NLR联合SAA、CRP检测在血液透析导管相关血流感染早期诊断中的应用价值

Application value of NLR combined with SAA and CRP detection in the early diagnosis of catheter-related bloodstream infections in hemodialysis

【目的】探究中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)联合血清淀粉样蛋白A(serum amyloid A,SAA)、C-反应蛋白(C-reactive protein,CRP)在血液透析导管相关血流感染早期诊断中的应用价值。【方法】选取2017年10月至2018年10月在本院治疗的127例尿毒症患者为研究对象,患者均行颈内静脉长期留置导管行血液透析。根据是否感染将其分为感染组29例与非感染组98例。检测NLR及血清CRP、SAA水平,并采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析NLR、SAA和CRP对血液透析导管相关血流感染的早期诊断价值。【结果】两组患者性别、年龄、体质量、透析原因、置管部位比较无显著差异(P>0.05);与未感染组比较,感染组NLR、SAA、CRP水平均显著升高,差异有统计学意义(P<0.05);ROC结果显示,NLR、SAA、CRP对血液透析导管相关血流感染诊断的曲线下面积(area under curve,AUC)分别为0.915、0.907、0.922,此时对应灵敏度分别为:85.71%、94.52%、95.90%,特异度分别为86.21%、82.76%、89.70%;三者联合检测AUC为0.942,此时的灵敏度和特异度分别为96.20%和92.30%。【结论】NLR联合SAA、CRP检测在血液透析导管相关血流感染早期诊断中具有较高价值。

【Objective】To explore the application value of neutrophil to lymphocyte ratio(NLR)combined with serum amyloid A(SAA)and C-reactive protein(CRP)in the early diagnosis of catheter-related bloodstream infections in hemodialysis.【Methods】A total of127 patients with uremia in our hospital from October 2017 to October 2018 were selected,and they all underwent hemodialysis with long-term indwelling catheter of internal jugular vein.According to infection or not,the patients were divided into infection group(29 cases)and non-infection group(98 cases).The levels of NLR,serum CRP and SAA were measured and receiver operating characteristic curve(ROC)curve was used to analyze the early diagnostic value of NLR,SAA and CRP in hemodialysis catheter-related bloodstream infection.【Results】There was no significant difference in gender,age,body mass,causes of dialysis and location of catheterization between the two groups(P>0.05).Compared with the non-infection group,the levels of NLR,SAA and CRP in the infection group increased significantly(P<0.05).The results of ROC showed that the areas under curve(AUC)of NLR,SAA and CRP for diagnosis of catheter-related bloodstream infections in hemodialysis were 0.915,0.907 and 0.922,respectively,the sensitivities were 85.71%,94.52%and 95.90%respectively,and the specificities were 86.21%,82.76%and 89.70%respectively.The combined AUC of the three methods was 0.942,and the sensitivity and specificity were 96.20%and 92.30%,respectively.【Conclusion】NLR combined with SAA and CRP detection shows a high value in the early diagnosis of catheter-related bloodstream infections in hemodialysis.