关键词: 膀胱癌, 尿路感染, 诱导型一氧化氮合酶, 铜蓝蛋白, Nod样受体蛋白3/白细胞介素-1β信号通路

Abstract:

Objective To investigate the relationship between inducible nitric oxide synthase （iNOS）， ceruloplasmin （CER）， and the Nod-like receptor protein 3 （NLRP3）/interleukin-1β （IL-1β） signaling pathway and urinary tract infection after bladder cancer surgery. Methods From August 2020 to August 2025， 102 patients who developed urinary tract infection after bladder cancer surgery and were admitted to the People's Hospital Affiliated to Shandong First Medical University were selected as the urinary tract infection group. Meanwhile， 102 patients who did not develop urinary tract infection after bladder cancer surgery during the same period were selected as the non-urinary tract infection group. The distribution of pathogenic bacteria in patients with urinary tract infection after bladder cancer surgery was analyzed. The clinical data， iNOS， CER， and the NLRP3/IL-1β signaling pathway were compared between the two groups. The influencing factors of urinary tract infection after bladder cancer surgery were analyzed using multivariate logistic regression analysis. The evaluation value of serum iNOS， CER， and the NLRP3/IL-1β signaling pathway for urinary tract infection after bladder cancer surgery was analyzed by the receiver operating characteristic （ROC） curve. Results A total of 128 strains of pathogenic bacteria were cultured from 102 patients with urinary tract infection following bladder cancer surgery. Escherichia coli and Klebsiella pneumoniae accounted for 37.50% and 17.97% respectively. The age of the urinary tract infection group was greater than that of the non-urinary tract infection group. Moreover， the proportion of patients with hypertension， diabetes， tumor stage Ⅲ/Ⅳ， operation duration > 360 min， and postoperative indwelling catheter time > 7 d was higher in the urinary tract infection group than in the non-urinary tract infection group （P < 0.05）. The levels of serum iNOS， CER， IL-1β， and peripheral blood NLRP3 in patients with urinary tract infection were higher than those in patients without urinary tract infection （P < 0.05）. Multivariate logistic regression analysis indicated that advanced age， diabetes mellitus， operation duration > 360 min， postoperative indwelling catheter time > 7 d， elevated serum iNOS level， elevated serum CER level， increased peripheral blood NLRP3 mRNA expression， and elevated serum IL-1β level were independent influencing factors of urinary tract infection after bladder cancer surgery （OR = 1.881， 4.773， 1.458， 6.322， 3.640， 2.442， 1.594， 3.677， P < 0.05）. The urinary tract infection group was considered as positive， while the non-urinary tract infection group was considered as negative. The areas under the curve （AUC） of serum iNOS， CER， NLRP3/IL-1β signaling pathway， and combined detection for evaluating urinary tract infection after bladder cancer surgery were 0.713， 0.736， 0.753， 0.747， and 0.939 respectively， and the AUC of combined detection was the highest （P < 0.05）. Conclusions Escherichia coli and Klebsiella pneumoniae were identified as the primary pathogens responsible for urinary tract infections following bladder cancer surgery. Advanced age， diabetes， an operation duration exceeding 360 minutes， a postoperative indwelling catheter time longer than 7 days， elevated serum iNOS levels， high serum CER levels， increased peripheral blood NLRP3 mRNA expression， and elevated serum IL-1β levels were determined to be independent influencing factors for urinary tract infections after bladder cancer surgery. The combination of serum iNOS， CER， and the NLRP3/IL-1β signaling pathway exhibited high evaluation value for urinary tract infections after bladder cancer surgery.

Key words: bladder cancer, urinary tract infection, inducible nitric oxide synthase, ceruloplasmin, nod-like receptor protein 3/interleukin-1β signaling pathway