腹膜透析患者腹膜冲洗液MMPs/TIMPs、25(OH)D 3水平变化与腹膜透析相关性腹膜炎、腹膜纤维化的关系

Relationship between the Changes of MMPs/TIMPs and 25(OH)D 3 Levels in Peritoneal Lavage Fluid and Peritoneal Dialysis-associated Peritonitis and Peritoneal Fibrosis in Patients Undergoing Peritoneal Dialysis

目的探究腹膜透析(PD)患者腹膜冲洗液基质金属蛋白酶(MMPs)/金属蛋白酶组织抑制因子(TIMPs)、血25-羟基维生素D_(3)[25(OH)D_(3)]水平变化与腹膜透析相关性腹膜炎(PDAP)、腹膜纤维化的关系。方法收集2018年1月—2020年1月收治的58例PD为研究对象,根据是否发生PDAP分为PDAP组和无PDAP组,根据是否出现腹膜纤维化分为腹膜纤维化组和无腹膜纤维化组,查阅患者临床病历资料,检测各组腹膜冲洗液中MMPs/TIMPs、25(OH)D_(3)水平,分析影响PD患者PDAP或腹膜纤维化发生的易感因素,采用受试者工作特征(ROC)曲线分析腹膜冲洗液MMPs/TIMPs、25(OH)D_(3)水平变化对PDAP或腹膜纤维化发生的预测价值。结果58例PD中13例(22.41%)出现PDAP,10例(17.24%)出现腹膜纤维化。多因素Logistic回归分析显示,年龄、透析时间、MMPs/TIMPs、25(OH)D_(3)是PD患者PDAP发生的影响因素(P<0.05,P<0.01);透析时间、MMPs/TIMPs、25(OH)D_(3)是PD患者腹膜纤维化发生的影响因素(P<0.05,P<0.01)。ROC曲线分析显示,腹膜冲洗液MMPs/TIMPs、25(OH)D_(3)联合检测预测PD患者PDAP、腹膜纤维化发生的曲线下面积、敏感度分别为0.840、0.835和0.892、0.811,均较二者单一检测高。结论PD患者发生PDAP、腹膜纤维化的风险不容忽视,加强对年龄≥60岁、PD时间较长高危人群的重视,通过监测腹膜冲洗液MMPs/TIMPs、25(OH)D_(3)水平,对PD患者PDAP、腹膜纤维化的有效防治十分重要。

Objective To investigate the relationship between the changes of matrix metalloproteinases(MMPs)/tissue inhibitors of metalloproteinases(TIMPs),blood 25-hydroxyvitamin D_(3)[25(OH)D_(3)]levels and peritoneal dialysis-associated peritonitis(PDAP)and peritoneal fibrosis in patients undergoing peritoneal dialysis(PD).Methods A total of 58 PD patients admitted from January 2018 to January 2020 were collected as research subjects.They were divided into PDAP group and non-PDAP group according to the occurrence of PDAP,and into peritoneal fibrosis group and non-peritoneal fibrosis group according to the occurrence of peritoneal fibrosis.Clinical medical records of the patients were consulted.The levels of MMPs/TIMPs and 25(OH)D_(3) in peritoneal lavage fluid of each group were detected,and the susceptibility factors affecting PDAP or peritoneal fibrosis in PD patients were analyzed.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of MMPs/TIMPs and 25(OH)D_(3) levels of peritoneal lavage fluid in PDAP or peritoneal fibrosis.Results Among 58 PD patients,13 cases(22.41%)showed PDAP and 10 cases(17.24%)showed peritoneal fibrosis.Multivariate Logistic regression analysis showed that age,duration of dialysis,MMPs/TIMPs and 25(OH)D_(3) were the influencing factors of PDAP in PD patients(P<0.05,P<0.01).Duration of dialysis time,MMPs/TIMPs and 25(OH)D_(3) were the influencing factors of peritoneal fibrosis in PD patients(P<0.05,P<0.01).ROC curve analysis showed that the area under the ROC curve of the combined detection of MMPs/TIMPs and 25(OH)D_(3) levels in peritoneal lavage fluid predicted the occurrence of PDAP and peritoneal fibrosis in PD patients and sensitivity were 0.840,0.835 and 0.892,0.811,respectively,which were higher than the two single detection.Conclusion The risk of PDAP and peritoneal fibrosis in PD patients should not be ignored.More attention should be paid to high-risk groups aged≥60 years and with long-term PD.Monitoring of the levels of MMPs/TIMPs and 25(OH)D_(3) in peritoneal lavage fluid is of significance in effective prevention and treatment of PDAP and peritoneal fibrosis in PD patients.