IgA肾病患者维持性透析期间血清白细胞介素-10和促红细胞生成素及和肽素与透析感染的关系

Correlations of serum interleukin-10,erythropoietin and copeptin levels with dialysis-related infection during maintenance hemodialysis in IgA nephropathy patients

目的观察行维持性透析治疗的IgA肾病患者血清白细胞介素(interleukin,IL)-10、促红细胞生成素(erythropoietin,EPO)、和肽素(copeptin)水平变化,探讨其预测IgA肾病患者发生透析感染的价值。方法行维持性透析治疗的IgA肾病患者224例,透析时间均>6个月,无透析感染情况发生。随访1年,根据IgA肾病患者随访期间透析感染发生情况分为感染组35例与未感染组189例。比较2组入组时血红蛋白及血清IL-10、EPO、copeptin水平,血液透析、腹膜透析比率等临床资料;采用多因素logistic回归分析IgA肾病患者发生透析感染的影响因素;绘制ROC曲线,评估血清IL-10、EPO、copeptin水平对IgA肾病患者发生透析感染的预测效能并采用三者联合检测预测224例IgA肾病患者透析感染发生情况,采用Kaplan-Meier生存曲线分析预测透析感染阳性患者与阴性患者随访期间总生存率。结果感染组合并糖尿病(51.43%)、血液透析(80.00%)比率及血清IL-10[(57.14±18.12)ng/L]、copeptin[(7.58±2.50)μmol/L]水平均高于未感染组[31.75%、41.80%、(30.69±10.18)ng/L、(4.25±1.41)μmol/L](P<0.05),EPO[(77.41±25.14)u/L]、血红蛋白[(56.84±12.31)g/L]水平均低于未感染组[(125.87±40.12)u/L、(78.12±15.49)g/L](P<0.05),2组年龄、性别比例、体质量指数,吸烟、饮酒、合并高血压比率及血肌酐水平比较差异均无统计学意义(P>0.05);糖尿病(OR=9.052,95%CI:6.374~12.854,P<0.001)、透析方式(OR=12.878,95%CI:8.125~20.413,P<0.001)、血清IL-10(OR=9.708,95%CI:7.259~12.983,P<0.001)、copeptin(OR=10.128,95%CI:6.837~15.693,P<0.001)、血红蛋白(OR=7.698,95%CI:5.455~10.862,P<0.001)、EPO(OR=8.678,95%CI:6.413~11.744,P<0.001)是IgA肾病患者发生透析感染的影响因素。血清IL-10、EPO、copeptin水平最佳截断值为12.38 ng/L、106.59 u/L、5.86μmol/L时,预测IgA肾病患者发生透析感染的AUC分别为0.712(95%CI:0.606~0.818,P<0.001)、0.751(95%CI:0.677~0.824,P<0.001)、0.850(95%CI:0.771~0.929,P<0.001),灵敏度分别为70.73%、71.65%、71.04%,特异度分别为69.31%、70.90%、86.24%,三者联合检测预测IgA肾病患者发生透析感染的AUC为0.938(95%CI:0.893~0.983,P<0.001),灵敏度为80.00%,特异度为94.71%。血清IL-10、EPO、copeptin联合检测预测224例IgA肾病患者发生透析感染阳性患者38例,阴性患者186例;随访至2022年3月1日,血清IL-10、EPO、copeptin联合检测预测透析感染阳性者随访期间总生存率[81.58%(31/38)]低于阴性者[99.46%(185/186)](χ^(2)=24.340,P<0.001)。结论糖尿病、血液透析,血清IL-10、copeptin水平升高,EPO水平降低是行维持性透析的IgA肾病患者发生透析感染的危险因素,血清IL-10、copeptin、EPO联合检测预测IgA肾病患者发生透析感染的价值较高。

Objective To observe the changes of serum interleukin-10(IL-10),erythropoietin(EPO)and copeptin levels,and to investigate their values to the prediction of dialysis-related infection during maintenance hemodialysis in IgA nephropathy patients.Methods Totally 224 patients with IgA nephropathy underwent maintenance hemodialysis for over 6 months,and no infection occurred.According to the 1-year follow-up result,224 patients were divided into infection group(n=35)and no-infection group(n=189).The levels of hemoglobin,IL-10,EPO and copeptin,and percentages of patients undergoing hemodialysis and peritomeal dialysis were compared between two groups at the time of enrollment.Multivariate logistic regression analysis was performed to assess the influencing factors of dialysis-related infection in IgA nephropathy patients.ROC curve was drawn to evaluate the efficiencies of serum IL-10,EPO and copeptin on predicting dialysis-related infection.The combined detection of serum IL-10,EPO and copeptin was used to predict infection in 224 IgA nephropathy patients,and Kaplan-Meier survival analysis was used to analyze the overall survival rate of negative and negative infection patients during follow-up.Results The percentages of patients with diabetes and hemodialysis,as well as the levels of serum IL-10and copeptin were higher in infection group[51.43%,80.00%,(57.14±18.12)ng/L,(7.58±2.50)μmol/L]than those in no-infection group[31.75%,41.80%,(30.69±10.18)ng/L,(4.25±1.41)μmol/L](P<0.05),the levels of EPO and hemoglobin were lower in infection group[(77.41±25.14)u/L,(56.84±12.31)g/L]than those in no-infection group[(125.87±40.12)u/L,(78.12±15.49)g/L](P<0.05),and there were no significant differences in the age,gender ratio,body mass index,percentages of patients with smoking,drinking and hypertension,and serum creatinine level between two groups(P>0.05).Diabetes(OR=9.052,95%CI:6.374-12.854,P<0.001),dialysis methed(OR=12.878,95%CI:8.125-20.413,P<0.001),serum IL-10(OR=9.708,95%CI:7.259-12.983,P<0.001),copeptin(OR=10.128,95%CI:6.837-15.693,P<0.001),hemoglobin(OR=7.698,95%CI:5.455-10.862,P<0.001)and EPO(OR=8.678,95%CI:6.413-11.744,P<0.001)were the influencing factors of dialysis-related infection in IgA nephropathy patients.When the optimal cut-off values of serum IL-10,EPO and copeptin were 12.38ng/L,106.59u/L and 5.86μmol/L,the AUCs for predicting dialysis-related infection in IgA nephropathy patients were 0.712(95%CI:0.606-0.818,P<0.001),0.751(95%CI:0.677-0.824,P<0.001)and 0.850(95%CI:0.771-0.929,P<0.001),the sensitivities were 70.73%,71.65%and 71.04%,and the specificities were 69.31%,70.90%and 86.24%,respectively.The AUCof combined detection of them three was 0.938(95%CI:0.893-0.983,P<0.001),the sensitivity was 80.00%,and the specificity was 94.71%.In 224IgA nephropathy patients,38 were predicted positive and 186 were predicted negative by the combined detection of IL-10,EPO and copeptin.Till March 1,2021,the overall survival rate predicted by the combined detection of serum IL-10,EPO and copeptin was lower in positive infection patients[81.58%(31/38)]than that in negative infection patients[99.46%(185/186)](χ^(2)=24.340,P<0.001).Conclusion Diabetes,hemodialysis,increased serum IL-10and copeptin levels,and decreased EPO level are the risk factors of dialysis-related infection in IgA nephropathy patients,and the combined detection of IL-10,EPO and copeptin has a high predictive value.