NGAL在腹膜透析相关性腹膜炎诊断中的应用

The application of NGAL in the diagnosis of peritoneal dialysis-related peritonitis

目的探讨中性粒细胞明胶酶相关脂质运载蛋白(NGAL)在透出液中的表达及其在诊断腹膜透析相关性腹膜炎(PDRP)中的作用。方法选取60例PDRP患者(G^+菌组24例、G^-菌组16例、培养阴性组20例)为腹膜炎组,同时选择30例腹透患者作为对照组。收集患者临床资料、透出液培养结果并检测透出液中NGAL、白细胞计数(WBC)、多核细胞百分比和白细胞介素-6(IL-6)水平及全血中的C反应蛋白浓度(CRP)、WBC,分析NGAL与腹膜炎发生的相关性。结果与对照组比较,腹膜炎组患者透出液中的NGAL、WBC、多核细胞百分比、IL-6及全血中的CRP、WBC、中性粒细胞百分比显著升高,而血白蛋白、血肌酐、转铁蛋白、转铁蛋白饱和度明显降低(P <0. 05); G^+菌组、G^-菌组、培养阴性组透出液中的NGAL、WBC、多核细胞百分比、IL-6均明显高于对照组(P <0. 05)。与培养阴性组比较,G^+菌组与G^-菌组透出液中的NGAL、多核细胞百分比显著升高(P <0. 05),但G^+菌组与G^-菌组之间差异无统计学意义。腹膜炎组透出液中的NGAL与WBC呈正相关性(r=0. 492,P <0. 05);而IL-6与WBC无相关性(r=0. 034,P> 0. 05)。应用二分类logistic回归分析发现透出液中NGAL与腹膜炎发生(OR=1. 028,P <0. 05)及培养阳性(OR=0. 998,P <0. 05)显著相关,但在鉴别G^+菌与G^-菌性腹膜炎中的作用无相关性。结论腹透透出液中NGAL可作为诊断PDRP及区分培养阳性腹膜炎及菌阴性腹膜炎的指标。

Objective To investigate the expression of neutrophil gelatinase-associated lipocalin(NGAL)in the effluent and the role of NGAL in the diagnosis of peritoneal dialysis-related peritonitis(PDRP).Methods 60 patients with PDRP were collected as the peritonitis group,and all the patients were divided into three groups according to the culture results of effluent namely the culture negative group(n=20),gram positive bacteria group(n=24),and gram negative bacteria group(n=16).Meanwhile,30 peritoneal dialysis patients were choosen as the control group.Besides the clinical data of the patients,culture results of effluent,white blood cell(WBC)count,percentage of multiple nuclear cell and the level of NGAL and interleukin 6(IL-6)in the effluent were collected.In addition,the concentration of C-reactive protein(CRP)and the white blood cell count in the whole blood were detected.The correlation between NGAL and peritonitis was analyzed.Results The level of NGAL,WBC count,the percentage of multiple nuclear cells,IL-6 in the effluent and the levels of CRP,WBC count,the percentage of neutrophil in the blood of peritonitis patients were obviously higher than the control group,while the levels of serum albumin,creatinine,transferrin and transferrin saturation were lower than the control group significantly(P<0.05).Compared with the control group,the levels of NGAL,WBC count,the percentage of multiple nuclear cells and IL-6 in effluent were significantly higher in the G+group,G^-group and culture negative group(P<0.05).NGAL and the percentage of multiple nuclear cells in the effluent of G^+group and G^-group were significantly higher than that of the negative group respectively(P<0.05).However,there was no statistically significant difference between the G^+group and G^-group.In the peritonitis group,NGAL was positively correlated with WBC count in the effluent(r=0.492,P<0.05),there was no correlation between IL-6 and WBC(r=0.034,P>0.05).With the application of binary classification logistic regression analysis,the results showed that NGAL in the effluent was significantly associated with the occurrence of peritonitis(OR=1.028,P<0.05)and positive culture(OR=0.998,P<0.05).There was no significant correlation in the prediction of G^+bacterial peritonitis or G^-bacterial peritonitis.Conclusion NGAL in the effluent may be used as a reliable indicator of the occurrence of PDRP,which can help to distinguish the occurrence of positive and negative culture peritonitis.