维持性血液透析患者hs-CRP、MCP-1、IL-6表达状况及其对血管通路感染的预测效能

Expression of hs-CRP, MCP-1 and IL-6 in patients undergoing maintenance hemodialysisand their predictive efficacy for vascular access infection

目的探究维持性血液透析(maintenance hemodialysis,MHD)患者外周血高敏C-反应蛋白(highly sensitive C-reactive protein,hs-CRP)、单核细胞趋化因子(monocyte chemotactic factor,MCP-1)和白细胞介素6(interleukin-6,IL-6)的表达水平及各临床因素对感染的预测效能。方法选取我院收治的MHD患者100例,按照在院治疗期间是否发生血管通路感染进行分组,感染组(n=30)和未感染组(n=70)。通过酶联免疫吸附法检测患者外周血hs-CRP、MCP-1和IL-6的表达水平,统计分析临床一般资料,通过多因素Logistics回归分析方法确认临床感染的风险因素,通过受试者工作曲线分析hs-CRP、MCP-1、IL-6对感染的预测效能。结果与未感染组相比,感染组血清hs-CRP、MCP-1和IL-6表达水平显著升高(P<0.05);多因素Logistics回归分析结果表明年龄>60岁、透析时间>1年、hs-CRP、MCP-1、IL-6、合并糖尿病、血清白蛋白下降是患者发生感染的危险因素,ROC分析表明血清hs-CRP、MCP-1、IL-6的ROC曲线下面积(the area under the ROC curve,AUC)分别为0.815、0.770和0.806,敏感度分别为68.10%、72.80%、82.00%,特异度分别为79.60%、72.70%、74.09%,而三者联合的AUC为0.935,敏感度和特异度分别为83.80%和92.91%,预测性能显著升高(Z=2.373)。结论MHD患者血清中hs-CRP、MCP-1、IL-6高表达,并且是患者血管通路感染的风险因素,联合使用血清hs-CRP、MCP-1和IL-6对MHD患者发生感染具有显著的预测价值。

Objective To explore the expression levels of high sensitive C-reactive protein(hs CRP),monocyte chemotactic protein 1(MCP-1)and interleukin-6(IL-6)in the peripheral blood of patients undergoing maintenance hemodialysis(MHD)and the predictive efficacy of various clinical factors for infection.Methods A total of 100 patients undergoing MHD admitted to our hospital were selected and divided into infection group(n=30)and non-infection group(n=70)according to occurrence of vascular access infection during hospitalization.The expression levels of hs-CRP,MCP-1 and IL-6 in peripheral blood of the patients were detected by enzyme-linked immunosorbent assay(ELISA),and the general clinical data were statistically analyzed.The risk factors of clinical infection were confirmed by multivariate Logistic regression analysis,and the predictive efficacy of hs-CRP,MCP-1 and IL-6 for infection was analyzed by receiver operating characteristic(ROC)curve.Results Compared with the non-infection group,the expression levels of serum hs-CRP,MCP-1 and IL-6 in the infection group were significantly higher(P<0.05).Multivariate logistic regression analysis showed that age>60 years,duration of dialysis>1 year,hs-CRP,MCP-1,IL-6,combined diabetes and decreased serum albumin were risk factors for infection.ROC analysis showed that the area under the ROC curve(AUC)of serum hs-CRP,MCP-1,and IL-6 was 0.815,0.770,and 0.806,respectively,the sensitivity was 68.10%,72.80%,82.00%,respectively,and the specificity was 79.60%,72.70%,and 74.09%,respectively.The AUC of the combination of the three was 0.935,and the sensitivity and specificity were 83.80%and 92.91%,respectively,and the predictive performance was significantly improved(Z=2.373).Conclusion The high expressions of serum hs-CRP,MCP-1 and IL-6 in patients undergoing MHD are risk factors for infection.The combined use of hs-CRP,MCP-1 and IL-6 in serum has a significant predictive value for infection in patients undergoing MHD.