血清降钙素原和高敏C反应蛋白在革兰氏阴性菌感染的腹膜透析相关性腹膜炎中的临床应用

Clinical application of serum procalcitonin and high sensitive C-reactive protein in peritoneal dialysis-associated peritonitis infected by Gram negative bacteria

目的探讨血清降钙素原(PCT)、高敏C反应蛋白(hs-CRP)在革兰氏阴性菌感染的腹膜透析相关性腹膜炎(PDAP)中的临床应用价值。方法回顾性分析2017年12月至2023年8月广东省佛山市南海区人民医院收治的165例腹膜透析患者的临床资料,根据培养结果将其分为革兰氏阴性菌组和非革兰氏阴性菌组;比较两组一般资料及实验室检查指标;采用多因素logistic回归分析革兰氏阴性菌感染PDAP发生的影响因素;受试者操作特征(ROC)曲线评价PCT、hs-CRP对革兰氏阴性菌感染PDAP的预测价值。结果165例腹膜透析患者共发生268例次PDAP,其中革兰氏阳性菌127例次、革兰氏阴性菌69例次、真菌5例次、分枝杆菌1例次、混合感染11例次、未找到病原菌55例次。两组PCT、hs-CRP、中性粒细胞与淋巴细胞比值及估算肾小球滤过率比较,差异有统计学意义(P<0.05)。多重共线性分析显示,方差膨胀因子均<10,提示各自变量间不存在多重共线性。多因素logistic回归分析显示,PCT(OR=1.085,95%CI:1.038~1.134,P<0.001)、hs-CRP(OR=1.008,95%CI:1.003~1.013,P=0.003)是革兰氏阴性菌感染PDAP发生的独立影响因素。ROC曲线分析显示,PCT联合hs-CRP对革兰氏阴性菌感染PDAP的诊断预测价值高于各项单独预测。结论PCT、hs-CRP是革兰氏阴性菌感染PDAP发生的独立影响因素,PCT联合hs-CRP对革兰氏阴性菌致PDAP具有较高预测价值。

Objective To investigate clinical application value of serum procalcitonin(PCT)and high sensitive C-reactive protein(hs-CRP)in peritoneal dialysis-associated peritonitis(PDAP)infected by Gram negative bacteria.Methods Clinical data of 165 patients with peritoneal dialysis admitted to Nanhai District People’s Hospital of Foshan City in Guangdong Province from December 2017 to August 2023 were retrospectively analyzed.Based on the culture results,they were divided into Gram negative bacterial group and non-Gram negative bacterial group.General information and laboratory test indicators of two groups were compared;multiple logistic regression was used to analyze the influencing factors of PDAP caused by Gram negative bacterial infection;receiver operator characteristic(ROC)curve was used to evaluate predictive value of PCT and hs-CRP for PDAP infection caused by Gram negative bacteria.Results A total of 268 cases of PDAP occurred in 165 peritoneal dialysis patients,included 127 cases of Gram positive bacteria,69 cases of Gram negative bacteria,5 cases of fungi,1 case of mycobacteria,11 cases of mixed infections,and 55 cases of pathogen not found.There were statistically significant differences in PCT,hs-CRP,neutrophil to lymphocyte ratio,and estimated glomerular filtration between two groups(P<0.05).Multic-ollinearity analysis showed that variance inflation factors were all less than 10,indicated that there was no multic-ollinearity among the variables.Multivariate logistic regression analysis showed that PCT(OR=1.085,95%CI:1.038-1.134,P<0.001)and hs-CRP(OR=1.008,95%CI:1.003-1.013,P=0.003)were independent influencing factors of PDAP caused by Gram negative bacterial infections.ROC curve analysis showed that the prediction value of PCT combined with hs-CRP for PDAP caused by Gram negative bacteria was higher than that of each single prediction.Conclusion PCT and hs-CRP are independent influencing factors for the occurrence of PDAP caused by Gram negative bacteria infection.PCT combined with hs-CRP has high predictive value for PDAP caused by Gram negative bacteria.