维持性血液透析患者血清降钙素原表达水平及对感染的诊断价值

Serum level of procalcitonin and its diagnostic value for infections in maintenance hemodialysis patients

目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清降钙素原(procalcitonin,PCT)的水平及影响因素,评估PCT对MHD患者感染的诊断价值。方法 采用横断面研究,选取非感染的MHD患者500例,根据PCT水平将无感染患者进一步分层,采用组间比较、单因素及多因素Logistic回归法探讨MHD患者PCT升高的影响因素。另选取合并临床感染的MHD患者115例,采用受试者工作特征曲线(ROC)及曲线下面积(AUC)分析,明确PCT诊断MHD患者合并感染的最佳界值。结果 与非感染组相比,感染组MHD患者血清PCT明显升高(Z=-14.204;P<0.001)。Logistic回归分析显示:以导管为血管通路(OR=2.142,95%CI:1.282~3.579,P=0.004)、男性(OR=1.517,95%CI:1.036~2.221,P=0.032)、血红蛋白<110g/L(OR=1.792,95%CI:1.225~2.623,P=0.003)、血磷≥1.78mmol/L(OR=1.608,95%CI:1.079~2.379,P=0.020)及甲状旁腺激素≥300pg/ml(OR=1.693,95%CI:1.156~2.479,P=0.007)是MHD患者PCT水平升高的独立危险因素。当截断值为0.851ng/ml时,PCT预测MHD患者感染的敏感度为85.2%,特异度为87.2%,AUC为0.924(95%CI:0.896~0.953)。结论 MHD患者PCT水平显著升高。临床实践中以PCT为指标来预测MHD感染状态时,诊断界值应上调。

Objective To explore the level and influencing factors of serum procalcitonin(PCT)in maintenance hemodialysis(MHD)patients,and to evaluate the diagnostic value of PCT for infections in MHD patients.Methods A total of 500 MHD patients without clinical infection were selected in this cross-sectional study.They were further stratified according to serum PCT level.The influencing factors for the higher serum PCT in MHD patients were investigated by inter-group comparison,univariate and multivariate logistic regression analyses.Additionally,a total of 115 MHD patients with clinical infections were recruited.The optimal cut-off value of serum PCT for the diagnosis of infections in the MHD patients was determined by receiver operating characteristic(ROC)curve and the area under the curve(AUC).Results Compared with non-infected groups,serum PCT was significantly elevated in patients in the infected group(Z=-14.204,P<0.001).Logistic regression showed that catheters as the dialysis access(OR=2.142,95%CI:1.282~3.579,P=0.004),male(OR=1.517,95%CI:1.036~2.221,P=0.032),hemoglobin<110g/L(OR=1.792,95%CI 1.225~2.623,P=0.003),blood phosphorus≥1.78mmol/L(OR=1.608,95%CI:1.079~2.379,P=0.020)and para-thyroid hormone>300pg/ml(OR=1.693,95%CI:1.156~2.479,P=0.007)were the independent risk factors for higher serum PCT level in MHD patients.When the cut-off value of serum PCT was set at 0.851ng/ml,the sensitivity and specificity of PCT to predict infections in MHD patients were 85.2%and 87.2%respectively,with the AUC of 0.924(95%CI 0.896~0.953).Conclusions Serum PCT is significantly increased in MHD patients.We recommend a higher diagnostic threshold of serum PCT for the clinical diagnosis of infections in MHD patients.