2型糖尿病肾病血液透析患者感染病原菌分布及对肾功能影响的研究

Pathogen distribution and the influence of infections on kidney functions of typeⅡ diabete patients with dialysis therapy

目的对2型糖尿病肾病血液透析患者感染病原菌分布进行分析,探讨感染对患者肾功能的影响,为临床相关治疗提供参考。方法对医院2008年5月-2014年11月诊治92例2型糖尿病肾病血液透析感染患者进行研究,设为感染组,采用BD公司的PHOENIXTM100全自动微生物鉴定系统对病原菌进行鉴定,酶联免疫吸附测定法检测患者感染后血清中肌酐、尿素氮、尿微量白蛋白及胱抑素(CysC)、脑钠肽前体(NT-proBNP)、C-反应蛋白(CRP)以及内皮素水平的变化;选取医院同期健康体检者110名为对照组,以未感染2型糖尿病肾病血液透析患者100例为未感染组。结果 92例感染患者共分离病原菌110株,其中革兰阳性菌59株,占53.6%,以表皮葡萄球菌16株,占14.5%,革兰阴性菌51株,占46.4%,以鲍氏不动杆菌13株,占11.8%;感染组患者血肌酐、尿素氮及微量尿蛋白水平明显高于同期健康体检者和未感染患者,差异有统计学意义(P<0.05);感染组患者胱抑素、脑钠肽前体、C-反应蛋白及内皮素水平明显升高,且与对照组和未感染组患者相比差异有统计学意义(P<0.01)。结论 2型糖尿病肾病血液透析患者容易受到病原菌感染,且能加剧肾损伤并增加血清中胱抑素、脑钠肽前体、C-反应蛋白及内皮素水平。

OBJECTIVE To analyze the distribution of pathogens causing infections in typeⅡ diabetic patients with dialysis therapy and to discuss the influence of infections on kidney functions so as to provide reference for clinical treatments.METHODSFrom May 2008 to Nov.2014,92 infected cases in our hospital with typeⅡ diabetes and received dialysis therapy were chosen as infection group.The infected pathogens were identified by PHOENIX TM100 and the serum creatinine,urea nitrogen,urine microalbumin,CysC,NT-proBNP,CRP and ET levels were detected by ELISA.Totally 110 cases of healthy subjects and 100 cases of non-infected patients were taken as control at the same period in our hospital.RESULTSTotally 110 stains of pathogens were identified from the 92 patients.The pathogens contained 59（53.6%）gram-positive strains,mainly including 16 strains of Staphylococcus epidermidis（14.5%）and 51（46.4%）gram-negative strains,mainly including 13 strains of Acinetobacter baumannii（11.8%）.The results also revealed that the serum Scr,BUN and micro-albuminuria were increased greatly in infected patients and the differences were significant（P〈0.01）.The results also showed that the serum endothelin,CysC, NT-proBNP and CRP were increased significantly in infected patients（P 0.01）.CONCLUSION TypeⅡ diabetic patients with dialysis are easy to suffer from pathogen infections and the infection can lead to increased endothelin,CysC,NT-proBNP and CRP and therefore,kidney disfunction.