血液透析中心导管相关血流感染危险因素及对氧磷酯酶1蛋白表达水平

Risk factors for catheter-related bloodstream infection in hemodialysis patients and expression of paraoxonase 1

目的探讨血液透析中心导管相关血流感染(CRBSI)危险因素及对氧磷酯酶1蛋白(PON-1)水平研究。方法选择海警医院血液透析中心2015年6月-2020年6月发生CRBSI的透析患者60例为研究组,按照1∶1比例未发生CRBSI患者中选60例纳入对照组,比较两组临床资料及C-反应蛋白(CRP)、降钙素原(PCT)及PON-1水平,采用多因素Logistic分析CRBSI发生的危险因素,受试者工作特征曲线(ROC)评价指标对于CRBSI的诊断价值。结果研究组置管时间较长、合并糖尿病、终末期肾病、恶性肿瘤患者占比较高,血清CRP、PCT水平高于对照组,PON-1水平低于对照组,差异具有统计学意义(P<0.05);共检出革兰阴性菌39株,占比65.00%,其中大肠埃希菌17株,占比28.33%;革兰阴性菌组血清CRP、PCT水平高于革兰阳性菌组,PON-1水平低于革兰阳性菌组,差异均具有统计学意义(P<0.05);置管时间较长、合并糖尿病、终末期肾病、恶性肿瘤是血液透析中心患者发生CRBSI的独立危险因素(P<0.05);ROC分析结果显示,血清CRP、PCT、PON-1对CRBSI进行诊断其曲线下面积(AUC)分别为0.751、0.782、0.761,三指标联合诊断时AUC为0.891,诊断效能最高。结论置管时间较长、合并糖尿病、终末期肾病、恶性肿瘤是血液透析中心患者发生CRBSI的独立危险因素,血清PON-1对于CRBSI具有较好的评估价值,联合CRP、PCT时诊断价值最高。

OBJECTIVE To explore the risk factors for catheter-related bloodstream infection(CRBSI) in hemodialysis center and analyze the level of paraoxonase 1(PON-1). METHODS A total of 60 dialysis patients who had CRBSI in hemodialysis center of China Coast Guard Hospital of the People’s Armed Police Force from Jun 2015 to Jun 2020 were assigned as the study group, and 60 patients without CRBSI were chosen as the control group in a 1∶1 ratio. The clinical data and levels of C-reactive protein(CRP), procalcitonin(PCT) and PON-1 were compared between the two groups, multivariate logistic analysis was performed for the risk factors for the CRBSI, and the values of the indexes in diagnosis of CRBSI were analyzed by means of receiver operating characteristic(ROC) curve. RESULTS The proportions of the patients with long catheter indwelling time, complicated diabetes mellitus, end-stage renal disease and malignant tumors were significantly higher in the study group than in the control group, the levels of serum CRP and PCT of the study group were significantly higher than those of the control group, and the PON-1 level of the study group was significantly lower than that of the control group(P<0.05). Totally 39(65.00%) strains of gram-negative bacteria were isolated, 17(28.33%) of which were Escherichia coli. The levels of serum CRP and PCT of the gram-negative bacteria group were significantly higher than those of the gram-positive bacteria group, the PON-1 level of the gram-negative bacteria group was significantly lower than that of the gram-positive bacteria group(P<0.05). Long catheter indwelling time, complication with diabetes mellitus, end-stage renal disease and malignant tumor were independent risk factors for the CRBSI in the hemodialysis patients(P<0.05). ROC curve analysis showed that the areas under curve(AUCs) of the serum CRP, PCT and PON-1 were respectively 0.751, 0.782 and 0.761 in diagnosis of CRBSI, and the AUC of the joint detection of the three indexes was 0.891, with the diagnostic efficiency the highest. CONCLUSION Long catheter indwelling time, complication with diabetes mellitus, end-stage renal disease and malignant tumor are the independent risk factors for the CRBSI in the patients of hemodialysis center, the serum PON-1 has high value in assessment of CRBSI, and its combination with CRP and PCT has the highest diagnostic value.