腹膜透析相关性腹膜炎腹透液CRP、PCT及CA125水平与临床意义
发布时间：2018-08-09 14:50
【摘要】：目的通过检测腹膜透析相关性腹膜炎(Peritoneal dialysis related peritonitis,PDAP)患者腹膜透析液中的C-反应蛋白(C-reactive protein,CRP)、降钙素原(procalcitonin,PCT)和癌抗原125(cancer antigen 125,CA-125)水平以及与患者各项临床资料相比,探讨CRP、PCT及CA-125水平变化在腹膜透析相关性腹膜炎中的临床意义。方法收集我院2013年7月至2016年7月间明确诊断的PDAP患者作为腹膜炎组,共60例。根据腹膜透析液培养结果的不同将腹膜炎组分为三组,分别为G+菌组24例,G-菌组16例,和培养阴性组20例。另外选择我院稳定腹膜透析(Peritoneal dialysis,PD)患者30例作对照组。收集所有腹透患者的基本临床资料,留取这些患者入院后第一次的腹膜透析滤出液标本(腹腔内至少保留2小时),用颗粒增强免疫透射比浊法检测患者腹透液中CRP表达水平,用酶联免疫荧光法检测患者腹透液中PCT表达水平,用电化学发光法检测患者CA-125表达水平,同时留取腹透液送我院检验科行细菌学培养。结果(1)腹膜炎组患者与稳定腹透的对照组相比,年龄、血红蛋白、甲状旁腺激素、铁蛋白两组之间差异无统计学意义(p0.05);腹膜炎组的血白细胞计数、中性粒细胞百分比显著高于稳定透析的对照组,且两者差异有统计学意义(p0.05);腹膜炎组的血肌酐、血白蛋白、转铁蛋白、转铁蛋白饱和度均较对照组降低,两者差异有统计学意义(p0.05);(2)与对照组稳定腹透患者相比,腹膜炎组患者的腹膜透析液中CRP、PCT及CA-125水平明显升高,差异有统计学意义(p0.05);在腹膜炎组中G+菌组、G-菌组和培养阴性组分别与对照组相比:三组腹膜透析液中的PCT、CA-125及白细胞计数、多个核细胞百分比均明显升高,且p0.05,差异有统计学意义;而腹透液CRP在G-菌组与对照组之间差异无统计学意义。(3)腹膜炎组的组间比较:G+菌组腹膜透析引出液中的CA-125明显高于培养阴性组,G-菌组和培养阴性组腹膜透析引出液中的多个核细胞百分比差异有统计学意义(p0.05)。但G+菌组和G-菌组相比以及G-菌组和培养阴性组相比,上述的各项指标之间差异无统计学意义;(4).腹膜炎组腹透液PCT、CA125与腹透液WBC呈正相关(r分别为0.446和0.325,p0.05);腹膜液CRP与腹透液WBC之间无相关性(r=0.001,p0.05);(5)应用二分类logistic回归分析对腹透液CRP、PCT、CA125及腹透液白细胞计数4项指标对腹膜炎发生预测作用大小及对腹透液培养预测作用大小进行方程拟合,腹透液CA125与腹膜炎发生显著相关(OR值=1.108,p0.05),与培养阳性显著相关(OR值=0.964,p0.05);但上述指标对预测鉴别革兰阳性菌和革兰阴性菌均没有意义。结论腹膜透析滤出液中CRP、PCT和CA-125水平升高是诊断腹膜透析相关性腹膜炎的可靠指标;其中CA-125水平升高是腹膜透析相关性腹膜炎培养阳性的可靠预测指标。
[Abstract]:Objective to detect the levels of C-reactive, procalcitonin-PCT and cancer antigen 125 (CA-125) in peritoneal dialysis fluid of patients with peritoneal dialysis associated peritonitis (Peritoneal dialysis related peritoneal peritonitis). To investigate the clinical significance of the changes of CRP T and CA-125 levels in peritoneal dialysis associated peritonitis. Methods from July 2013 to July 2016, 60 patients with PDAP were selected as peritonitis group. According to the results of peritoneal dialysis fluid culture, the peritonitis group was divided into three groups: G bacteria group (n = 24), G bacteria group (n = 16) and culture negative group (n = 20). In addition, 30 patients with stable peritoneal dialysis (Peritoneal dialysissis PD) in our hospital were selected as control group. The basic clinical data of all patients with peritoneal dialysis were collected and the first peritoneal dialysis fluid samples (at least 2 hours in abdominal cavity) were collected. The expression of CRP in peritoneal dialysis fluid was detected by particle enhanced immunoturbidimetry. The expression of PCT in peritoneal dialysis fluid was detected by enzyme-linked immunofluorescence assay (Elisa), and the expression level of CA-125 was detected by electrochemiluminescence method. At the same time, the peritoneal dialysate was taken and sent to the laboratory of our hospital for bacteriological culture. Results (1) there was no significant difference in age, hemoglobin, parathyroid hormone and ferritin between the peritonitis group and the stable peritoneal dialysis group (p0.05). The percentage of neutrophils was significantly higher than that in the stable dialysis group (p0.05), and the serum creatinine, albumin and transferrin saturation in the peritonitis group were lower than those in the control group. There was a significant difference between the two groups (p0. 05); (2). Compared with the stable peritoneal dialysis patients in the control group, the levels of CRP); (T and CA-125 in peritoneal dialysis fluid in the peritonitis group were significantly higher than those in the control group. In the group of peritonitis, the percentage of PCT CA-125 and leukocyte in peritoneal dialysis fluid of the three groups was significantly higher than that of the control group, and the percentage of the cells in the G group and the culture negative group were significantly higher than that in the control group. And p0.05, the difference was statistically significant. However, there was no significant difference in CRP between G- bacteria group and control group. (3) the CA-125 in peritoneal dialysis exudate in the group of peritonitis was significantly higher than that in the culture negative group and negative group. (3) the CA-125 in the peritoneal dialysis exudate in the group of peritonitis was significantly higher than that in the group of culture negative bacteria and the group with negative culture. The percentage of multiple nuclear cells in the solution was significantly different (p0.05). However, there was no significant difference in the above indexes between G group and G bacteria group and between G bacteria group and culture negative group. (4). In peritonitis group, there was a positive correlation between WBC and CRP in peritoneal dialysate (r = 0.446 and 0.325%, respectively), but no correlation between CRP in peritoneal fluid and WBC in peritoneal dialysate (r 0.001 p0.05); (5). Two classification logistic regression analysis was used to analyze the four indexes of CRP and leukocyte count in peritoneal dialysate. The prediction effect of peritonitis and the predictive effect of peritoneal dialysate culture were fitted by equation. CA125 in peritoneal dialysis fluid was significantly correlated with peritonitis (OR = 1.108, p0.05) and culture positive (OR = 0.964, p0.05), but the above indexes had no significance in predicting Gram-positive bacteria and Gram-negative bacteria. Conclusion the elevated levels of CRPP-PCT and CA-125 in peritoneal dialysis filtrate are reliable markers for the diagnosis of peritoneal dialysation-associated peritonitis, and the increase of CA-125 level is a reliable predictor of positive culture of peritoneal dialysis-associated 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
本文编号：2174434
[Abstract]:Objective to detect the levels of C-reactive, procalcitonin-PCT and cancer antigen 125 (CA-125) in peritoneal dialysis fluid of patients with peritoneal dialysis associated peritonitis (Peritoneal dialysis related peritoneal peritonitis). To investigate the clinical significance of the changes of CRP T and CA-125 levels in peritoneal dialysis associated peritonitis. Methods from July 2013 to July 2016, 60 patients with PDAP were selected as peritonitis group. According to the results of peritoneal dialysis fluid culture, the peritonitis group was divided into three groups: G bacteria group (n = 24), G bacteria group (n = 16) and culture negative group (n = 20). In addition, 30 patients with stable peritoneal dialysis (Peritoneal dialysissis PD) in our hospital were selected as control group. The basic clinical data of all patients with peritoneal dialysis were collected and the first peritoneal dialysis fluid samples (at least 2 hours in abdominal cavity) were collected. The expression of CRP in peritoneal dialysis fluid was detected by particle enhanced immunoturbidimetry. The expression of PCT in peritoneal dialysis fluid was detected by enzyme-linked immunofluorescence assay (Elisa), and the expression level of CA-125 was detected by electrochemiluminescence method. At the same time, the peritoneal dialysate was taken and sent to the laboratory of our hospital for bacteriological culture. Results (1) there was no significant difference in age, hemoglobin, parathyroid hormone and ferritin between the peritonitis group and the stable peritoneal dialysis group (p0.05). The percentage of neutrophils was significantly higher than that in the stable dialysis group (p0.05), and the serum creatinine, albumin and transferrin saturation in the peritonitis group were lower than those in the control group. There was a significant difference between the two groups (p0. 05); (2). Compared with the stable peritoneal dialysis patients in the control group, the levels of CRP); (T and CA-125 in peritoneal dialysis fluid in the peritonitis group were significantly higher than those in the control group. In the group of peritonitis, the percentage of PCT CA-125 and leukocyte in peritoneal dialysis fluid of the three groups was significantly higher than that of the control group, and the percentage of the cells in the G group and the culture negative group were significantly higher than that in the control group. And p0.05, the difference was statistically significant. However, there was no significant difference in CRP between G- bacteria group and control group. (3) the CA-125 in peritoneal dialysis exudate in the group of peritonitis was significantly higher than that in the culture negative group and negative group. (3) the CA-125 in the peritoneal dialysis exudate in the group of peritonitis was significantly higher than that in the group of culture negative bacteria and the group with negative culture. The percentage of multiple nuclear cells in the solution was significantly different (p0.05). However, there was no significant difference in the above indexes between G group and G bacteria group and between G bacteria group and culture negative group. (4). In peritonitis group, there was a positive correlation between WBC and CRP in peritoneal dialysate (r = 0.446 and 0.325%, respectively), but no correlation between CRP in peritoneal fluid and WBC in peritoneal dialysate (r 0.001 p0.05); (5). Two classification logistic regression analysis was used to analyze the four indexes of CRP and leukocyte count in peritoneal dialysate. The prediction effect of peritonitis and the predictive effect of peritoneal dialysate culture were fitted by equation. CA125 in peritoneal dialysis fluid was significantly correlated with peritonitis (OR = 1.108, p0.05) and culture positive (OR = 0.964, p0.05), but the above indexes had no significance in predicting Gram-positive bacteria and Gram-negative bacteria. Conclusion the elevated levels of CRPP-PCT and CA-125 in peritoneal dialysis filtrate are reliable markers for the diagnosis of peritoneal dialysation-associated peritonitis, and the increase of CA-125 level is a reliable predictor of positive culture of peritoneal dialysis-associated 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】
相关期刊论文 前8条
1 张群;胡晓波;;降钙素原在革兰阳性菌和革兰阴性菌感染鉴别诊断中的价值探讨[J];检验医学;2015年11期
2 陶瑾;申新宏;艾永红;杨玉霞;;血清降钙素原在患者腹膜透析感染性腹膜炎中的诊断价值[J];中华医院感染学杂志;2015年16期
3 刘德玲;张苗;蒋春明;孙t$;王娟;;革兰阴性菌与革兰阳性菌致腹膜透析相关性腹膜炎的临床特征[J];东南大学学报(医学版);2015年03期
4 申新宏;陶瑾;王焕;;透出液癌胚抗原125在腹膜透析患者腹膜感染时的变化与病原菌分布[J];中华医院感染学杂志;2015年09期
5 曹雪莹;周建辉;蔡广研;陈香美;;腹膜透析滤出液生物标志物的研究进展[J];中华肾病研究电子杂志;2015年01期
6 张宜明;刘雷;孟雪;魏明明;王栋;张昆;曲小菡;李新建;;培养阴性腹膜透析相关性腹膜炎的实验室指标及预后分析[J];中华诊断学电子杂志;2014年03期
7 Jacob A Akoh;;Peritoneal dialysis associated infections: An update on diagnosis and management[J];World Journal of Nephrology;2012年04期
8 张涛;周虹;王用金;曹守冬;张剑梅;;降钙素原在急诊抗感染中的诊断意义[J];中华急诊医学杂志;2010年05期
，本文编号：2174434
本文链接：https://www.wllwen.com/linchuangyixuelunwen/2174434.html
最近更新
教材专著
