中国血液净化 ›› 2023, Vol. 22 ›› Issue (05): 339-343.doi: 10.3969/j.issn.1671-4091.2023.05.005

• 临床研究 • 上一篇    下一篇

维持性血液透析患者血清降钙素原表达水平及对感染的诊断价值

赵书茵   李 萍   梁献慧   

  1. 450052 郑州,郑州大学第一附属医院1血液净化中心 2肾脏病研究所
  • 收稿日期:2022-12-09 修回日期:2023-02-22 出版日期:2023-05-12 发布日期:2023-05-12
  • 通讯作者: 梁献慧 E-mail:fccliangxh@zzu.edu.cn

Serum level of procalcitonin and its diagnostic value for infections in maintenance hemodialysis patients

ZHAO Shu-yin, LI Ping, LIANG Xian-hui   

  1. Blood Purification Center and   2Research Institute of Nephrology, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, China
  • Received:2022-12-09 Revised:2023-02-22 Online:2023-05-12 Published:2023-05-12
  • Contact: 450052 郑州,郑州大学第一附属医院1血液净化中心 2肾脏病研究所 E-mail:fccliangxh@zzu.edu.cn

摘要: 目的 探讨维持性血液透析(maintenance hemodialysis,MHD)患者血清降钙素原(procalcitonin,PCT)的水平及影响因素,评估PCT对MHD患者感染的诊断价值。 方法 采用横断面研究,选取非感染的MHD患者500例,根据PCT水平将无感染患者进一步分层,采用组间比较、单因素及多因素Logistic回归法探讨MHD患者PCT升高的影响因素。另选取合并临床感染的MHD患者115例,采用受试者工作特征曲线(ROC)及曲线下面积(AUC)分析,明确PCT诊断MHD患者合并感染的最佳界值。 结果  与非感染组相比,感染组MHD患者血清PCT明显升高(Z=-14.204;P<0.001)。Logistic回归分析显示:以导管为血管通路(OR =2.142,95% CI:1.282~3.579,P=0.004)、男性(OR=1.517,95% CI:1.036~2.221,P=0.032)、血红蛋白<110g/L(OR=1.792,95% CI:1.225~2.623,P=0.003)、血磷≥1.78mmol/L(OR=1.608,95% CI:1.079~2.379,P=0.020)及甲状旁腺激素≥300pg/ml(OR=1.693,95% CI:1.156~2.479,P=0.007)是MHD患者PCT水平升高的独立危险因素。当截断值为0.851ng/ml时,PCT预测MHD患者感染的敏感度为85.2%,特异度为87.2%,AUC为0.924(95% CI:0.896~0.953)。 结论  MHD患者PCT水平显著升高。临床实践中以PCT为指标来预测MHD感染状态时,诊断界值应上调。

关键词: 维持性血液透析, 降钙素原, 微炎症, 感染

Abstract: Objective   To explore the level and influencing factors of serum procalcitonin (PCT) in maintenance hemodialysis (MHD) patients, and to evaluate the diagnostic value of PCT for infections in MHD patients.  Methods  A total of 500 MHD patients without clinical infection were selected in this cross-sectional study. They were further stratified according to serum PCT level. The influencing factors for the higher serum PCT in MHD patients were investigated by inter-group comparison, univariate and multivariate logistic regression analyses. Additionally, a total of 115 MHD patients with clinical infections were recruited. The optimal cut-off value of serum PCT for the diagnosis of infections in the MHD patients was determined by receiver operating characteristic (ROC) curve and the area under the curve (AUC).  Results   Compared with non-infected groups,serum PCT was significantly elevated in patients in the infected group (Z=-14.204, P<0.001). Logistic regression showed that catheters as the dialysis access (OR=2.142, 95% CI:1.282~3.579, P=0.004), male (OR=1.517, 95% CI: 1.036~2.221, P=0.032), hemoglobin<110g/L (OR=1.792, 95% CI 1.225~2.623, P=0.003), blood phosphorus≥1.78mmol/L (OR=1.608, 95% CI:1.079~2.379, P=0.020) and parathyroid hormone >300pg/ml (OR=1.693, 95% CI:1.156~2.479, P=0.007) were the independent risk factors for higher serum PCT level in MHD patients. When the cut-off value of serum PCT was set at 0.851ng/ml, the sensitivity and specificity of PCT to predict infections in MHD patients were 85.2% and 87.2% respectively, with the AUC of 0.924 (95% CI 0.896~0.953).  Conclusions  Serum PCT is significantly increased in MHD patients. We recommend a higher diagnostic threshold of serum PCT for the clinical diagnosis of infections in MHD patients.

Key words: Maintenance hemodialysis, Procalcitonin, Microinflammation, Infection

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