCR), while the expression of PI3K and Akt proteins was determined using Western blot assay. Multivariate logistic regression was performed to analyze the risk factors associated with infection after surgery for complex kidney stones. The expression levels of serum miRNA-145 and miRNA-218, as well as the grayscale values of PI3K and Akt proteins, were compared between the infection and non-infection groups. Pearson correlation analysis was conducted to assess the correlation between the expression of miRNA-145, miRNA-218, PI3K, and Akt and the occurrence of postoperative infections.
ResultsAmong the 213 patients with complex kidney stones, 46 (21.60%) developed infections after PCNL, while 167 (78.40%) did not. There were no statistically significant differences between the two groups in terms of sex, age, history of hypertension, history of coronary heart disease, and history of smoking (all P > 0.05). The proportion of patients in the infection group with stone diameters ≥ 3 cm was higher than that in the non-infection group [78.26% (36/46) vs. 47.31% (79/167)]. The proportion of patients with diabetes in the infection group was higher than that in the non-infection group [30.43% (14/46) vs. 10.79% (18/167)]. Moreover, the incidence of moderate to severe hydronephrosis in the infection group was higher than that in the non-infection group [ 89.13% (41/46) vs. 68.86% (115/167)]. The proportion of patients with a surgical duration of ≥ 60 minutes in the infection group was higher than that in the non-infection group [86.96% (40/46) vs. 61.68% (103/167)]. Additionally, the proportion of patients in the infection group with a duration of postoperative urinary catheterization of ≥ 7 days was significantly higher than that in the non-infection group [69.57% (32/46) vs. 23.95% (40/167)]. The differences in stone diameter ≥ 3 cm, presence of diabetes, moderate to severe hydronephrosis, surgical duration ≥ 60 minutes, and postoperative urinary catheterization duration ≥ 7 days between the two groups were statistically significant ( χ² = 13.91, 10.91, 7.55, 10.44, 33.53, all P < 0.05). Factors such as stone diameter ≥ 3 cm, presence of diabetes, moderate to severe hydronephrosis, surgical duration ≥ 60 minutes, and postoperative urinary catheterization duration ≥ 7 days were identified as independent risk factors for infection after surgery for complex kidney stones ( OR = 7.192, 4.870, 5.089, 12.988, 9.007). In the infection group, the relative expression levels of serum miRNA-145 and miRNA-218 were (1.37 ± 0.38) and (0.76 ± 0.21), respectively, which were significantly lower than those in the non-infection group [(2.86 ± 0.62), (1.97 ± 0.38), t = 15.50, 20.71, both P < 0.001]. In the infection group, the grayscale values of PI3K protein expression and Akt protein expression were (1.23 ± 0.31) and (0.98 ± 0.23), respectively, which were significantly higher than those in the non-infection group [(0.68 ± 0.20), (0.42 ± 0.12), t = 14.49, 22.36, both P < 0.001]. Pearson correlation analysis revealed that the expressions of miRNA-145 and miRNA-218 were negatively correlated with postoperative infections, while the expressions of PI3K and Akt were positively correlated with postoperative infection ( r = -0.57, -0.48, 0.62, 0.59, all P < 0.001).
ConclusionsPostoperative infection in complex kidney stones is influenced by multiple factors, among which stone diameter, presence of diabetes, degree of hydronephrosis, surgical duration, and duration of postoperative urinary catheterization are independent risk factors. Additionally, patients with postoperative infection exhibit low expression levels of miRNA-145 and miRNA-218, while PI3K and Akt proteins show high expression levels.
马飞跃,丁春珊. 复杂性肾结石术后感染相关危险因素分析及与miRNA-145、miRNA-218和PI3K/Akt蛋白通路表达的关系[J]. 中国基层医药,2025,32(03)：426-431.
DOI:10.3760/cma.j.cn341190-20240730-00976版权归中华医学会所有。
未经授权，不得转载、摘编本刊文章，不得使用本刊的版式设计。
除非特别声明，本刊刊出的所有文章不代表中华医学会和本刊编委会的观点。
马飞跃：试验设计、采集数据、起草文章；丁春珊：统计分析、技术支持
文档即答
智问智答
机器翻译
你好，我可以帮助您更好的了解本文，请向我提问您关注的问题。
