慢性肾衰竭患者维持性血液透析期间血清PCT、IL-6和免疫球蛋白水平与透析感染的关系

Relationship between serum PCT,IL-6 and immunoglobulins levels and dialysis infection in patients with chronic renal failure during maintenance hemodialysis

目的分析慢性肾衰竭(CRF)患者维持性血液透析(MHD)期间血清降钙素原(PCT)、白细胞介素-6(IL-6)、免疫球蛋白(Ig)水平与透析感染的关联性,为临床诊疗提供参考依据。方法选取2021年1月-2022年12月开封市人民医院收治的102例行MHD治疗的CRF患者为研究对象,行病原菌培养及分离、鉴定,检出病原菌感染阳性为感染组(n=31),阴性为未感染组(n=71);另收集同期入院体检的62名健康人群作为对照组。比较3组血清PCT、IL-6及IgG、IgM、IgA水平,使用受试者工作特征(ROC)曲线评估血清指标对CRF患者MHD期间感染的诊断价值。结果感染组糖尿病肾病者比例明显多于未感染组,差异有统计学意义(χ^(2)=4.533,P<0.05)。感染组与未感染组合并低蛋白血症、糖尿病、高血压者比例均明显多于对照组,差异均有统计学意义(χ^(2)=35.868、35.014、35.506,P均<0.05)。3组血清PCT、IL-6及IgG、IgM、IgA水平比较,差异均有统计学意义(F=424.901、330.103、38.650、32.061、104.712,P均<0.05),其中感染组和未感染组血清PCT、IL-6水平显著高于对照组(P均<0.05),且感染组PCT、IL-6水平高于未感染组(P均<0.05);感染组和未感染组血清IgG、IgM、IgA均低于对照组(P均<0.05),且感染组IgG、IgM、IgA低于未感染组(P均<0.05)。ROC曲线分析显示,血清PCT、IL-6及IgG、IgM、IgA诊断CRF患者MHD期间感染的截断值分别为0.84 ng/mL、10.85 ng/L、8.85 g/L、0.85 g/L、1.41 g/L(P均<0.05),且5项联合诊断价值最高,曲线下面积为0.987(P<0.05)。结论监测血清PCT、IL-6及IgG、IgM、IgA水平,有利于临床诊断CRF患者MHD期间并发感染。

Objective To analyze the association of serum levels of procalcitonin(PCT),interleukin-6(IL-6)and immunoglobulins(Ig)with dialysis infection in patients with chronic renal failure(CRF)during maintenance hemodialysis(MHD).Methods A total of 102 patients with CRF undergoing MHD in the Kaifeng People's Hospital from January 2021 to December 2022 were selected as the research subjects.After pathogen culture and isolation and identification they were divided into the infected group(n=31)and the non-infected group(n=71),and 62 healthy people admitted to hospital during the same period were collected as control group.Serum levels of PCT,IL-6,IgG,IgM and IgA were compared among the three groups.Receiver operating characteristics(ROC)curve was used to evaluate the diagnostic value of serum indicators on infection in patients with CRF during MHD.Results The number of patients with diabetic nephropathy in infected group were significantly more than those in non-infected group(χ^(2)=4.533,P<0.05),and the number of patients with hypoproteinemia,diabetes mellitus and hypertension in infected group and non-infected group were significantly more than those in control group(χ^(2)=35.868,35.014,35.506,all P<0.05).Serum levels of PCT,IL-6,IgG,IgM and IgA in the three groups were statistically different(F=424.901,330.103,38.650,32.061,104.712;all P<0.05).Serum levels of PCT and IL-6 were significantly higher in infected group and non-infected group than those in control group(all P<0.05),and were higher in infected group than those in non-infected group(P<0.05).The levels of serum IgG,IgM and IgA in infected and non-infected groups were lower than those in control group(all P<0.05),and the above levels in infected group were lower than those in non-infected group(P<0.05).ROC curve analysis showed that the cutoff values of serum PCT,IL-6,IgG,IgM and IgA in the diagnosis of infection in patients with CRF during MHD were 0.84 ng/mL,10.85 ng/L,8.85 g/L,0.85 g/L and 1.41 g/L,respectively(all P<0.05),and the combined diagnostic value of five items was the highest,area under the curve was 0.987(P<0.05).Conclusion Monitoring the levels of serum PCT,IL-6,IgG,IgM and IgA was conducive to the clinical diagnosis of concurrent infection during MHD in patients with CRF.