血清中性粒细胞明胶酶相关脂质运载蛋白、胎球蛋白A、白细胞介素-6与腹膜透析相关感染程度的关联性及对预后的影响

Association of serum neutrophil gelatinase-associated lipid transport protein, fetoprotein A, and interleukin-6 with the extent of peritoneal dialysis-associated infection and the prognostic impact

目的 探讨血清中性粒细胞明胶酶相关脂质运载蛋白(NGAL)、胎球蛋白A(Fetuin A)、白细胞介素-6(IL-6)与腹膜透析相关感染程度的关联性及对预后影响。方法 选取社旗县妇幼保健院2016年8月至2019年4月腹膜透析相关感染病人74例作为研究对象,根据30 d预后情况分预后良好组(43例)、预后不良组(31例)。检测两组治疗前、治疗7 d后血清NGAL、Fetuin A、IL-6水平、感染可能性(IPS)评分,动态观察上述血清指标与IPS评分相关性,logistic回归分析腹膜透析相关感染预后影响因素,受试者工作特征(ROC)曲线分析血清NGAL、Fetuin A、IL-6对预后不良预测价值,并以Kaplan-Meier曲线分析生存情况。结果 治疗7 d后,预后良好组血清NGAL(542.06±95.34)μg/L、IL-6水平(13.06±3.80)ng/L、IPS评分(10.14±1.03)分低于预后不良组(640.78±104.90)μg/L、(17.18±4.73)ng/L、(13.65±1.18)分,Fetuin A水平(0.68±0.28)g/L高于预后不良组(0.48±0.16)g/L(P<0.05);IPS评分与血清NGAL、IL-6呈正相关,与血清Fetuin A呈负相关(P<0.05);透析龄、NGAL、IL-6、IPS评分是腹膜透析相关感染预后的独立危险因素,Fetuin A是腹膜透析相关感染预后的保护因素(P<0.05);NGAL预测预后不良的曲线下面积(AUC)值为0.809,大于IL-6、Fetuin A;Kaplan-Meier曲线显示,血清NGAL、IL-6、Fetuin A高危组、低危组生存曲线对比,差异有统计学意义(P<0.05)。结论 腹膜透析病人血清NGAL、IL-6水平变化与腹膜透析相关感染严重程度呈正相关,Fetuin A与感染程度呈负相关,动态监测NGAL、Fetuin A、IL-6水平变化有助于预后评估及治疗。

Objective To investigate the association of serum neutrophil gelatinase-associated lipid transport protein(NGAL),fetuin A(Fetuin A) and interleukin-6(IL-6) with the extent of peritoneal dialysis-associated infections and their prognostic impact.Methods Seventy-four patients with peritoneal dialysis-related infections treated in the Maternal and Child Health Hospital of Sheqi County from August 2016 to April 2019 were selected as study subjects,and were assigned into good prognosis group(n=43) and poor prognosis group(n=31) according to 30 d prognosis.Serum NGAL,Fetuin A,IL-6 levels,and infection probability score(IPS) were detected before and 7 d after treatment in both groups,and the correlation between the above serum indicators and IPS was dynamically observed.Logistic regression analysis was performed to analyze the factors influencing the prognosis of peritoneal dialysis-associated infection,and receiver operating characteristic(ROC) curves were used to analyze the predictive value of serum NGAL,Fetuin A,IL-6 for poor prognosis,and Kaplan-Meier curves for survival.Results After 7 d of treatment,levels of serum NGAL,IL-6,and IPS in the good prognosis group were lower than those in the poor prognosis group [(542.06±95.34) μg/L vs.(640.78±104.90) μg/L,(13.06±3.80) ng/L vs.(17.18±4.73) ng/L,and(10.14±1.03) vs.(13.65±1.18),respectively],while Fetuin A level was higher than that in the poor prognosis group [(0.68±0.28) g/L vs.(0.48±0.16) g/L,P<0.05].IPS was positively correlated with serum NGAL and IL-6 levels and negatively correlated with serum Fetuin A level(P<0.05).Dialysis age,NGAL,IL-6,and IPS were independent risk factors for the prognosis of peritoneal dialysis-associated infection,while Fetuin A was a protective factor for the prognosis of peritoneal dialysis-associated infection(P<0.05).The AUC value of NGAL predicting poor prognosis was 0.809,which was greater than that of IL-6 and Fetuin A.Kaplan-Meier curves showed that there was statistically significant difference in the survival curve between serum NGAL,IL-6,and Fetuin A highrisk group and low-risk group(P<0.05).Conclusions Changes in serum NGAL and IL-6 levels of peritoneal dialysis patients were positively correlated with the severity of peritoneal dialysis-related infection,and Fetuin A was negatively correlated with the degree of infection.Dynamic monitoring of changes in NGAL,Fetuin A,and IL-6 levels would be helpful for prognostic assessment and treatment.