血清PCT、RDW与腹膜透析相关性腹膜炎病原菌的关系探讨

Relationship between the levels of serum procalcitonin and red blood cell distribution width and the pathogen species in peritoneal dialysis-related peritonitis

目的探讨血清降钙素原(procalcitonin,PCT)、红细胞分布宽度(red blood cell distribution width,RDW)与腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)的病原菌关系。方法收集2018年1月~2022年1月就诊于安徽医科大学第二附属医院肾脏内科的87例确诊PDAP患者进行回顾性分析,根据透出液病原菌培养结果分为革兰氏阴性菌感染组(24例)与革兰氏阳性菌感染组(63例),比较2组患者的临床资料及实验室检查指标的差异性,运用Logistic回归分析革兰氏阴性菌感染的PDAP危险因素,ROC曲线评价血清标志物RCT、RDW对革兰氏阴性菌感染的PDAP的预测价值。结果革兰氏阳性菌感染组中以表皮葡萄球菌为主(36.51%),革兰氏阴性感染组中以大肠埃希菌为主(41.67%)。与革兰氏阳性菌感染组相比,革兰氏阴性菌感染组PDAP患者的透出液有核细胞数(Z=-2.745,P=0.006)、透出液多核细胞百分比(Z=-0.273,P=0.005)、血清PCT(Z=-4.345,P<0.001)、C反应蛋白(Z=-2.859,P=0.004)、RDW(Z=-2.908,P=0.004)及纤维蛋白原(t=-2.602,P=0.011)水平均明显升高,而胆固醇水平明显降低(t=2.091,P=0.040)。多因素Logistic回归分析显示高血清PCT(OR=1.034,95%CI:1.001~1.069,P=0.045)、高RDW(OR=1.499,95%CI:1.037~2.167,P=0.031)是PDAP患者发生革兰氏阴性菌感染的独立危险因素。ROC曲线结果分析显示,PCT联合RDW对革兰氏阴性菌感染PDAP发生的预测价值最大,曲线下面积为0.815(95%CI:0.717~0.890,P<0.001)。结论高血清PCT、高RDW水平是革兰氏阴性菌感染的PDAP独立危险因素,两者联合对革兰氏阴性菌感染导致的PDAP有着较好的预测作用。

Objective To explore the relationship between the levels of serum procalcitonin(PCT)and red blood cell distribution width(RDW)and the pathogen species in peritoneal dialysis-associated peritonitis(PDAP).Methods A total of 87 cases with PDAP treated in the Nephrology Department,the Second Affiliated Hospital of Anhui Medical University from January 2018 to January 2022 were retrospectively analyzed.According to the bacterial culture results of outflow dialysate,patients were divided into Gram-negative bacterial infection group(G-group,n=24)and Gram-positive bacterial infection group(G+group,n=63).Clinical data and laboratory indexes were compared between the two groups.Logistic regression was used to analyze the risk factors for G-bacterial PDAP.ROC curve was used to assess the predictive value of serum PCT and RDW for G-bacterial PDAP.Results The predominant species was Staphylococcus epidermidis(36.51%)in the G+group,and was Escherichia coli(41.67%)in the G-group.The number of nucleated cells(Z=-2.745,P=0.006)and percentage of multinucleated cells in the outflow dialysate(Z=-0.273,P=0.005),serum PCT(Z=-4.345,P<0.001),serum C-reactive protein(Z=-2.859,P=0.004),RDW(Z=-2.908,P=0.004)and fibrinogen(t=-2.602,P=0.011)were significantly higher in G-group than in G+group,while serum cholesterol(t=2.091,P=0.040)was significantly lower in G-group than in G+group.Multivariate logistic regression demonstrated that higher serum PCT(OR=1.034,95%CI 1.001~1.069,P=0.045)and higher RDW(OR=1.499,95%CI 1.037~2.167,P=0.031)were the independent risk factors for G-bacterial PDAP.ROC curve showed that serum PCT combined with RDW had the greatest predictive value for the presence of G-bacterial PDAP,with the area under the curve of 0.815(95%CI 0.717~0.890,P<0.001).Conclusion Higher levels of serum PCT and RDW are the independent risk factors for G-bacterial PDAP.Serum PCT combined with RDW had a better predictive value for the presence of G-bacterial PDAP.