Department of Urology, Affiliated Hospital of Hangzhou Normal University, China.
Adv Clin Exp Med. 2019 Jan;28(1):125-132. doi: 10.17219/acem/94157.
The topic of whether preoperative Th1/Th2 cells and their related factors have a predictive value for postoperative febrile urinary tract infection (UTI) in patients with ureteral calculi has not been explored.
The objective of this study was to investigate the role of preoperative Th1/Th2 cells and related cytokines in the prediction of postoperative febrile UTI after ureteroscopy in patients with ureteral calculi.
One hundred sixty patients who underwent ureteroscopic pneumatic lithotripsy in the Affiliated Hospital of Hangzhou Normal University (China) were recruited and divided into febrile UTI group (n = 78) and non-UTI group (n = 82). Flow cytometry was used to detect the proportions of Th1 and Th2 cells (Th1% and Th2%). Detection of Th1/Th2 cell-related cytokines was conducted using enzyme-linked immunosorbent assay (ELISA). Quantitative real-time polymerase chain reaction (qRT-PCR) was applied to measure the expression of T-bet and GATA3.
Compared with patients in non-UTI group, those in febrile UTI group had significantly increased proportions of Th2 cells, levels of Th2 cytokines (interleukin (IL)-4, IL-10 and IL-5), and mRNA expression of Th2-associated transcription factor GATA3 (all p < 0.05). In addition, the Th1/Th2 ratio of febrile UTI group was significantly lower than that of non-UTI group (p < 0.001). Receiver operating characteristic (ROC) curve analysis showed that the accuracy rate of Th2%, Th1/Th2 ratio, and IL-4, IL-10 and IL-5 levels for the diagnosis of postoperative febrile UTI in patients with ureteral calculi was 90.63%, 85.00%, 72.50%, 87.50%, and 91.88%, respectively, and their combined diagnostic sensitivity was 97.4% with specificity as high as 100%.
Perioperative Th2 dominance was correlated with the risk of postoperative febrile UTI after ureterscopy in patients with ureteral calculi, which can provide clinical guidance for the development of individualized treatment.
术前 Th1/Th2 细胞及其相关因素是否对输尿管结石患者术后发热性尿路感染（UTI）具有预测价值这一问题尚未得到探讨。
本研究旨在探讨术前 Th1/Th2 细胞及其相关细胞因子在预测输尿管结石患者输尿管镜术后发热性 UTI 中的作用。
选取在杭州师范大学附属医院（中国）接受输尿管镜气压弹道碎石术的 160 例患者，分为发热性 UTI 组（n=78）和非 UTI 组（n=82）。采用流式细胞术检测 Th1 和 Th2 细胞（Th1%和 Th2%）的比例。采用酶联免疫吸附试验（ELISA）检测 Th1/Th2 细胞相关细胞因子。采用实时定量聚合酶链反应（qRT-PCR）检测 T 细胞转录因子（T-bet）和 GATA 结合蛋白 3（GATA3）的表达。
与非 UTI 组患者相比，发热性 UTI 组患者的 Th2 细胞比例、Th2 细胞因子（白细胞介素（IL）-4、IL-10 和 IL-5）水平以及 Th2 相关转录因子 GATA3 的 mRNA 表达均显著升高（均 P<0.05）。此外，发热性 UTI 组的 Th1/Th2 比值明显低于非 UTI 组（P<0.001）。受试者工作特征（ROC）曲线分析显示，Th2%、Th1/Th2 比值以及 IL-4、IL-10 和 IL-5 水平对诊断输尿管结石患者术后发热性 UTI 的准确率分别为 90.63%、85.00%、72.50%、87.50%和 91.88%，联合诊断的敏感性为 97.4%，特异性高达 100%。
围手术期 Th2 优势与输尿管结石患者输尿管镜术后发热性 UTI 的风险相关，可为制定个体化治疗方案提供临床指导。
