血清C反应蛋白与白蛋白比值、白细胞介素-22、肝素结合蛋白对慢性肾衰竭血液透析患者并发感染的早期预测价值

The value of serum CRP/ALB,IL-22 and heparin binding protein for early prediction of infection in chronic renal failure patients undergoing hemodialysis

目的探讨血清C反应蛋白(CRP)与白蛋白(ALB)比值、白细胞介素(IL)-22、肝素结合蛋白(heparin binding protein,HBP)对慢性肾衰竭(chronic renal failure,CRF)血液透析患者并发感染的早期预测价值。方法选取2021年1月─2023年6月成都市第六人民医院CRF患者113例,均行血液透析治疗,根据透析6个月内是否并发院内感染分为感染组(26例)与无感染组(87例)。比较2组血清CRP/ALB、IL-22、HBP水平,分析血清CRP/ALB、IL-22、HBP水平对CRF血液透析患者并发感染的预测价值。结果感染组血清CRP、CRP/ALB、IL-22、HBP水平高于无感染组(t=3.880、5.228、5.454、5.246,均P<0.001),ALB水平低于无感染组(t=5.291,P<0.001);血清CRP/ALB、IL-22、HBP与感染可能性评分(infection probability score,IPS)呈正相关(r=0.811、0.791、0.826,均P<0.001);血清CRP/ALB、IL-22、HBP预测CRF血液透析患者并发感染的曲线下面积(AUC)分别为0.752(95%CI:0.662~0.828)、0.811(95%CI:0.727~0.879)、0.800(95%CI:0.714~0.869);血清CRP/ALB、IL-22、HBP阳性表达的CRF血液透析患者并发感染风险分别是阴性表达患者的4.232倍(95%CI:2.158~8.299,P<0.001)、5.854倍(95%CI:2.558~13.395,P<0.001)、6.049倍(95%CI:2.803~13.056,P<0.001);血清CRP/ALB、IL-22、HBP联合预测CRF血液透析患者并发感染的AUC为0.927(95%CI:0.863~0.968),大于CRP/ALB、IL-22、HBP单独预测(Z=2.565、2.435、2.079,P=0.010、0.015、0.038),敏感度为88.46%,特异度为80.46%。结论血清CRP/ALB、IL-22、HBP与CRF血液透析患者并发感染可能性显著相关,能有效预测感染风险,且联合预测价值较为可靠。

Objective To investigate the value of serum C-reactive protein(CRP)/albumin(ALB),interleukin-22(IL-22)and heparin binding protein(HBP)for the early prediction of infection in chronic renal failure(CRF)patients undergoing hemodialysis.Methods A total of 113 CRF patients undergoing hemodialysis in Chengdu Sixth People's Hospital from January 2021 to June 2023 were selected as the research subjects.They were divided into an infection group(26 cases)and a non-infection group(87 cases)based on whether they had an infection in hospital within 6 months of dialysis.The levels of serum CRP/ALB,IL-22 and HBP were compared between the two groups,and the value of serum CRP/ALB,IL-22 and HBP levels for the prediction of infection in CRF patients undergoing hemodialysis were then analyzed.Results In the infection group,the levels of serum CRP,CRP/ALB,IL-22 and HBP were higher(t=3.880,5.228,5.454 and 5.246 respectively;P<0.001)and the level of ALB was lower(t=5.291,P<0.001)as compared those with the non-infection group.Serum CRP/ALB,IL-22 and HBP were positively correlated with the infection probability score(IPS)(r=0.811,0.791 and 0.826 respectively;95%CI:0.704~0.935,0.683~0.917 and 0.718~0.951 respectively;P<0.001).The area under the curve(AUC)of serum CRP/ALB,IL-22 and HBP for predicting infection in CRF patients undergoing hemodialysis were 0.752(95%CI:0.662~0.828),0.811(95%CI:0.727~0.879),and 0.800(95%CI:0.714~0.869)respectively.The risk of infection in the patients with positive expression of serum CRP/ALB,IL-22 and HBP was 4.232 times(95%CI:2.158~8.299),5.854 times(95%CI:2.558~13.395)and 6.049 times(95%CI:2.803~13.056)respectively,higher than that in the patients with negative expressions(all P<0.001).The AUC of combined serum CRP/ALB,IL-22 and HBP to predict infection in the patients was 0.927(95%CI:0.863~0.968),greater than the AUCs of the three indicators separately(Z=2.565,2.435 and 2.079 respectively;P=0.010,0.015 and 0.038 respectively),with the sensitivity of 88.46%and the specificity of 80.46%.Conclusion Serum CRP/ALB,IL-22 and HBP are significantly correlated with the possibility of concurrent infection in CRF patients undergoing hemodialysis.They can effectively predict the risk of infection,especially when combination of the three indicators is used for the prediction.