血浆补体H因子在腹膜透析患者预后判断中的临床意义

The clinical significance of plasma complement factor H in the prognosis of patients with peritoneal dialysis

目的探讨腹膜透析患者中血浆补体H因子的水平及其对预后的判断价值。方法选择2018年4月至2021年4月海军军医大学第二附属医院肾脏病科随访的腹膜透析患者82例,根据免疫透射比浊法检测的血浆补体H因子水平分为低H因子组(<320μg/mL,n=41)和高H因子组(>320μg/mL,n=41),选择同时期体检中心性别、年龄匹配的健康体检者82例作为健康对照组。分析腹透患者血浆H因子水平与其临床指标的相关性;随访3年,分析血浆H因子与腹透并发症及预后的相关性。结果低H因子组和高H因子组在性别、年龄、透析龄、尿量、透析充分性等差异无统计学意义,但低H因子组较高H因子组的血浆白蛋白、总蛋白及胆固醇水平低(P<0.05)。在3年的随访中,低H因子组腹透相关性腹膜炎发生率高于高H因子组(P<0.05)。多因素回归分析进一步证实,低水平H因子是发生腹透相关性腹膜炎的独立危险因素(OR=4.24,95%CI 1.18~15.33)。结论腹膜透析患者血浆补体H因子水平低可能提示低蛋白血症及腹透相关性腹膜炎的发生风险的增加。

Objective To explore the levels of plasma complement factor H(CFH)in peritoneal dialysis(PD)patients and its judging value for prognosis.Methods Eighty-two PD patients followed up by the Department of Nephrology,The Second Affiliated Hospital of Naval Medical University were included in the study.Patients were divided by the CFH levels based on immunoassay turbidimetric detection into low H factor group(<320μg/mL,n=41)and high H factor group(>320μg/mL,n=41),while 82 healthy individuals matched by gender and age were selected as the healthy control group.The correlation between plasma CFH and laboratory results,complications,and prognosis in PD patients was analyzed over a 3-year follow-up.Results There were no differences between the two groups in terms of gender,age,dialysis duration,urine output,and dialysis adequacy,whereas the plasma albumin,total protein and cholesterol were significantly lower in the low CFH group compared with the patients in the high CFH group(P<0.05).During the 3-year follow-up,the incidence of peritonitis was significantly higher in the low CFH group than in the high CFH group(P<0.05).Multivariate regression analysis further confirmed that low CFH level was an independent risk factor for the development of PD associated peritonitis(OR=4.24,95%CI 1.18-15.33).Conclusions Reduced levels of plasma CFH in PD patients might suggest the increased risk of hypoalbuminemia and PD-associated peritonitis.