基线全身炎症反应指数对腹膜透析相关性腹膜炎发生和预后的预测价值  

The predictive value of baseline systemic inflammatory response index for the occurrence and prognosis of peritoneal dialysis-related peritonitis

作　　者：林如 马雅楠 张金金 王瑞峰[1] 刘桂凌[1] LIN Ru;MA Ya-nan;ZHANG Jin-jin;WANG Rui-feng;LIU Guiling(Department of Nephrology,the Second Afiliated Hospital of Anhui Medical University,Hefei 230601,China)

机构地区：[1]安徽医科大学第二附属医院肾脏内科,合肥230601

出　　处：《中国血液净化》2024年第2期91-96,共6页Chinese Journal of Blood Purification

基　　金：安徽医科大学第二附属医院临床研究重点培育项目(2021LCZD16)。

摘　　要：目的 探讨基线全身炎症反应指数(systemic inflammatory response index,SIRI)对腹膜透析(peritoneal dialysis,PD)患者腹膜透析相关性腹膜炎(peritoneal dialysis-related peritonitis,PDAP)发生和预后的预测价值。方法 回顾性分析2014年1月—2020年12月于安徽医科大学第二附属医院行PD置管的140例患者为研究对象,根据是否发生PDAP分为腹膜炎组和非腹膜炎组,比较2组患者一般临床资料及实验室指标。采用二分类Logistic回归分析PDAP发生的危险因素,采用受试者工作特征(ROC)曲线评估基线SIRI对PDAP发生的预测价值。根据腹膜炎组的预后情况将其进一步分为治疗成功组与治疗失败组,分析腹膜炎治疗失败的危险因素。结果 腹膜炎组的SIRI(Z=-4.347,P<0.001)、白细胞计数(Z=-3.590,P<0.001)、血磷(Z=-5.499,P<0.001)、血清碱性磷酸酶(Z=-2.452,P=0.014)、总胆固醇(Z=-2.195,P=0.028)水平高于非腹膜炎组,差异有统计学意义。多因素Logistic回归分析显示:基线高SIRI(OR=2.084,95%CI:1.054~4.121,P=0.035)、高血磷(OR=11.826,95%CI:4.204~33.262,P<0.001)及高血清碱性磷酸酶(OR=1.010,95%CI:1.002~1.019,P=0.022)是PDAP发生的危险因素。ROC曲线结果显示SIRI的曲线下面积为0.720(95%CI:0.633~0.808,P<0.001),灵敏度和特异度分别为69.2%和67.0%。高基线SIRI水平(OR=0.446,96%CI:0.208~0.959,P=0.039)是PDAP治疗失败的危险因素。结论 基线全身炎症反应指数与维持性腹膜透析患者发生腹膜透析相关性腹膜炎发生风险相关,对腹膜透析相关性腹膜炎的发生和预后有较好的预测价值。Objective To investigate the predictive value of baseline systemic inflammatory response index(SIRI)for peritoneal dialysis-associated peritonitis(PDAP)in peritoneal dialysis(PD)patients.Methods A total of 140 patients undergoing PD catheterization in the Second Affiliated Hospital of Anhui Medical University from January 2014 to December 2020 were retrospectively analyzed.They were divided into peritonitis group and non-peritonitis group according to the presence or absence of PDAP.General clinical data and laboratory indexes were compared between the two groups.Binary logistic regression was used to analyze the risk factors for PDAP,and receiver operating characteristic(ROC)curve was used to evaluate the predictive value of baseline SIRI for the occurrence of PDAP.According to the prognosis in peritonitis group,the patients were further divided into a successful treatment group and an ineffective treatment group;the risk factors for peritonitis treatment failure were then analyzed.Results SIRI(Z=-4.347,P<0.001),white blood cell count(Z=-3.590,P<0.001),serum phosphorus(Z=-5.499,P<0.001),serum alkaline phosphatase(Z=-2.452,P=0.014),and total cholesterol(Z=-2.195,P=0.028)were significantly higher in the peritonitis group than in the non-peritonitis group.Multivariate logistic regression showed that higher SIRI(OR=2.084,95%CI:1.054~4.121,P=0.035),higher serum phosphorus(OR=11.826,95%CI:4.204~33.262,P<0.001)and higher serum alkaline phosphatase(OR=1.010,95%CI:1.002~1.019,P=0.022)were the risk factors for PDAP.ROC curve showed that the area under the curve of SIRI was 0.720,with the sensitivity of 69.2% and specificity of 67%.Higher baseline SIRI level(OR=0.446,96%CI:0.208~0.959,P=0.039)was a risk factor for treatment failure of PDAP.Conclusions The baseline SIRI is associated with the risk of PDAP in PD patients,and is a good predictive indicator for the occurrence and prognosis of PDAP.

关 键 词：全身炎症反应指数 腹膜透析相关性腹膜炎 危险因素 

分 类 号：R459.5[医药卫生—治疗学]