糖尿病肾病血液透析合并肺部感染危险因素及血清MCP-1与IL-12变化  

Analysis of variation of serum levels of hs-CRP,MCP-1 and IL-12 in hemodialysis patients with diabetic nephropathy complicated with pulmonary infection

作　　者：张春霞 罗洋 郭一丹 ZHANG Chun-xia;LUO Yang;GUO Yi-dan(Beijing Shijitan Hospital,Capital Medical University,Beijing 100038,China)

机构地区：[1]首都医科大学附属北京世纪坛医院肾内科,北京100038

出　　处：《中华医院感染学杂志》2020年第15期2316-2320,共5页Chinese Journal of Nosocomiology

基　　金：北京市自然科学基金资助项目(2018030)。

摘　　要：目的探讨糖尿病肾病(Diabetic Nephropathy,DN)行血液透析(Hemodialysis,HD)合并肺部感染患者的相关危险因素分析以及超敏C-反应蛋白(High-sensitivity C-reactive protein,hs-CRP)、单核细胞趋化蛋白-1(Monocyte chemoattractant protein-1,MCP-1)、白细胞介素-12(Interleukin-12,IL-12)表达水平的变化,为临床诊断和治疗该类疾病提供参考依据。方法采用回顾性分析法,选取2015年1月-2018年12月在首都医科大学附属北京世纪坛医院就诊的DN血透患者186例为研究对象,根据患者有无发生肺部感染将其分为研究组(发生肺部感染)86例和对照组(未发生肺部感染)100例。采用酶联免疫吸附法(Enzyme-linked immunosorbent assay,ELISA)检测血清hs-CRP、MCP-1、IL-12的水平,对比研究组与对照组以及研究组治疗前、后血清hs-CRP、MCP-1、IL-12的水平;采用全自动微生物分析仪进行血液样本病原菌的鉴定;收集患者资料,采用Logistic回归分析确定发生肺部感染的危险因素。结果研究组86例患者的痰样本中,共检出108株病原菌,其中,革兰阴性菌占67.59%,主要包括铜绿假单胞菌、肺炎克雷伯菌,革兰阳性菌占32.41%,主要包括金黄色葡萄球菌、表皮葡萄球菌;Logistic回归分析显示发生肺部感染的危险因素为年龄增长、透析时间长、低血红蛋白、低血浆白蛋白、空腹血糖升高及透析不充分(P<0.05)。治疗前,研究组血清hs-CRP、MCP-1、IL-12的表达水平均高于对照组,治疗后,研究组血清hs-CRP、MCP-1、IL-12水平有明显下降,差异具有统计学意义(P<0.05)。结论DN血透患者肺部感染率高,独立危险因素多,临床上应该积极控制血糖,维持稳定的内环境,保证良好的营养条件,从而降低肺部感染的发生。OBJECTIVE To explore the risk factors of pulmonary infection in patients with diabetic nephropathy(DN)undergoing hemodialysis(HD),to find the changes of high sensitivity C-reactive protein(hs-CRP),monocyte chemoattractant protein-1(MCP-1)and interleukin-12(IL-12)expression levels in order to provide reference for clinical diagnosis and treatment of the disease.METHODS Retrospective analysis was performed on 186 patients with diabetic nephropathy undergoing hemodialysis from Jan.2015 to Dec.2018.All subjects were divided into the study group with pulmonary infection(86 cases)and the control group without pulmonary infection(100 cases).Serum levels of hs-CRP,MCP-1 and IL-12 were detected by enzyme-linked immunosorbent assay(ELISA).The pathogenic bacteria were identified by automatic microbial analyzer.The risk factors of pulmonary infection were determined by logistic regression analysis.RESULTS Among the sputum samples in 86 patients of the study group,108 pathogenic bacteria were detected,of which Gram-negative bacteria accounted for 67.59%,mainly including Pseudomonas aeruginosa and Klebsiella pneumoniae,and Gram-positive bacteria accounted for 32.41%,mainly including Staphylococcus aureus and Staphylococcus epidermidis.Logistic regression analysis showed that the risk factors of pulmonary infection were aging,long dialysis time and low hemoglobin,low plasma albumin,hyperglycemia and inadequate dialysis(P<0.05).Before the treatment,the serum levels of hs-CRP,MCP-1 and IL-12 in the study group were higher than that in the control group.After the treatment,the serum levels of hs-CRP,MCP-1 and IL-12 in the study group decreased significantly(P<0.05).CONCLUSION The incidence of pulmonary infection was high in patient with DN after hemodialysis and many risk factors related with it.In clinical practice,we should actively control blood sugar,maintain a stable internal environment and ensure good nutrition conditions,so as to reduce the incidence of pulmonary infection.

关 键 词：糖尿病肾病 血液透析 肺部感染 危险因素 超敏C-反应蛋白 单核细胞趋化蛋白-1 白细胞介素-12 

分 类 号：R563.1[医药卫生—呼吸系统]