PCT和D-D及血流变学与慢性肾病血液透析继发肺部感染的关系分析

Relationship between PCT,D-D,hemorheology and secondary pulmonary infection in chronic kidney disease after hemodialysis

目的探讨降钙素原(PCT)、D-二聚体(D-D)及血流变学与慢性肾病(CKD)血液透析继发肺部感染的关系。方法选取2019年1月-2021年9月期间于联勤保障部队第九〇四医院常州医疗区血液透析中心收治的82例CKD血液透析患者作为研究对象,根据患者透析治疗3个月期间继发肺部感染情况将其分为感染组(n=28)和非感染组(n=54),检测患者入院时血清PCT、D-D、血流变学指标(低切表观黏度、高切表观黏度和血浆黏度)水平,采用单因素、多因素logisitic回归分析以及受试者工作特征(ROC)曲线分析以上血清指标、血流变学指标水平与CKD血液透析患者继发肺部感染的关系。并根据肺炎严重指数(PSI)将感染组患者分为轻/中度组(n=17)和重度组(n=11),分析感染程度与各指标的关系。结果感染组患者的PCT、D-D、低切表观黏度、高切表观黏度和血浆黏度水平[(2.18±0.39)ng/mL、(675.24±65.57)ng/mL、(12.96±2.04)mpa·s、(8.82±1.31)mpa·s、(1.92±0.34)mpa·s]均高于非感染组[(0.26±0.08)ng/mL、(381.65±40.43)ng/mL、(8.57±1.12)mpa·s、(7.69±1.04)mpa·s、(1.16±0.26)mpa·s],差异均有统计学意义(t=34.973、25.044、12.608、4.263、11.274,P均<0.05)。ROC曲线分析结果显示,PCT、D-D、低切表观黏度、高切表观黏度和血浆黏度联合检测预测CKD血液透析患者肺部感染的曲线下面积(AUC)值为0.908,明显高于PCT、D-D、低切表观黏度、高切表观黏度和血浆黏度单独预测的0.810、0.744、0.718、0.709、0.611,差异均有统计学意义(P均<0.05)。影响CKD血液透析患者继发肺部感染的单因素分析结果显示,2组在是否合并糖尿病、肾功能、白蛋白、PCT、D-D、低切表观黏度和高切表观黏度水平方面比较差异均有统计学意义(P均<0.05);多因素回归分析结果显示,合并糖尿病、白蛋白<35 g/L、PCT≥1.68 ng/mL、D-D≥479.25 ng/mL、低切表观黏度≥10.62 mpa·s是CKD血液透析患者继发肺部感染的独立影响因素。重度组患者PCT、D-D、低切表观黏度、高切表观黏度和血浆黏度水平均高于轻/中度组,差异均有统计学意义(P均<0.05)。结论血清PCT、D-D和血流变学指标在血液透析继发肺部感染患者血清中处于较高水平,且各指标与患者感染程度相关,联合检测以上各项指标水平对于临床上诊断CKD血液透析患者继发肺部感染的应用价值较高。

Objective To explore the relationship between procalcitonin(PCT),D-dimer(D-D),hemorheology and secondary pulmonary infection in chronic kidney disease(CKD)after hemodialysis.Methods A total of 82 hemodialysis patients with CKD admitted to the Hemodialysis Center,Changzhou Medical District,the 904th Hospital of Joint Logistic Support Force,were retrospectively enrolled as the research objects between January 2019 and September 2021.The patients were divided into infection group(n=28)and non-infection group(n=54)according to the secondary pulmonary infection during 3 months of dialysis treatment.The levels of serum PCT,D-D and hemorheology indexes(low-shear apparent viscosity,high-shear apparent viscosity and plasma viscosity)were detected at admission.The relationship between the above serum indexes,hemorheology indexes and secondary pulmonary infection was analyzed by univariate,multivariate logistic regression and receiver operating characteristic(ROC)curve analysis.According to pneumonia severity index(PSI),patients in infection group were divided into mild/moderate group(n=17)and severe group(n=11).The relationship between infection degree and different indexes was analyzed.Results The levels of PCT,D-D,low-shear apparent viscosity,high-shear apparent viscosity and plasma viscosity in infection group[(2.18±0.39)ng/mL,(675.24±65.57)ng/mL,(12.96±2.04)mpa·s,(8.82±1.31)mpa·s,(1.92±0.34)mpa·s]were higher than those in non-infection group[(0.26±0.08)ng/mL,(381.65±40.43)ng/mL,(8.57±1.12)mpa·s,(7.69±1.04)mpa·s,(1.16±0.26)mpa·s],the differences were statistically significant(t=34.973,25.044,12.608,4.263,11.274;all P<0.05).The results of ROC curve analysis showed that area under curve(AUC)of PCT combined with D-D,low-shear apparent viscosity,high-shear apparent viscosity and plasma viscosity for predicting pulmonary infection was 0.908,significantly greater than that of single index(0.810,0.744,0.718,0.709,0.611),the differences were statistically significant(all P<0.05).The results of univariate analysis showed that there were significant differences between the two groups in diabetes mellitus,renal function,albumin,PCT,D-D,low-shear apparent viscosity and high-shear apparent viscosity(all P<0.05).The results of multivariate regression analysis showed that diabetes mellitus,albumin<35 g/L,PCT≥1.68 ng/mL,D-D≥479.25 ng/mL and low-shear apparent viscosity≥10.62 mpa·s were independent influencing factors of secondary pulmonary infection in hemodialysis patients with CKD.The levels of PCT,D-D,low-shear apparent viscosity,high-shear apparent viscosity and plasma viscosity in severe group were higher than those in mild/moderate group,the differences were statistically significant(all P<0.05).Conclusions The levels of serum PCT,D-D and hemorheology indexes were relatively higher in hemodialysis patients with secondary pulmonary infection.The combined detection of the above indexes had higher diagnostic value for secondary pulmonary infection in CKD after hemodialysis.