隧道式导管与动静脉内瘘血管通路的维持性血液透析患者C反应蛋白、中性粒细胞与淋巴细胞比值、血红蛋白水平变化差异及预测感染价值  

Changes in C-reactive protein,neutrophil-to-lymphocyte ratio,and hemoglobin levels in mainte⁃nance hemodialysis patients with tunnel catheter and arteriovenous fistula vascular access and their predictive values for infections

作　　者：王子竞 钟杰 龚雪峰 茹雪 Wang Zi-jing;Zhong Jie;Gong Xue-feng;Ru Xue(Department of Nephrology,Affiliated Hospital of Panzhihua University,Panzhihua 617000,China)

机构地区：[1]攀枝花学院附属医院肾内科,攀枝花617000

出　　处：《临床肾脏病杂志》2025年第3期186-193,共8页Journal Of Clinical Nephrology

基　　金：四川省中医药管理局科学技术研究专项课题(2021MS373)。

摘　　要：目的 探讨隧道式导管与动静脉内瘘(autostatic arteriovenous fistula,AVF)血管通路的维持性血液透析(maintenance hemodialysis,MHD)患者C反应蛋白(C-reactive protein,CRP)、中性粒细胞与淋巴细胞比值(neutrophil to lymphocyte ratio,NLR)、血红蛋白(hemoglobin,Hb)水平变化差异及预测感染的价值。方法 选取2020年1月1日至2022年6月30日攀枝花学院附属医院MHD患者108例,根据不同血管通路分组,其中47例隧道式导管血管通路患者作为导管组,61例AVF血管通路患者作为AVF组。比较两组患者基线时、随访6个月时肾功能指标(血肌酐、尿素氮)、透析充分性(单室尿素清除指数、尿素下降率、平衡后尿素清除指数)、CRP、NLR、Hb水平及感染发生率,分析CRP、NLR、Hb水平对感染的预测价值。结果 两组患者基线时、随访6个月时血肌酐、尿素氮、单室尿素清除指数、尿素下降率、平衡后尿素清除指数比较,差异无统计学意义(P>0.05);AVF组患者随访6个月时CRP[(12.92±3.17)mg/L比(16.35±5.11)mg/L]、NLR[(3.36±0.74)比(4.57±1.23)]水平低于导管组,Hb水平[(110.52±12.16)g/L比(100.31±14.47)g/L]高于导管组(P<0.05);AVF组患者感染发生率13.11%低于导管组31.91%(P<0.05);感染组随访6个月时CRP[(18.85±5.09)mg/L比(13.21±3.36)mg/L]、NLR[(5.60±1.21)比(3.43±1.08)]水平高于基线时,Hb水平[(94.70±11.96)g/L比(109.16±14.14)g/L]低于基线时(P<0.05);受试者工作特征曲线结果分析,随访6个月时CRP、NLR、Hb联合预测MHD并发感染的曲线下面积为0.928(95%CI:0.862~0.969),敏感度为78.26%,特异度为91.76%,大于各指标单独预测(P<0.05);以随访6个月时CRP、NLR、Hb的截断值分为低水平、高水平,随访6个月时CRP、NLR高水平患者并发感染风险是低水平患者的7.180倍(95%CI:2.623~19.656)、4.750倍(95%CI:1.730~13.043);Hb低水平患者并发感染风险是高水平患者的5.567倍(95%CI:2.272~14.085)(P<0.05)。结论 与隧道式导管血管通路患者相Objective To investigate the differences in C-reactive protein(CRP),neutrophil-to-lymphocyte ratio(NLR)and hemoglobin(Hb)levels in maintenance hemodialysis(MHD)patients with tunnel catheter and arteriovenous fistula(AVF)and their value in predicting infections.Methods A total of 108 MHD patients from 1 January 2020 to 30 June 2022 were selected from Affiliated Hopital of Pan-zhihua College and grouped according to different vascular accesses.Forty-seven patients with tunnel catheter vascular access were included in the catheter group and 61 patients with AVF vascular access were included in the AVF group.Renal function indicators(serum creatinine[Scr],blood urea nitrogen[BUN]),dialysis adequacy(single ventricular urea clearance index[spKt/V],urea reduction ratio[URR],post-equilibrium urea clearance index[eKt/V]),CRP,NLR,Hb and incidence of infection were compared between the two groups at baseline and at 6-month follow-up.The predictive values of CRP,NLR and Hb levels for infections were analyzed.Results There were no significant differences in Scr,BUN,spKt/V,URR,and eKt/V between the two groups at baseline and at 6 months follow-up(P>0.05).At the 6-month follow-up,CRP(12.92±3.17 mg/L vs.16.35±5.11 mg/L)and NLR(3.36±0.74 vs.4.57±1.23)in the AVF group were significantly lower than those of the catheter group,while Hb(110.52±12.16 g/L vs.100.31±14.47 g/L)was significantly higher(P<0.05).The incidence of infection in the AVF group was significantly lower than the catheter group(13.11%vs.31.91%,P<0.05).At the 6-month follow-up,CRP(18.85±5.09 mg/L vs.13.21±3.36 mg/L)and NLR(5.60±1.21 vs.3.43±1.08)in the infection group were significantly higher than those at baseline,while Hb(94.70±11.96 g/L vs.109.16±14.14 g/L)was significantly lower(P<0.05).Re-ceiver operating characteristic(ROC)curve results showed that the area under the curve(AUC)of a com-bination of CRP,NLR,and Hb in predicting MHD-related infection at 6 months of follow-up was 0.928(95%CI:0.862-0.969),with a sensitivity of 78.26%and a specificity of

关 键 词：血管通路 维持性血液透析 C反应蛋白 中性粒细胞与淋巴细胞比值 血红蛋白 感染 

分 类 号：R73[医药卫生—肿瘤]