NGAL在腹膜透析相关性腹膜炎中的诊断价值

发布时间：2018-06-12 08:26

本文选题：腹膜透析相关性腹膜炎 + NGAL　；参考：《安徽医科大学》2017年硕士论文

【摘要】：目的探讨腹膜透析引出液中中性粒细胞明胶酶相关脂质运载蛋白(Neutrophil gelatinase-associated lipocalin,NGAL)在腹膜透析相关性腹膜炎(Peritoneal dialysis related peritonitis,PDAP)中的诊断价值。方法选择2013年7月~2016年7月于本中心明确诊断的PDAP患者共60例作为腹膜炎组。根据培养结果将腹膜炎组分为三组,其中培养阴性组20例、G+菌组24例和G-菌组16例。同时选择于本中心稳定腹膜透析(Peritoneal dialysis,PD)患者共30例作为对照组。收集全部患者的临床相关资料、血清以及腹膜透析引出液中的标本,应用酶联免疫吸附试验(Enzyme Linked Immunosorbent Assay,ELISA)检测所有患者入院当天第一袋腹膜透析引出液中的NGAL水平,同时由本中心检验科进行腹透液的培养,同时检出腹膜透析引出液中的IL-6、白细胞计数(WBC)、多个核细胞百分比及全血中的白细胞计数、C反应蛋白(C-reactive protein,CRP)的浓度。采用SPSS16.0对上述数据及病例一般临床资料进行统计分析。结果1.腹膜炎组和对照组比较:腹膜炎组腹膜透析引出液中的NGAL、IL-6、WBC、多个核细胞百分比明显高于对照组,差异有统计学意义(P0.05);一般资料中全血中的白细胞计数、中性粒细胞百分比、CRP明显高于对照组,差异有统计学意义(P0.05);血肌酐、白蛋白、转铁蛋白、转铁蛋白饱和度低于对照组,差异有统计学意义(P0.05);年龄、血红蛋白、铁蛋白以及甲状旁腺激素两组无明显差别,差异并无统计学意义(P0.05)。2.G-菌组、G+菌组、培养阴性组分别与对照组比较:三组腹膜透析引出液中的NGAL、IL-6、WBC、多个核细胞百分比均明显高于对照组,差异有统计学意义(P0.05)。3.腹膜炎组的组间比较:G+菌组腹膜透析引出液中的NGAL、多个核细胞百分比明显高于培养阴性组,差异有统计学意义(P0.05),但与G-菌组比较差异无统计学意义(P0.05);G-菌组腹膜透析引出液中的NGAL、多个核细胞百分比明显高于培养阴性组,差异有统计学意义(P0.05)。4.腹膜炎组腹膜透析引出液中的NGAL与WBC呈正相关(r=0.492,P0.05);而IL-6与WBC无相关性(r=0.034,P0.05)。5.应用二分类logistic回归分析对腹膜透析引出液中的NGAL、IL-6及WBC 3项指标预测腹膜炎发生的作用大小及预测腹膜透析引出液培养阳性和培养阴性、G+菌性腹膜炎与G-菌性腹膜炎的作用大小进行方程拟合,NGAL与腹膜炎发生显著相关(OR值=1.028,P0.05),与培养阳性显著相关(OR值=0.998,P0.05),在预测G+菌性腹膜炎与G-菌性腹膜炎的作用中无明显相关性(P0.05)。结论腹膜透析引出液中NGAL可作为PDAP发生的可靠指标,有助于区分培养阳性腹膜炎及菌阴性腹膜炎的发生。
[Abstract]:Objective to investigate the diagnostic value of neutrophil gelatinase-associated lipocalin NGALs (Neutrophil gelatinase-associated lipocalin NGALs) in peritoneal dialysis (PD) -associated peritonitis patients with peritoneal dialysis related pneumonia (PDAP). Methods 60 patients with PDAP diagnosed in our center from July 2013 to July 2016 were selected as peritonitis group. According to the culture results, the peritonitis group was divided into three groups, including 20 cases of negative culture group, 24 cases of G bacteria group and 16 cases of G- bacteria group. At the same time, 30 patients with Peritoneal dialysissis (PDD) were selected as the control group. The clinical data of all the patients were collected, and the serum and peritoneal dialysis extract samples were collected. The level of NGAL in the first bag of peritoneal dialysis extract was detected by enzyme linked immunosorbent Assayosorbent ELISAs by enzyme linked immunosorbent assay (Elisa). At the same time, the culture of peritoneal dialysis solution was carried out by the laboratory of our center. The concentrations of IL-6, WBC, the percentage of multiple nuclear cells and the whole blood leukocyte count, C-reactive protein (C-reactive protein) were detected. The above data and general clinical data were analyzed by SPSS 16.0. Result 1. The percentage of multiple nuclear cells in peritoneal dialysis exudate of peritonitis group was significantly higher than that in control group (P 0.05). Serum creatinine, albumin and transferrin saturation were significantly lower than those in the control group (P 0.05). There was no significant difference in ferritin and parathyroid hormone between the two groups. Compared with the control group, the percentages of multiple nuclear cells in the peritoneal dialysis solution of the three groups were significantly higher than those in the control group (P < 0.05). In the peritonitis group, the percentage of multiple nucleocellutes in peritoneal dialysis exudates in the group of 20% G bacteria was significantly higher than that in the negative culture group. The difference was statistically significant (P 0.05), but there was no significant difference between G- group and G- bacteria group. The percentage of multiple karyocytes in peritoneal dialysis solution of G- group was significantly higher than that of negative culture group (P 0. 05. 4). In peritonitis group, there was a positive correlation between NGAL and WBC, but no correlation between IL-6 and WBC. Application of two classification logistic regression analysis to predict the occurrence of peritonitis by using three indexes of NGALL IL-6 and WBC in peritoneal dialysis exudates and to predict the positive and negative culture of peritoneal dialysis exudates for the development of peritonitis and G- bacterial peritonitis The effect of NGAL was significantly correlated with the occurrence of peritonitis (OR = 1.028) and culture positive correlation (P < 0.05). There was no significant correlation between NGAL and G- bacterial peritonitis in predicting the role of G bacillary peritonitis and G- bacterial peritonitis. Conclusion NGAL in peritoneal dialysis solution can be used as a reliable marker of PDAP, and it is helpful to distinguish positive peritonitis from bacterial peritonitis.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R692.5

【参考文献】