腹膜透析并发感染性腹膜炎的危险因素及血清sCD14和HNL与SAA的诊断价值

Risk factors of infectious peritonitis in peritoneal dialysis patients and diagnostic value of serum levels of sCD14,HNL and SAA

目的探讨腹膜透析患者并发感染性腹膜炎的危险因素及血清可溶性CD14(sCD14)、中性粒细胞载脂蛋白(HNL)、淀粉样蛋白A(SAA)的诊断价值.方法选取2021年1月—2022年12月徐州市第一人民医院收治的腹膜透析患者352例,根据是否并发感染性腹膜炎分为发生组(61例)和未发生组(291例);采用Logistic法分析腹膜透析患者并发感染性腹膜炎的危险因素;分别采用流式细胞仪、酶联免疫吸附法检测血清sCD14、HNL、SAA表达水平;比较发生组和未发生组血清sCD14、HNL、SAA表达水平,并采用受试者工作特征(ROC)曲线分析三者对腹膜透析患者并发感染性腹膜炎的诊断价值.结果多因素Logistic回归分析结果显示,年龄大、初中以下文化程度、合并糖尿病、使用高糖透析液及血清白蛋白(Alb)水平低均是腹膜透析患者并发感染性腹膜炎的危险因素(P<0.05);发生组血清sCD14、HNL、SAA表达水平均高于未发生组(P<0.05);绘制ROC曲线获得sCD14、HNL、SAA联合检测诊断腹膜透析患者并发感染性腹膜炎的AUC高于各项单独检测(P<0.05),敏感度和特异度为80.30%,68.00%.结论腹膜透析患者并发感染性腹膜炎后血清sCD14、HNL、SAA呈高表达,联合检测有助于诊断腹膜透析患者并发感染性腹膜炎;腹膜透析患者并发感染性腹膜炎的高危因素有年龄大、初中以下文化程度、合并糖尿病、使用高糖透析液及血清Alb水平低等.

OBJECTIVE To investigate the high risk factors of infectious peritonitis in peritoneal dialysis patients,and to analyze the diagnostic value of serum soluble cluster of differentiation14(sCD14),human neutrophil lipoca-lin(HNL)and serum amyloid A(SAA)levels.METHODS The clinical data of 352 patients treated with peritoneal dialysis in the First People's Hospital of Xuzhou from Jan 2021 to Dec 2022 were collected retrospectively.They were divided into the occurrence group(61 cases)and non-occurrence group(291 cases)according to whether in-fectious peritonitis occurred.The clinical data between the two groups were compared,and the risk factors of peri-toneal dialysis patients complicated with infectious peritonitis were analyzed by univariate and multivariate analy-sis.The expression levels of serum sCD14,HNL and SAA were detected by flow cytometry and enzyme-linked immunosorbent assay.The expression levels of serum sCD14,HNL and SAA were compared between the occur-rence group and the non-occurrence group.Receiver operating characteristic(ROC)curve was used to analyze the diagnostic value of sCD14,HNL and SAA alone and combined detection in peritoneal dialysis patients complicated with infectious peritonitis.RESULTS Multivariate logistic regression analysis showed that old age,education level below junior high school,diabetes mellitus,use of high glucose dialysate and low serum albumin(Alb)level were all risk factors for infectious peritonitis in peritoneal dialysis patients(P<0.05).The expression levels of sCD14,HNL and SAA in serum of the occurrence group were significantly higher than those of the non-occurrence group(P<0.05).ROC curve showed that the AUC of the combined detection of sCD14,HNL and SAA in the diagno-sis of peritoneal dialysis patients with infectious peritonitis was higher than that of the individual detection(P<0.05),and the sensitivity and specificity were 80.30%and 68.00%,respectively.CONCLUSION The expression of sCD14,HNL and SAA in serum of peritoneal dialysis patients complicated with infectious peritonitis is high,and the combined detection is helpful for the diagnosis of infectious peritonitis.The high risk factors of infectious peritonitis in peritoneal dialysis patients include old age,education level below middle school,diabetes mellitus,use of high glucose dialysate and low serum Alb level.