维持性血液透析患者并发感染的危险因素及miR-155与NLR和PTH预测价值  

Risk factors of complicated nosocomial infection and predictive value of miR-155,NLR and PTH in maintenance hemodialysis patients

作　　者：王鹏鸽 王萌萌 王碧月 孙夕然 张靖华[1] WANG Peng-ge;WANG Meng-meng;WANG Bi-yue;SUN Xi-ran;ZHANG Jing-hua(Zhengzhou Seventh People's Hospital,Zhengzhou,Henan 450000,China)

机构地区：[1]郑州市第七人民医院肾移植肾内科,河南郑州450000

出　　处：《中华医院感染学杂志》2024年第8期1159-1162,共4页Chinese Journal of Nosocomiology

基　　金：河南省医学科技攻关联合共建项目(LHGJ20191126)。

摘　　要：目的探讨维持性血液透析(MHD)患者发生医院感染的风险因素及微小核糖核酸(miR)-155、中性粒细胞/淋巴细胞比值(NLR)、甲状旁腺素(PTH)对其的预测价值。方法回顾性选取388例2020年1月-2022年12月于郑州市第七人民医院行MHD的患者作为研究对象,根据患者是否发生医院感染分为感染组(n=53)和未感染组(n=335)。分析MHD患者医院感染的风险因素,比较两组血清中miR-155、静脉血中NLR和PTH水平,分析miR-155、NLR、PTH单独及联合检测对MHD患者医院感染的预测价值。结果388例行MHD患者发生医院感染为53例,占13.66%;透析时间久、贫血、低蛋白血症、糖尿病、血红蛋白(Hb)水平低均为MHD患者医院感染的风险因素(P<0.05);与未感染组相比,感染组血清中miR-155、静脉血中NLR和PTH水平较高(P<0.05);miR-155、NLR、PTH联合检测对MHD患者医院感染的诊断曲线下面积(AUC)值高于单独检测的AUC值(P<0.05),且联合检测的敏感度为96.23%,特异度为79.40%。结论MHD患者医院感染发生率较高,其风险因素为透析时间久、贫血、低蛋白血症、糖尿病、Hb水平低,此类患者血清中miR-155、静脉血中NLR和PTH水平较高,且三者联合检测诊断价值高。OBJECTIVE To investigate the risk factors of nocomial infection and the predictive value of micro ribo-nucleic acid(miR-155),neutrophil/lymphocyte ratio(NLR)and parathyroid hormone(PTH)in maintenance he-modialysis(MHD)patients.METHODS Clinical data of 388 patients undergoing MHD in the Seventh People's Hospital of Zhengzhou from Jan 2020 to Dec 2022 were retrospectively collected in the study.They were divided into the infected group(n=53)and the non-infected group(n=335)according to whether nosocomial infection occurred in the patients.The risk factors of nosocomial infection in MHD patients were analyzed,the levels of ser-um miR-155 and venous blood NLR and PTH were compared between the two groups.The predictive value of in-dividual and combined detection of miR-155,NLR and PTH for nosocomial infection in MHD patients was ana-lyzed.RESULTS Nosocomial infection occurred in 53 of 388 patients(13.66%)undergoing MHD.Long dialysis time,anemia,hypoproteinemia,diabetes and low level of hemoglobin(Hb)were risk factors for nosocomial in-fection in MHD patients(P<0.05).Compared with the non-infected group,the levels of serum miR-155,plasma NLR and PTH in the infected group were higher(P<0.05).The area under the diagnostic curve(AUC)value of the combined detection of miR-155,NLR and PTH for nosocomial infection in MHD patients was higher than that of the individual detection(P<0.05),and the sensitivity and specificity of the combined detection were 96.23%and 79.40%,respectively.CONCLUSION The incidence of nosocomial infection in MHD patients is higher,and its risk factors include long dialysis time,anemia,hypoproteinemia,diabetes,and low level of Hb.The serum level of miR-155 and plasma levels of NLR and PTH in these patients are higher,and the combined detection of the three indexes was of high diagnostic value.

关 键 词：维持性血液透析 医院感染 风险因素 微小核糖核酸-155 中性粒细胞/淋巴细胞比值 甲状旁腺素 

分 类 号：R692[医药卫生—泌尿科学]