血小板/淋巴细胞比值与腹膜透析相关性腹膜炎预后的关系:一项回顾性研究

Association of platelet-to-lymphocyte ratio with the outcomes of peritoneal dialysis-associated peritonitis:a retrospective study

目的探讨血小板/淋巴细胞比值(platelet to lymphocyte ratio,PLR)与腹膜透析相关腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)患者治疗失败的相关性。方法选取2018年1月至2022年10月在华中科技大学同济医学院附属武汉中心医院肾内科住院,符合临床PDAP诊断标准的136例患者作为研究对象,收集患者的人口学、临床及实验室检查等资料,根据PDAP的临床结局,将研究对象分为治疗成功组与治疗失败组,比较两组患者的一般资料和相关临床实验室指标,采用多因素Logistic回归分析法研究PLR值与PDAP治疗失败的关系,绘制受试者工作特征曲线(receiver operating characteristic curve,ROC)分析PLR对PDAP患者治疗失败的预测价值。结果共136例腹膜透析患者发生221例次PDAP。与治疗成功组相比,治疗失败组的PLR[(472±296)比(232±10~6)]、中性粒细胞/淋巴细胞比值[(15.40±11.20)比(7.49±5.92)]、血小板[(256±92)×10^(9)/L比(216±84)×10^(9)/L]水平均显著上升,差异具有统计学意义(P<0.05),而血清白蛋白[(25.08±4.79)g/L比(28.21±5.31)g/L]、淋巴细胞计数水平[(0.59±0.28)×10^(9)/L比(1.06±0.47)×10^(9)/L]均显著性下降,差异具有统计学意义(P<0.01)。多因素Logistic回归分析表明PLR(每100)(OR=2.419,95%CI:1.748~3.346,P<0.001)、血钠(OR=0.856,95%CI:0.768~0.952,P=0.004)是PDAP治疗失败的独立危险因素。ROC曲线显示PLR是PDAP患者治疗失败的预测因子(截断值为341,曲线下面积为0.803,95%CI:0.720~0.886,P<0.001)。结论PLR、血钠是PDAP治疗失败的独立危险因素,PLR作为一种经济、易获得的指标,是PDAP发生不良结局的新标志。

Objective To explore the correlation between platelet-to-lymphocyte ratio(PLR)and failed treatment in patients with peritoneal dialysis-associated peritonitis(PDAP).Methods From Jan-uary 2018 to October 2022,136 hospitalized patients fulfilling the clinical diagnostic criteria of PDAP were selected as study subjects.Demographic profiles,clinical examinations and laboratory parameters were recorded.They were assigned into two groups of successful treatment and failed treatment.General profiles and relevant clinical data of two groups were compared.The relationship between PLR and failed treatment of PDAP was examined by multivariate Logistic regression analysis.And receiver operating characteristic(ROC)curve was plotted for examining the predictive value of PLR on failed treatment of PDAP.Results A total of 221 bouts of PDAP occurred in 136 PD patients.As compared with successful treatment group,the levels of PLR[(472±296)vs(232±106)],NLR[(15.40±11.20)vs(7.49±5.92)]and platelet[(256±92)×10^(9)/L vs(216±84)×10^(9)/L]spiked markedly in failed treatment group.There were statistically significant differences(P<0.05).And serum albumin[(25.08±4.79)g/L vs(28.21±5.31)g/L]and lymphocyte count[(0.59±0.28)×10^(9)/L vs(1.06±0.47)×10^(9)/L]declined markedly.There were statistically significant differences(P<0.01).Multivariate Logistic regression analysis revealed that PLR(percentage)(OR=2.419,95%CI:1.748-3.346,P<0.001)and sodium(OR=0.856,95%CI:0.768-0.952,P=0.004)were independent risk factors for failed treatment of PDAP.And ROC curve indicated that PLR was a predictor of failed treatment(cut-off value=341,AUC=0.803,95%CI:0.720-0.886,P<0.001).Conclusions PLR and serum sodium are independent risk factors for failed treatment of PDAP.And PLR is an economical and easily accessible marker for the occurrence of adverse outcomes in PDAP.