老年慢性肾衰竭透析后感染患者的HBP和NLR水平  

HBP and NLR of elderly chronic renal failure patients with infection after nemodialysis

作　　者：范福玲[1] 董艳彩[2] 王君华[1] 彭庚[2] 王静[1] FAN Fu-ling;DONG Yan-cai;WANG Jun-hua;PENG Geng;WANG Jing(Luohe Medical College,Luohe,Henan 462000,China)

机构地区：[1]河南漯河医学高等专科学校,河南漯河462000 [2]河南漯河医学高等专科学校第一附属医院(漯河市中心医院)心内科,河南漯河462000]

出　　处：《中华医院感染学杂志》2020年第12期1840-1844,共5页Chinese Journal of Nosocomiology

基　　金：河南省高等教育教学改革研究与实践基金资助项目(2017SJGLX591)。

摘　　要：目的探究血清肝素结合蛋白(Heparin-binding protein,HBP)水平、中性粒细胞与淋巴细胞比值(Neutrophil-to-lymphocyte ratio,NLR)在老年慢性肾衰竭(Chronic renal failure,CRF)患者透析后感染诊断及预后的价值。方法选取漯河市中心医院2018年6月-2019年3月老年CRF透析后感染患者55例作为研究组,随机选择透析后未感染患者51例作为对照组,检测对比两组血清HBP、NLR值,采用受试者工作特征(ROC)曲线分析血清HBP、NLR值对透析后感染的诊断价值,并检测对比研究组治疗后不同预后患者的血清HBP、NLR值,分析预后不良影响因素及血清HBP水平、NLR值对预后不良的预测价值。结果研究组细菌感染者33例,血清HBP水平、NLR值为(32.06±10.09)μg/L、(9.93±2.76),病毒感染者22例,血清HBP水平、NLR值为(22.17±8.13)μg/L、(7.12±2.24)均高于对照组,且细菌感染者血清HBP水平、NLR值高于病毒感染者(P<0.001);血清HBP联合NLR诊断老年CRF患者透析后感染的AUC为0.806高于单独诊断,且联合诊断的敏感度为76.36%,特异度为78.43%;年龄、血清HBP水平、NLR值是老年CRF患者透析后感染预后不良的影响因素(P<0.001);治疗2周后NLR预后预测的AUC为0.793,大于治疗2周后HBP的0.740,当截断值>8.10时,敏感度为76.47%,特异度为76.32%。结论 HBP、NLR在老年CRF透析后感染患者血液系统中呈异常高表达状态,均为透析后感染预后不良的重要影响因素,在老年CRF患者透析后感染诊断及预后评估方面均具有重要价值。OBJECTIVE To investigate the value of serum heparin-binding protein(HBP) levels and Neutrophil-to-lymphocyte ratio(NLR) in the diagnosis and prognosis of infection in elderly patients with chronic renal failure(CRF) after dialysis. METHODS A total of 55 elderly patients with CRF infection after dialysis from Jun. 2018 to Mar. 2019 in Luohe Central Hospital were selected as the study group, and 51 patients without infection after dialysis were selected as the control group. The serum HBP and NLR values of the two groups were compared and tested.The receiver operating characteristic(ROC) curve was used to analyze the diagnostic value of serum HBP and NLR values for post-dialysis infection, The serum HBP and NLR values of patients with different prognosis after treatment in the study group were detected and compared, and the influencing factors of adverse prognosis and the predictive value of serum HBP levels and NLR values for poor prognosis were analyzed. RESULTS Thirty-three patients were bacterial infection in the study group, and their serum HBP levels and NLR values were(32.06±10.09) μg/L and(9.93±2.76), respectively. 22 cases were viral infections, and their serum HBP levels and NLR values were(22.17±8.13) μg/L,(7.12±2.24), respectively, all higher than those of the control group. The serum HBP levels and NLR values of bacterial infection were significantly higher than those of virus infection(P<0.05). The AUC of serum HBP combined with NLR in the diagnosis of elderly CRF patients after dialysis was 0.806, significantly higher than that of single diagnosis, and the sensitivity of the combined diagnosis was 76.36% and the specificity was 78.43%. Age, serum HBP level, and NLR value were the influencing factors of poor prognosis of infection after dialysis in elderly CRF patients(P<0.001). The predicted AUC of NLR prognosis after 2 weeks of treatment was 0.793, which was greater than 0.740 of HBP after 2 weeks of treatment. When the cutoff value was over 8.10, the sensitivity was 76.47% and the specificity

关 键 词：慢性肾衰竭 血液透析 感染 肝素结合蛋白 中性粒细胞与淋巴细胞比值 受试者工作特征曲线 

分 类 号：R692.54[医药卫生—泌尿科学]