腹膜透出液乳铁蛋白水平对腹膜透析相关性腹膜炎的诊断价值初步探讨

Preliminary Study on the Diagnostic Value of Peritoneal Dialysis Fluid Lactoferrin Level in Peritoneal Dialysis-related Peritonitis

目的:探讨腹透液乳铁蛋白(lactoferrin,Lf)水平在腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)诊断、治疗及预后中的作用。方法:纳入2019年09月—2022年09月在天门市第一人民医院肾内科就诊的腹膜透析患者的临床资料。使用人乳铁蛋白酶联免疫吸附测定试剂盒检测腹透液Lf水平。根据患者是否发生腹膜炎分为对照组、腹膜炎组。收集患者的性别、年龄、病原菌、转归等临床资料及相关实验室资料。采用Logistic回归法分析腹透液Lf与PDAP的关系;应用受试者工作特征曲线(ROC)分析腹透液Lf对PDAP的预测价值,并比较不同类型病原菌感染的腹透液Lf水平。结果:与对照组相比,腹膜炎组患者腹透液Lf水平明显升高(P<0.001),多因素Logistic回归分析提示,腹透液Lf升高是腹膜透析患者发生PDAP的独立相关因素(P<0.001),腹透液Lf预测腹膜透析患者PDAP的曲线下面积为0.946(95%CI 0.917~0.975,P<0.001),特异度为89.1%,敏感度为89.4%。与革兰阴性菌组相比,革兰阳性菌组的腹透液Lf水平明显升高(P<0.001)。此外,拔管及死亡的患者腹透液Lf水平均明显高于无不良预后的PDAP患者(P<0.001)。结论:腹膜透出液Lf水平升高可作为腹膜透析患者发生PDAP的辅助诊断指标,其高水平提示革兰阳性菌感染,也提示更高的拔管率及死亡率。

Objective:To investigate the role of lactoferrin(lactoferrin,Lf)in the diagnosis,treatment and prognosis of peritoneal dialysis-associated peritonitis(peritoneal dialysis-associated peritonitis,PDAP).Methods:The clinical data of peritoneal dialysis patients admitted to the Department of Nephrology,Tianmen First People’s Hospital from September 2019 to September 2022 were included.The level of Lf in peritoneal dialysis fluid was detected by human lactoferrin-linked immunosorbent assay kit.According to whether the patients had peritonitis,they were divided into control group and peritonitis group.The clinical data such as gender,age,pathogen,outcome and related laboratory data were collected.Logistic regression analysis was used to analyze the relationship between Lf and PDAP;receiver operating characteristic(ROC)curve was used to analyze the predictive value of peritoneal dialysis fluid Lf for PDAP,and the levels of Lf in different types of pathogen infection were compared.Results:Compared with the control group,the level of peritoneal dialysis fluid Lf in the peritonitis group was significantly higher(P<0.001).Multivariate Logistic regression analysis showed that the increase of peritoneal dialysis fluid Lf was an independent related factor for PDAP in peritoneal dialysis patients(P<0.001).The area under the curve of Lf in predicting PDAP in peritoneal dialysis patients was 0.946(95%CI 0.917~0.975,P<0.001),the specificity was 89.1%,and the sensitivity was 89.4%.Compared with the Gram-negative bacteria group,the Lf level in the peritoneal dialysis fluid of the Gram-positive bacteria group was significantly increased(P<0.001).In addition,the Lf levels of peritoneal dialysis fluid in patients with extubation and death were significantly higher than those in PDAP patients without adverse prognosis(P<0.001).Conclusion:The increase of Lf level in peritoneal dialysate can be used as an auxiliary diagnostic index for PDAP in peritoneal dialysis patients.The high level of Lf indicates Gram-positive bacterial infection,and also indicates higher extubation rate and mortality.