单糖特征分析在腹膜透析相关性腹膜炎病原菌诊断中的价值  

Diagnostic value of monosaccharide in peritoneal dialysis-associated peritonitis

作　　者：公智卿 陈怿鹏 卢冬梅[1] 辛丽丽[1] 郭菁 邢广群[1] Gong Zhiqing;Chen Yipeng;Lu Dongmei;Xin Lili;Guo Jing;Xing Guangqun(Department of Nephrology,the Affiliated Hospital of Qingdao University,Qingdao 266555,China)

机构地区：[1]青岛大学附属医院肾病科,山东青岛266555

出　　处：《临床荟萃》2022年第11期1012-1016,共5页Clinical Focus

基　　金：青岛市科技局成果转化计划科技惠民专项——ANCA相关性小血管炎的发病机制研究及早期发现的重大意义(15-9-2-90-nsh);青岛市卫生健康委员会优秀学科带头人培养计划。

摘　　要：目的单糖是病原菌的重要组成成分,不同类型的病原菌具有不同的单糖特征。本研究拟通过高效液相色谱法测定腹膜透析液中单糖的水平,探讨单糖检测对腹膜炎及引起腹膜炎的病原菌的诊断价值。方法收集2020年10月01日至2021年10月31日到青岛大学附属医院西海岸肾病科住院的腹膜透析患者的腹膜透析液样本90例,其中包括无腹膜炎样本52个,腹膜炎样本38个,腹膜炎样本中革兰阳性菌腹膜炎腹透液样本24个,革兰阴性菌腹膜炎腹透液样本14个。利用高效液相色谱法测定所有样本中降解的甘露糖、葡萄糖、岩藻糖浓度,比较无腹膜炎组腹透液样本与革兰阳性菌腹膜炎组、革兰阴性菌腹膜炎组腹透液样本在甘露糖、葡萄糖、岩藻糖水平上的差异;采用Logistic回归分析各单糖水平与腹膜炎发生的关系,采用受试者工作特征(ROC)曲线评估各单糖水平对腹膜炎不同病原菌的诊断价值。结果3组各单糖水平差异有统计学意义(P<0.01)。与无腹膜炎组相比,腹膜炎组的葡萄糖浓度和岩藻糖浓度均显著下降(P<0.01)。与革兰阴性菌腹膜炎组相比,革兰阳性菌腹膜炎组甘露糖浓度显著下降(P<0.01)。Logistic回归分析表明,腹膜透析液岩藻糖浓度是腹膜炎发生的独立危险因素(P<0.01);腹膜透析液甘露糖浓度是革兰阳性菌腹膜炎发生的独立危险因素(P<0.01)。ROC曲线分析结果显示,岩藻糖浓度对腹膜炎发生有较高的诊断价值,AUC面积是0.820,95%CI(0.732,0.908),敏感度为71.05%,特异度为84.62%,最佳截断值为3.045μmol/L。甘露糖浓度对革兰阳性菌腹膜炎有较高的诊断价值,AUC面积是0.863,95%CI(0.740,0.986),敏感度为78.57%,特异度为83.33%,最佳截断值为0.345μmol/L。结论腹膜透析液中降解的岩藻糖浓度是腹膜透析相关性腹膜炎发生的独立危险因素,腹膜透析液中降解的甘露糖浓度是革兰阳性菌腹膜炎发生的独立危险因素�Objective Based on the fact that monosaccharide as an important component of pathogenic bacteria,this study investigated the diagnostic value of monosaccharide in peritoneal dialysate(PD)-associated peritonitis using high performance liquid chromatography(HPLC).Methods Peritoneal dialysate fluid samples were collected from 90 peritoneal dialysis patients hospitalized in the West Coast Nephrology Department,Affiliated Hospital of Qingdao University from October 1,2020 to October 31,2021,including 52 normal samples(non-peritonitis group)and 38 peritonitis samples(24 in Gram-positive bacteria[GPB]peritonitis group and 14 in Gram-negative bacteria[GNB]peritonitis group).HPLC was used to determine the concentration of degraded mannose,glucose and fucose in the samples.The concentrations of mannose,glucose and fucose were analyzed.Logistic regression was used to analyze the relationship between monosaccharides and peritonitis,and receiver operating characteristic(ROC)curve was drawn to evaluate the diagnostic value of monosaccharides for peritonitis.Results Monosaccharide differences levels were significant among the three groups(P<0.01).Compared with the non-peritonitis group,the glucose concentration and fucose concentration in both peritonitis groups were significantly decreased(P<0.01).Mannose concentration was different between peritonitis groups(P<0.01).Logistic regression analysis showed that fucose concentration was a risk factor for peritonitis(P<0.01),with Mannose concentration for a risk factor of GPB(P<0.01).ROC curve analysis showed that the fucose concentration had high diagnostic value for PD-associated peritonitis,AUC area is 0.820,95%CI(0.732,0.908),sensitivity is 71.05%,specificity is 84.62%,and the optimal cut-off value is 3.045μmol/L.Similar diagnostic value for mannose concentration to GPB,AUC area for 0.863,95%CI(0.740,0.986),sensitivity for 78.57%,specificity for 83.33%,and the optimal cut-off valuefor 0.345μmol/L.Significant decreased mannose concentration was in GPB.Conclusion The degraded fu

关 键 词：腹膜透析 腹膜炎 单糖 高效液相色谱法 

分 类 号：R572.2[医药卫生—消化系统]