HIV阳性肾衰竭患者动静脉内瘘手术后感染与外周血CD4计数、白蛋白的相关性分析

Correlation analysis between the arteriovenous fistula infection and the levels of peripheral blood CD4 count and albumin in HIV-positive renal failure patients after arteriovenous fistula surgery

目的分析人类免疫缺陷病毒(human immune deficiency virus,HIV)阳性肾衰竭患者动静脉内瘘手术后感染与外周血CD4计数、白蛋白(ALB)的相关性。方法选取2016年7月—2023年10月成都市公共卫生临床医疗中心HIV阳性肾衰竭初次行动静脉内瘘手术患者,根据患者是否发生动静脉内瘘感染分为感染组和未感染组。Logistic分析动静脉内瘘手术后发生感染的影响因素,以Spearman法分析外周血CD4计数、ALB水平与感染可能性评分(infection probability score,IPS)、急性生理功能和慢性健康状况评分系统Ⅱ(acute physiology and chronic health evaluation,APACHEⅡ)的相关性。并通过受试者工作特征(ROC)曲线分析外周血CD4计数、ALB预测动静脉内瘘手术后发生感染的价值。结果共纳入96例患者,其中感染组20例,非感染组76例。感染组穿刺点反复穿刺率、穿刺点过敏率均高于未感染组(χ^(2)=9.970、7.191,P=0.002、0.007);感染组外周血CD4计数、ALB水平低于未感染组(t=8.073、7.092,P=0.001、0.001)。穿刺点反复穿刺(OR=3.552,95%CI:1.186~10.637,P=0.001)、穿刺点过敏(OR=4.042,95%CI:1.245~13.120,P=0.001)、外周血CD4计数(OR=0.370,95%CI:0.182~0.753,P=0.001)、ALB水平(OR=0.356,95%CI:0.176~0.720,P=0.001)均为HIV阳性肾衰竭患者初次动静脉内瘘手术后发生感染的影响因素。感染组CD4计数<200个/μl患者IPS、APACHEⅡ评分高于CD4计数≥200个/μl患者(t=3.774、4.123,P=0.001、0.001),ALB<30 g/L患者IPS、APACHEⅡ评分高于ALB≥30 g/L患者(t=3.594、4.229,P=0.002、0.001);感染组外周血CD4计数、ALB水平与IPS、APACHEⅡ评分呈负相关(r=-0.576、-0.621、-0.562、-0.643,P=0.001、0.001、0.001、0.001);外周血CD4计数、ALB预测HIV阳性肾衰竭患者初次动静脉内瘘手术后发生感染的AUC分别为0.763、0.800,二者联合预测的AUC为0.947,大于单独预测的AUC(Z=2.793、2.078,P=0.007、0.035)。结论HIV阳性肾衰竭初次行动静脉内瘘患者手术后感染与外周血CD4计数、ALB水平密切相关,二者联合可为临床预测动静脉内瘘感染提供重要参考依据。

Objective To analyze the correlation between the infection after the arteriovenous fistula(AVF)surgery and the levels of peripheral blood CD4 count and albumin(ALB)in human immunodeficiency virus(HIV)-positive patients with renal failure undergoing hemodialysis.Methods A total of 96 patients with HIV-positive and renal failure primarily undergoing AVF surgery for hemodialysis at the Chengdu Public Health Clinical Medical Center from July 2016 to October 2023 were selected as the research subjects.They were divided into an infection group(20 cases)and an non-infected group(76 cases)based on whether they had AVF infection.Logistic regression was used to analyze the factors affecting the occurrence of infection after AVF surgery.Spearman correlation was used to analyze the correlation between peripheral blood CD4 count,ALB level,infection probability score(IPS),and acute physiology and chronic health evaluation II(APACHE II)score.Receiver operating characteristic(ROC)curve was used to analyze the predictive value of peripheral blood CD4 count and ALB for the occurrence of AVF infection after the surgery.Results The repeated puncture rate and the rate of allergy at puncture site were 55.00%and 45.00%respectively in the infection group,higher than those of 19.74%and 14.47%respectively in the non-infection group(χ^(2)=9.970 and 7.191;P=0.002 and 0.007).The peripheral blood CD4 count and ALB level were lower in the infected group than in the non-infected group(t=8.073 and 7.092;P=0.001 and 0.001).Repeated puncture at the puncture site(OR=3.552,95%CI:1.186~10.637,P=0.001),allergy at puncture site(OR=4.042,95%CI:1.245~13.120,P=0.001),peripheral blood CD4 count(OR=0.370,95%CI:0.182~0.753,P=0.001),and ALB level(OR=0.356,95%CI:0.176~0.720,P=0.001)were the factors affecting the occurrence of infection after the first AVF surgery in HIV-positive renal failure patients undergoing hemodialysis(P<0.05).In the infection group,patients with CD4 count<200 cells/μl had higher IPS and APACHE II scores than those with CD4 count≥200 cells/μl(t=3.774 and 4.123;P=0.001 and 0.001);patients with ALB<30 g/L had higher IPS and APACHE II scores than those with ALB≥30 g/L(t=3.594 and 4.229;P=0.002 and 0.001);peripheral blood CD4 count and ALB level were negatively correlated with IPS and APACHE II scores(r=-0.576,-0.621,-0.562 and-0.643 respectively;P=0.001,0.001,0.001 and 0.001 respectively).The area under the curves of peripheral blood CD4 count and ALB for predicting infection in HIV-positive renal failure patients undergoing hemodialysis after AVF surgery were 0.763 and 0.800 respectively;the area under the curve of combined use of peripheral blood CD4 count and ALB was 0.947,significantly greater than that of individual use of the two factors for the prediction(Z=2.793 and 2.078;P=0.007 and 0.035).Conclusion Infection after the first AVF surgery in HIV-positive renal failure patients is closely related to peripheral CD4 count and ALB level.Combined use of peripheral CD4 count and ALB level can provide an important reference to predict AVF infection.