血液透析患者测定血清降钙素原和高敏C反应蛋白的临床意义  

Clinical significance of detecting serum procalcitonin and high sensitivity c-reactive protein level in hemodialysis patients

作　　者：吴虹[1] 肖跃飞[1] 

机构地区：[1]航天中心医院肾脏内科(辽宁医学院航天中心医院研究生培养基地),北京100049

出　　处：《中华临床医师杂志（电子版）》2016年第9期44-47,共4页Chinese Journal of Clinicians(Electronic Edition)

摘　　要：目的探讨检测血清降钙素原(PCT)与高敏C反应蛋白(hs-CRP)在血液透析患者中的临床意义。方法选取2013年11月开始在本院进行维持性血液透析(MHD)的患者320例,透析前检测hs-CRP和血清PCT水平,将hs-CRP>5.00 mg/L的病例纳入本研究。截止到2014年12月共收集到微炎症病例169例,其中使用内瘘透析患者110例,导管透析患者59例。随诊1年临床诊断导管局部感染者24例,导管相关性菌血症者13例。检测菌血症患者抗生素治疗0、3、7、14 d时的hs-CRP、PCT水平。结果血液透析患者PCT、hs-CRP不同程度升高,普遍存在微炎症状态,发生率为52.81%(169/320);内瘘组与导管组比较,导管组PCT[(2.96±1.12)ng/ml]、hs-CRP[(49.70±2.02)mg/L]水平明显高于内瘘组PCT[(0.46±0.19)ng/ml]、hs-CRP[(14.78±1.32)mg/L]水平,差异均具有统计学意义(均P<0.05);导管局部感染组与导管相关性菌血症组比较,后者PCT水平[(8.29±0.06)ng/ml]明显高于前者[(0.96±0.09)ng/ml],且差异具有统计学意义(P<0.01)。PCT联合hs-CRP检测,导管相关性菌血症诊断的敏感度上升至94.93%,特异度提高到95.20%。结论 50%以上的血液透析患者普遍存在微炎症状态。导管透析患者炎症反应程度重于内瘘透析患者。PCT可以很好地鉴别出导管感染的程度,更早地反映抗生素疗效。PCT联合检测hs-CRP,可以提高导管相关性菌血症诊断的敏感度和特异度,对血液透析患者炎症监测、血管通路的选择和维护有很好的临床指导作用。Objective To investigate the clinical significance of detecting serum procalcitonin（PCT） and high sensitivity C-reactive protein（hs-CRP） in hemodialysis patients. Methods Hs-CRP and serum PCT were detected pre-dialysis in 320 patients with maintenance hemodialysis（MHD） from November 2013, the patients whose hs-CRP5.00 mg/L were involved in our study. As of December 2014, 169 cases of inflammation were collected, including 110 cases of fistula dialysis, 59 cases of catheter dialysis. After one year＇s follow-up, 24 cases were diagnosed local catheter infection, 13 cases were diagnosed catheter-related bacteremia. Hs-CRP and PCT were detected after antibiotic treatment for 0, 3, 7, 14 d in patients with bacteremia. Results Hs-CRP and PCT increased at different degree in all MHD patients, and microinflammation was commonly happened in MHD patients with the rate of 52.81%. Hs-CRP [（49.70±2.02）mg/L] and PCT [（2.96±1.12）ng/ml] in catheter patients were higher than those [（14.78±1.32）mg/L,（0.46±0.19）ng/ml] in fistula group and the differences had statistical significance（P〈0.05）; PCT levels [（8.29±0.06）ng/ml] were higher in catheter-related bacteremia group compared with local catheter infection group [（0.96±0.09）ng/ml] and the difference had statistical significance. The sensitivity and specificity of catheter-related bacteremia diagnosis were improved to 94.93% and 95.20% respectively while PCT combined with hs-CRP detection were applied. Conclusions The prevalence of hemodialysis is more than 50% of the MHD patients, and the inflammatory is more severe in patients with internal fistula. PCT can well identify the extent of catheter infection, earlier reflect antibiotic drug efficacy. Combined detection of PCT and hs-CRP can improve the sensitivity and specificity for the diagnosis of bacteremia, which is a good clinical guidance for inflammation monitoring and vascular access selection and maintenance in MHD patients.

关 键 词：肾透析 炎症 C反应蛋白质 血清降钙素原 血管通路 

分 类 号：R459.5[医药卫生—治疗学]