Department of Urology, GOP Taksim Education Training and Research Hospital, Karayolları Str. No:621 Gaziosmanpasa, İstanbul, Turkey.
Department of Urology, Yeniyüzyıl University Medicine Faculty, Gaziosmanpaşa Hospital, İstanbul, Turkey.
BMC Urol. 2020 Apr 19;20(1):42. doi: 10.1186/s12894-020-00608-3.
Medical expulsive therapy (MET) is recommended for ureteral stones when there is no indication for interventional treatment. Spontaneous passage (SP) may not always be perceived in patients undergoing MET. We aimed to demonstrate the effects of inflammatory factors on spontaneous ureteral stone passage in patients undergoing MET.
Our study was conducted between August and November, 2016, in healthy volunteers and patients with a single distal ureteral stone between 5 and 10 mm in diameter and no indications for interventional therapy. Blood and urine samples from all patients and healthy volunteers were tested. The patients were followed up every 2 weeks for 1 month unless emergency situations appeared. Patients with stone-free status at follow-up were concluded to have achieved complete stone passage [SP(+)], and failure [SP(-)] was concluded if the patient had not passed the stone by the end of the study. Blood samples of the patients and the control group were analyzed, recording WBC (white blood cell), CRP (c-reactive protein), SED (sedimentation), MPV (mean platelet volume), NLR (neutrophil-to-lymphocyte ratio), and serum procalcitonin levels. Abnormalities in urine samples were recorded. All patients received diclofenac sodium 75 mg/day, tamsulosin 0.4 mg/day, and at least 3 l/day fluid intake. Patients were followed for a month with kidney, ureter, bladder (KUB) plain films, ultrasonography (USG), and unenhanced abdominal CT scans while undergoing MET. Comparative statistical analyses were performed between the SP(+) and SP(-) groups.
The procalcitonin levels of the SP(-) group were significantly higher (207 ± 145.1 pg/ml) than in the SP(+) group (132.7 ± 28.1 pg/ml) (p = 0.000). The leucocyturia rate of the SP(-) group was significantly higher than in the SP(+) group (p = 0.004). Based on the ROC curve analysis, 160 pg/ml (86.7% sensitivity, 70.8% specificity, p < 0.001; AUC: 0.788 95% CI (0.658-0.917) was identified as the optimal cut-off value for procalcitonin. In logistic regression analysis, a significant efficacy of procalcitonin and leucocyturia was observed in the univariate analysis on spontaneous passage. In the multivariate analysis, significant independent activity was observed with procalcitonin. (p < 0.05).
Our findings suggest that high procalcitonin levels and the presence of leucocyturia have a strong negative effect on SP of ureteral stones between 5 and 10 mm in diameter. This relationship can be explained by stone impaction, possibly caused by increased mucosal inflammation.
当没有介入治疗指征时，医学排石疗法（MET）被推荐用于输尿管结石。接受 MET 的患者不一定能感知到自发排石（SP）。我们旨在证明炎症因子对接受 MET 的患者输尿管结石自发排出的影响。
我们的研究于 2016 年 8 月至 11 月在健康志愿者和直径 5-10mm 的单一远端输尿管结石且无介入治疗指征的患者中进行。对所有患者和健康志愿者的血液和尿液样本进行检测。除非出现紧急情况，否则患者将在 1 个月内每 2 周随访一次。如果患者在研究结束时仍未排出结石，则将其归为完全结石排出（SP(+)），否则为失败（SP(-)）。分析患者和对照组的血液样本，记录白细胞计数（WBC）、C 反应蛋白（CRP）、沉降率（SED）、平均血小板体积（MPV）、中性粒细胞与淋巴细胞比值（NLR）和血清降钙素原水平。记录尿液样本中的异常情况。所有患者均接受双氯芬酸钠 75mg/天、坦索罗辛 0.4mg/天和至少 3L/天的液体摄入。接受 MET 的患者在 1 个月内进行肾脏、输尿管、膀胱（KUB）平片、超声检查（USG）和非增强腹部 CT 扫描随访。对 SP(+)和 SP(-)组进行了比较统计分析。
SP(-)组的降钙素原水平明显高于 SP(+)组（207±145.1pg/ml 比 132.7±28.1pg/ml，p=0.000）。SP(-)组的白细胞尿发生率明显高于 SP(+)组（p=0.004）。基于 ROC 曲线分析，160pg/ml（86.7%的灵敏度，70.8%的特异性，p<0.001；AUC：0.788，95%CI（0.658-0.917））被确定为降钙素原的最佳截断值。在单因素分析中，降钙素和白细胞尿对自发性排石有显著疗效，在逻辑回归分析中。在多因素分析中，降钙素具有显著的独立活性。（p<0.05）。
我们的研究结果表明，5-10mm 直径的输尿管结石直径的高降钙素水平和白细胞尿对 SP 有强烈的负面影响。这种关系可以用结石嵌顿来解释，可能是由于黏膜炎症增加所致。
