免疫指标在血液透析糖尿病肾病患者肺部感染的诊断价值

Value of immune indexes in diagnosis of pulmonary infection in diabetic nephropathy patients undergoing hemodialysis

目的分析免疫指标在血液透析(HD)糖尿病肾病(DN)患者肺部感染的诊断价值。方法收集2020年1月-2021年12月在琼海市中医院肾内科行HD治疗的106例DN患者为研究对象,根据其是否合并社区获得性肺炎(CAP)将其分为研究组(合并CAP,44例)和对照组(未合并CAP,62例)。对两组患者入院时的血清免疫球蛋白(Ig)G、IgA、IgM、补体(C)3、C4、降钙素原(PCT)、超敏C-反应蛋白(hs-CRP)水平及外周血CD_(4)^(+)淋巴细胞比例、CD_(8)^(+)淋巴细胞比例、CD_(4)^(+)/CD_(8)^(+)淋巴细胞比值进行检测和比较。结果研究组患者血清IgG、IgM、C3水平及外周血CD_(4)^(+)淋巴细胞比例、CD_(4)^(+)/CD_(8)^(+)淋巴细胞比值均低于对照组(P<0.05),血清PCT、hs-CRP水平均高于对照组(P<0.05)。免疫功能指标及血清PCT、CRP诊断接受HD治疗DN患者合并CAP的受试者工作特征(ROC)曲线下面积(AUC)均有统计学意义(P<0.05),其中,CD_(4)^(+)/CD_(8)^(+)淋巴细胞比值的AUC最高为0.945。结论在接受HD治疗DN患者中,合并CAP的患者表现为免疫功能指标恶化和血清PCT、hs-CRP水平升高,这些指标在CAP的辅助诊断中具有一定的价值。

OBJECTIVE To analyze the value of immune indexes in diagnosis of pulmonary infection in diabetic nephropathy(DN)patients undergoing hemodialysis(HD).METHODS A total of 106 DN patients who underwent HD in nephrology department of Qionghai Hospital of Traditional Chinese Medicine from Jan 2020 to Dec 2021 were recruited as the study objects and divided into the study group with 44 cases[complicated with community-acquired pneumonia(CAP)]and the control group with 62 cases(without CAP)according to the status of complication with CAP.The levels of serum immunoglobin(Ig)G,IgA,IgM,complement(C)3,C4,procalcitonin(PCT)and high-sensitivity C-reactive protein(hs-CRP)as well as the peripheral blood CD_(4)^(+)lymphocyte percentage,CD_(8)^(+)lymphocyte percentage and ratio of CD_(4)^(+)to CD_(8)^(+)lymphocyte were detected and compared between the two groups of patients at the admission to hospital.RESULTS The levels of serum IgG,IgM and C3 as well as the peripheral blood CD_(4)^(+)lymphocyte percentage and ratio of CD_(4)^(+)to CD_(8)^(+)lymphocyte were lower in the study group than in the control group(P<0.05);the levels of serum PCT and hs-CRP of the study group were higher than those of the control group(P<0.05).There was significant differences in the area under receiver operating characteristic(ROC)curve(AUC)for diagnosis of CAP in the DN patients among the immune indexes and serum PCT and CRP(P<0.05),and the AUC of the ratio of CD_(4)^(+)to CD_(8)^(+)lymphocyte was the highest(0.945).CONCLUSION The DN patients complicated with CAP who undergo HD show the deterioration of immune function indexes and the rise of serum PCT and hs-CRP levels,and the indexes have certain value in auxiliary diagnosis of CAP.