尿毒症并发血液透析导管相关性感染免疫指标与PCT和CRP的诊断价值

Analysis of diagnostic value of immunological indicators and PCT and CRP in uremic patients complicated with hemodialysis catheter-associated infection

目的探讨尿毒症患者血液透析导管相关感染免疫指标改变及血清C-反应蛋白(CRP)、降钙素原(PCT)的诊断价值分析。方法选择攀钢总医院内分泌科2016年7月-2019年7月进行血液透析确诊导管感染的尿毒症患者40例作为感染组,另选择在医院进行血液透析的未感染尿毒症患者60例作为非感染组。对研究对象导管分泌物中病原进行培养,检测两组患者透析前后血清免疫球蛋白、CRP、PCT水平变化。结果感染组患者年龄为(68.81±6.25)岁,高于非感染组患者(P=0.007);感染组导管口分泌物中病原培养结果以革兰阳性菌为主(70.45%),金黄色葡萄球菌检出率最高(36.36%);与透析前相比,两组患者透析后免疫球蛋白M(IgM)、免疫球蛋白A(IgA)、免疫球蛋白G(IgG)、补体C3、C4、CRP、PCT均升高(P<0.001);感染组透析后IgM、IgA、IgG、C3、C4、CRP、PCT分别为(1.62±0.12)g/L、(1.91±0.21)g/L、(10.12±1.35)g/L、(1.15±0.08)g/L、(0.68±0.07)g/L、(34.21±12.18)mg/L、(0.84±0.27)μg/L高于非感染组(P<0.001);ROC分析结果表明,透析后CRP、PCT水平对尿毒症血液透析患者发生导管感染的截断值分别为12.83 mg/L、0.53 ng/ml,差异有统计学意义(P<0.001)。结论尿毒症患者血液透析发生导管相关感染后免疫指标及炎症蛋白水平明显升高,血清CRP、PCT水平变化对其具有良好的诊断效能,具有一定的临床价值。

OBJECTIVE To investigate the changes of immunological indicators of hemodialysis catheter-related infections and the diagnostic value of serum C-reactive protein(CRP)and procalcitonin(PCT)in patients with uremia.METHODS Totally 40 patients with uremia who diagnosed with catheter infection during hemodialysis from Jul.2016 to Jul.2019 in Endocrinology Department of Panzhihua Iron and Steel General Hospital were collected as the experimental group,and another 60 uninfected uremia patients who underwent hemodialysis in our hospital were selected as control group.The pathogens in the catheter secretions of the study subjects were cultured,and the levels of serum immunoglobulin,CRP and PCT were measured before and after dialysis in the two groups of patients.RESULTS The age of patients in the infection group was(68.81±6.25),significantly higher than that in the non infection group(P=0.007).The pathogen culture results in the secretion of catheter mouth of the infection group were mainly Gram-positive bacteria(70.45%),with the highest detection rate of Staphylococcus aureus(36.36%).Compared with those before dialysis,the immunoglobulin M(IgM),immunoglobulin A(IGA)and immunoglobulin G(IgG),complement C3,C4,CRP,PCT were increased in both groups after dialysis significantly(P<0.001).The levels of IgM,IgA,IgG,C3,C4,CRP and PCT in the infection group were(1.62±0.12)g/L,(1.91±0.21)g/L,(10.12±1.35)g/L,(1.15±0.08)g/L,(0.68±0.07)g/L,(34.21±12.18)mg/L,(0.84±0.27)μg/L,respectively,significantly higher than those in the uninfection group(P<0.001).The results of ROC analysis showed that the cutoff value of CRP and PCT level after dialysis for catheter infection in uremic hemodialysis patients were 12.83 mg/L and 0.53 ng/ml,respectively,with significant differences(P<0.001).CONCLUSION The immunological indexes and inflammatory protein levels of uremic patients with hemodialysis after catheter-related infection are significantly increased.The changes of serum CRP and PCT levels have good diagnostic efficacy and have certain clincial value.