sCD14、hs-CRP、HNL对CRF腹膜透析细菌性腹膜炎诊断价值及意义

The diagnostic value and significance of sCD14,hs⁃CRP and HNL on bacterial peritonitis caused by peritoneal dialysis in CRF

目的探讨可溶性CD14(sCD14)、高敏C反应蛋白(hs-CRP)、中性粒细胞载脂蛋白(HNL)对慢性肾衰竭(CRF)腹膜透析细菌性腹膜炎诊断价值及意义。方法选取2017年9月至2020年9月本院收治的70例CRF腹膜透析细菌性腹膜炎患者(腹膜炎组)、142例CRF腹膜透析患者(透析组)及33例健康人群(对照组),比较各组基线资料、sCD14、hs-CRP、HNL水平,并比较不同sCD14、hs-CRP、HNL水平者感染可能性(IPS)评分、Kt/V,采用Pearson分析各指标与IPS评分、Kt/V关系,采用Logistic回归方程分析细菌性腹膜炎的相关影响因素,采用受试者工作特征曲线(ROC)及ROC下面积(AUC)分析各指标的诊断价值。结果腹膜炎组糖尿病患者占比高于透析组,sCD14、hs-CRP:腹膜炎组>透析组>对照组,腹膜炎组HNL高于透析组、对照组,差异均有统计学意义(P<0.05);sCD14、hs-CRP、HNL高水平者IPS评分高于低水平患者,Kt/V低于低水平患者差异有统计学意义(P<0.05);sCD14、hs-CRP、HNL与IPS评分呈正相关,与Kt/V呈负相关(P<0.05);Logistic回归方程分析显示,将糖尿病控制后,sCD14、hs-CRP、HNL仍与细菌性腹膜炎的发生相关(P<0.05);sCD14、hs-CRP、HNL诊断细菌性腹膜炎的AUC为0.822、0.810、0.819,hs-CRP+sCD14诊断细菌性腹膜炎的AUC为0.903(P<0.05)。结论sCD14、hs-CRP、HNL在CRF腹膜透析细菌性腹膜炎诊断中具有重要的临床意义,并与腹膜透析患者感染风险和透析充分性有关。

Objective To investigate the diagnostic value and significance of soluble cluster of differentiation 14(sCD14),hypersensitive C⁃reactive protein(hs⁃CRP),and human neutrophillipocalin(HNL)for bacterial peritonitis caused by peritoneal dialysis in chronic renal failure(CRF).Methods From September 2017 to September 2020,70 CRF patients with bacterial peritonitis caused by peritoneal dialysis(peritonitis group),142 CRF patients with peritoneal dialysis(dialysis group)and 33 healthy people(control group)were selected from our hospital.The baseline data,sCD14,hs⁃CRP,and HNL levels of each group were compared,and the infection probability score(IPS),Kt/V,and Kt/V of people with different levels of sCD14,hs⁃CRP and HNL were compared.Pearson was used to analyze the relationship between each indicator and the IPS score and Kt/V,and the Logistic regression equation was used to analyze the relevant influencing factors of bacterial peritonitis.Receiver operating characteristic curve(ROC)and area under ROC(AUC)were used to analyze the diagnostic value of each indicator.Results The proportion of diabetic patients in the peritonitis group was higher than that of the dialysis group.The sCD14,hs⁃CRP levels:peritonitis group>dialysis group>control group,HNL in the peritonitis group was higher than that in the dialysis group and the control group(P<0.05).The IPS scores of patients with high levels of sCD14,hs⁃CRP and HNL were higher than those with low levels,and the Kt/V was lower than those with low levels(P<0.05).sCD14,hs⁃CRP,HNL were positively correlated with IPS score,and negatively correlated with Kt/V(P<0.05).Logistic regression analysis showed that after diabetes was controlled,sCD14,hs⁃CRP,and HNL were still related to the occurrence of bacterial peritonitis(P<0.05).The AUC of sCD14,hs⁃CRP and HNL for the diagnosis of bacterial peritonitis were 0.822,0.810,0.819,and the AUC of hs⁃CRP+sCD14 for the diagnosis of bacterial peritonitis was 0.903(P<0.05).Conclusions The sCD14,hs⁃CRP and HNL have important clinical significance in the diagnosis of bacterial peritonitis caused by peritoneal dialysis in CRF and are related to the risk of infection and adequacy of dialysis in peritoneal dialysis patients.