中国血液净化

中国血液净化 ›› 2023, Vol. 22 ›› Issue (1): 22-26.doi: 10.3969/j.issn.1671-4091.2023.01.005

• 临床研究 • 上一篇    下一篇

正五聚蛋白3在腹膜透析相关性腹膜炎中的诊断价值

柯 莹  郑晓君  李清雲  崔彤霞   朱伟平   

  1. 519000 珠海，中山大学附属第五医院肾内科
  • 收稿日期:2022-06-15 修回日期:2022-11-07 出版日期:2023-01-12 发布日期:2023-01-12
  • 通讯作者: 朱伟平 E-mail:zhuwp@mail.sysu.edu.cn

The diagnostic value of pentraxin3 (PTX3) in peritoneal dialysis-related peritonitis 

KE Ying, ZHENG Xiao-jun, LI Qing-yun, CUI Tong-xia, ZHU Wei-ping   

  1. Department of Nephrology, The Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai 519000, China
  • Received:2022-06-15 Revised:2022-11-07 Online:2023-01-12 Published:2023-01-12
  • Contact: 519000 珠海，1中山大学附属第五医院肾内科 E-mail:zhuwp@mail.sysu.edu.cn

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摘要： 目的 探讨正五聚蛋白3(pentraxin3,PTX3)在腹膜透析相关性腹膜炎(Peritoneal dialysis-related peritonitis，PDRP)中的诊断价值。 方法 纳入2020年1月～2021年6月在中山大学附属第五医院肾内科住院的31名PDRP患者以及同期58名正常腹膜透析患者作为研究对象。收集研究对象的腹膜透析引出液(peritoneal effluent，PE)，批量用酶联免疫吸附测定法检测PE中PTX3(pentraxin3 in peritoneal effluent,pPTX3)。将研究对象的pPTX3与临床资料作统计学分析。 结果 pPTX3在PDRP组的表达水平显著高于非PDRP组(Z=-7.314，P＜0.001)；相比血白细胞、血淋巴细胞与单核细胞比值、血降钙素原、血超敏C反应蛋白，pPTX3(AUC=0.972，95%CI：0.913～0.995，P＜0.001)对PDRP的诊断效能更高。pPTX3和PE白细胞(AUC=0.991,95%CI：0.943～1.000，P＜0.001)对PDRP的诊断效能的差异无统计学意义(Z=1.161,P=0.246)；31例PDRP患者中有24例培养出病原菌，其中15例培养出革兰氏阳性菌，9例培养出革兰氏阴性菌，pPTX3在革兰氏阴性菌组表达水平显著高于革兰氏阳性菌组(Z=-2.684,P=0.005)；PDRP入组的31例患者中有18例患者完整留取了治疗第1，3，5，9和11天的PE,其中治愈的患者有14例，未治愈的患者有4例。治愈组的pPTX3-治疗时间曲线呈不断下降趋势，第11天无限接近X轴；未治愈组的pPTX3-治疗时间曲线在第1至5天呈下降趋势，第5天后未再下降。 结论  pPTX3是诊断PDRP有效的生物标志物，在鉴别革兰氏阳性菌与革兰氏阴性菌感染、评估PDRP治疗疗效及预后有一定参考价值。

关键词: 正五聚蛋白3, 炎症标志物, 腹膜透析相关性腹膜炎

Abstract: Objective  To explore the diagnostic value of pentraxin3 (PTX3) in peritoneal dialysis-related peritonitis (PDRP).   Methods  A total of 31 patients with PDRP and 58 patients without PDRP on normal peritoneal dialysis and hospitalized in the Nephrology Department, The Fifth Hospital of Sun Yat-sen University from January 2020 to June 2021 were recruited as the study subjects. Peritoneal effluent (PE) of the study subjects was collected and PTX3 in PE (pPTX3) was assayed in batches by enzyme-linked immunosorbent assay. The clinical data and pPTX3 of the study subjects were statistically analyzed.  Results  The expression level of pPTX3 in the PDRP group was significantly higher than that in the non-PDRP group (Z=-7.314, P＜0.001). Compared with blood contents of white blood cells, procalcitonin, lymphocyte to monocyte ratio and hypersensitive C-reactive protein, pPTX3 is more effective for the diagnosis of PDRP (area under the cure =0.972, 95% CI: 0.913～0.995, P<0.0001). There was no significant difference in pPTX3 and leukocytes in PE (AUC=0.991,95% CI: 0.943～1.000, P＜0.0001) for the diagnosis of PDRP (Z=1.161, P=0.246). Pathogens in PE were positive in 24 of the 31 patients with PDRP, of which 15 patients were Gram-positive bacterial infections and 9 patients were Gram-negative bacterial infections. pPTX3 was significantly higher in the patients with Gram-negative bacterial infections than in those with Gram-positive bacterial infections (Z=            -2.684, P=0.005). PE was collected at the 1st, 3rd, 5th, 9th and 13th day of treatment in 18 of the 31 patients with PDRP; in the 14 patients whose PDRP were cured, the pPTX3-treatment time curve gradually went downward and infinitely approached the X axis at the 11th day; in the 4 patients whose PDRP could not be cured, the pPTX3-treatment time curve gradually went downward from the 1st day to the 5th day then remained at this level after the 5th day.   Conclusions  pPTX3 is an effective biomarker for the diagnosis of PDRP, and may also be useful for the differentiation of Gram-negative bacterial infection from Gram-positive bacterial infection and for the evaluation of therapeutic efficacy and prognosis of PDRP.

Key words: Pentraxin3, Inflammatory marker, Peritoneal dialysis-associated peritonitis

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