Abstract: Background　Acute renal colic（ARC） is an emergency that can be treated conservatively，but its combination with urinary tract infection（UTI） can be life-threatening.Infection evaluation parameters include white blood cell count（WBC） and C-reactive protein（CRP） levels，but they may not significant increase.Objective　To evaluate the prevalence of UTI in ARC patients diagnosed based on urine culture，and the predictive value of emergency routine blood and urine tests in ARC with UTI.Methods　200 consecutive patients with ARC due to ureteral calculi were recruited from Emergency Department，Hainan General Hospital from December 2017 to December 2018，196 ARC patients met the inclusion and exclusion criteria，including 26 with UTI（infected group） and 170 without（non-infected group） diagnosed by 3 times of urine culture.General information，including gender，age，time from onset of symptoms to emergency visit，average temperature，history of diabetes and immunodeficiency was collected.White blood cell count，and serum CRP were measured，and nitrite urine test and midstream urine culture were performed.Multivariate logistic regression analysis was used to explore the influencing factors of emergency ARC with UTI.ROC curve analysis was used to evaluate the clinical value of predictive parameters in emergency ARC with UTI.Results　The infected group had higher age，higher prevalence of positive result of nitrite in urine and higher average serum CRP than non-infected group（P<0.05）.Multivariate Logistic regression analysis showed that age，nitrite in urine，and CRP were the influencing factors of UTI in ARC patients（P<0.05）.For the prediction of UTI in ARC，the AUC of age was 0.754〔95%CI（0.688，0.813）〕 with 65.4% sensitivity，76.5% specificity，93.5% negative predictive value（NPV） and 29.8% positive predictive value（PPV） when the optimal cut-off point was determined as 56 years old，the AUC of serum CRP was 0.682〔95%CI（0.612，0.747）〕 with 53.9% sensitivity，80.6% specificity，91.9% NPV and 29.8% PPV when the optimal cut-off point was determined as 8.3 mg/L，and the AUC of positive result of nitrite in urine was 0.698〔95%CI（0.597，0.905）〕 with 69.2% sensitivity，93.0% specificity，94.2% NPV，and 30.3% PPV.Conclusion　Age，nitrite in urine，and serum CRP are associated with UTI in ARC.≥56 years old，serum CRP≥8.3 mg/L，and positive nitrite result in urine may have higher predictive value for UTI in ARC.

Key words: Renal colic, Urinary tract infections, Age, C-reactive protein, Forecasting, Root cause analysis

摘要： 背景　急性肾绞痛（ARC）是一种可以保守治疗的急症，但与尿路感染（UTI）合并可危及生命。感染评估参数包括血白细胞计数（WBC）和C反应蛋白（CRP）水平，但这些参数可能会升高不显著。目的　评估基于尿培养（UC）确诊的ARC患者的UTI发生率，以及急诊中常规血液和尿液检查结果预测ARC患者发生UTI的价值。方法　选取2017年12月—2018年12月于海南省人民医院急诊科就诊的因输尿管结石而出现ARC的患者200例，符合纳入、排除标准的ARC患者196例，其中3次UC均明确诊断UTI的26例（有感染组），无UTI的170例（无感染组）。收集患者一般资料，包括性别、年龄、出现症状到急诊就诊时间、平均体温、糖尿病病史、免疫功能低下病史UTI症状。完善血WBC、尿亚硝酸盐、CRP检查并留取中断尿行UC。多因素Logistic回归分析探讨ARC患者发生UTI的影响因素，采用受试者工作特征（ROC）曲线评价相关影响因素预测ARC患者发生UTI的临床价值。结果　有感染组年龄、尿亚硝酸阳性比例、CRP水平高于无感染组（P<0.05）。多因素Logistic回归分析结果显示，年龄、尿亚硝酸盐阳性、CRP为ARC患者发生UTI的影响因素（P<0.05）。56岁为预测ARC患者发生UTI的最佳截断值，ROC曲线下面积（AUC）95%CI为0.754（0.688，0.813）时，灵敏度为65.4%，特异度为76.5%，阴性预测值（NPV）为93.5%，阳性预测值（PPV）为29.8%；CRP 8.3 mg/L为预测ARC患者发生UTI的最佳截断值，AUC 95%CI为0.682（0.612，0.747）时，灵敏度为53.9%，特异度为80.6%，NPV为91.9%，PPV为29.8%。尿亚硝酸阳性预测ARC患者发生UTI的AUC 95%CI为0.698（0.597，0.905），灵敏度为69.2%，特异度为93.0%，NPV为94.2%，PPV为30.3%。结论　年龄、尿亚硝酸盐阳性、CRP是急诊ARC患者发生UTI的影响因素，ARC患者年龄≥56岁、CRP≥8.3 mg/L及尿亚硝酸盐阳性预测发生UTI的价值较高。

关键词: 肾绞痛, 泌尿道感染, 年龄, C反应蛋白质, 预测, 影响因素分析