腹膜透析相关性腹膜炎并发症的早期预示指标研究  

Early Biomarkers on Predicting Peritonitis Occurrence of Peritoneal Dialysis Patients

作　　者：徐晓萍[1] 徐磊[1] 唐碧霞[2] 方炜[2] 应春妹[1] 

机构地区：[1]上海交通大学医学院附属仁济医院检验科,上海200127 [2]上海交通大学医学院附属仁济医院肾脏科,上海200127

出　　处：《现代检验医学杂志》2013年第1期74-76,共3页Journal of Modern Laboratory Medicine

摘　　要：目的 临床诊断腹膜透析相关性腹膜炎的时间和周期比较长,早期预警判断感染的并发需要实验室的辅助.方法 收集46例腹膜透析并发腹膜炎患者,其中28例治愈,18例治疗失败.比较不同预后腹膜透析患者,血清C反应蛋白（CRP）、清蛋白（Alb）、前清蛋白（Pre-alb）水平和腹膜炎前透析液/血浆肌酐（D/P）比值等;留取腹膜透析后在应用观察抗生素治疗的第0天～第7天的腹腔透出液,比较不同预后患者腹膜透析后的不同时间点,腹腔透出液白细胞计数（WBC）、微量清蛋白和总蛋白水平.结果 ①治疗失败组72 h内血清CRP显著高于治愈组（171.5 vs 89.1 mg/dl,t=2.409,P=0.023）,清蛋白、前清蛋白浓度和腹膜炎前透析液/血浆肌酐（D/P）比值等指标在二组间差异无统计学意义（P〉0.05）;②治疗失败组腹膜透析后第4～7天腹腔透出液WBC显著升高（P〈0.01）;③治愈组第5天腹腔透出液微量清蛋白及总蛋白水平明显低于治疗失败组（P=0.021,P=0.040）;ROC曲线确定第5天微量清蛋白的cut-off值为618.5 mg/dl（敏感度和特异度分别为80.0%,56.2%）,曲线下面积0.825（95% CI：0.607～1）;微量总蛋白的cut-off值为885.5 mg/dl（敏感度85.7%,特异度55.6%）,曲线下面积0.746 （95% CI：0.527～0.965）.结论 除外腹膜炎的严格诊断指标,选择监测第5天的腹腔透出液WBC、微量蛋白水平、透析3天后的血清CRP水平,能够早期预示腹膜透析相关性腹膜炎并发症的发生,为及时干预、改善预后提供有效的实验室辅助.Objective There are some difficulties in early diagnosing the peritonitis occurrence of peritoneal dialysis patients. Methods 46 patients were separated into the cured group ＆ the failure one according to their treatments. Evaluated the ser- um C-reactive protein（CRP）, albumin, pre-albumin, dialysate over plasma （D/P） ereatinine ratio before the occurrence of peritonitis and calculated the white blood cells （WBC）,analyzed micro protein levels of the peritoneal dialysate at different points of time during their peritoneal dialysis. Results OSerum CRP within 72 hours were higher in the failure group than that in the cured one（171.5 vs 89, 1 mg/dl,t= 2. 409, P = 0. 023）, however albumin, pre-albumin and the D/P ratio had no difference between them （P〉0.05） ;（2）WBC in the dialysate showed no difference within the first 3 days, but changed apparently in the fourth-seventh days （P〈0.01） （3）The 5th point of peritoneal dialysis,the cured group showed lower levels of all micro total protein ＆ micro albumin in the dialysate than the failure one （P = 0. 021, P= 0. 040）. By ROC eurve the cut off value of micro albumin was 618.5 mg/dl （sensitivity ＆ specific were 80.0% ＆ 56.2%）,the under area was 0. 825 （95 % CI：0. 607-1）,also the cut off value of micro total protein was 885.5 mg/dl （sensitivity ＆ specific were 85.7 % ＆ 55.6%） ,the under area was 0. 746 （95% CI：0, 527%0. 965）. Conclusion Identify the 5th day of the peritoneal dialysis patients,evaluate their peritoneal dialysate WBC,levels of micro proteins ＆ within 72 hours serum CRP can early give valuable prognostic of peritonitis and therapeutic implications for patients who undergoing the peritoneal dialysis.

关 键 词：腹膜炎 腹膜透析 微量蛋白 

分 类 号：R572.2[医药卫生—消化系统] R446.112[医药卫生—内科学]