發(fā)布時間：2018-06-12 08:26

  本文選題：腹膜透析相關(guān)性腹膜炎 + NGAL　； 參考：《安徽醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討腹膜透析引出液中中性粒細(xì)胞明膠酶相關(guān)脂質(zhì)運載蛋白(Neutrophil gelatinase-associated lipocalin,NGAL)在腹膜透析相關(guān)性腹膜炎(Peritoneal dialysis related peritonitis,PDAP)中的診斷價值。方法選擇2013年7月~2016年7月于本中心明確診斷的PDAP患者共60例作為腹膜炎組。根據(jù)培養(yǎng)結(jié)果將腹膜炎組分為三組,其中培養(yǎng)陰性組20例、G+菌組24例和G-菌組16例。同時選擇于本中心穩(wěn)定腹膜透析(Peritoneal dialysis,PD)患者共30例作為對照組。收集全部患者的臨床相關(guān)資料、血清以及腹膜透析引出液中的標(biāo)本,應(yīng)用酶聯(lián)免疫吸附試驗(Enzyme Linked Immunosorbent Assay,ELISA)檢測所有患者入院當(dāng)天第一袋腹膜透析引出液中的NGAL水平,同時由本中心檢驗科進行腹透液的培養(yǎng),同時檢出腹膜透析引出液中的IL-6、白細(xì)胞計數(shù)(WBC)、多個核細(xì)胞百分比及全血中的白細(xì)胞計數(shù)、C反應(yīng)蛋白(C-reactive protein,CRP)的濃度。采用SPSS16.0對上述數(shù)據(jù)及病例一般臨床資料進行統(tǒng)計分析。結(jié)果1.腹膜炎組和對照組比較:腹膜炎組腹膜透析引出液中的NGAL、IL-6、WBC、多個核細(xì)胞百分比明顯高于對照組,差異有統(tǒng)計學(xué)意義(P0.05);一般資料中全血中的白細(xì)胞計數(shù)、中性粒細(xì)胞百分比、CRP明顯高于對照組,差異有統(tǒng)計學(xué)意義(P0.05);血肌酐、白蛋白、轉(zhuǎn)鐵蛋白、轉(zhuǎn)鐵蛋白飽和度低于對照組,差異有統(tǒng)計學(xué)意義(P0.05);年齡、血紅蛋白、鐵蛋白以及甲狀旁腺激素兩組無明顯差別,差異并無統(tǒng)計學(xué)意義(P0.05)。2.G-菌組、G+菌組、培養(yǎng)陰性組分別與對照組比較:三組腹膜透析引出液中的NGAL、IL-6、WBC、多個核細(xì)胞百分比均明顯高于對照組,差異有統(tǒng)計學(xué)意義(P0.05)。3.腹膜炎組的組間比較:G+菌組腹膜透析引出液中的NGAL、多個核細(xì)胞百分比明顯高于培養(yǎng)陰性組,差異有統(tǒng)計學(xué)意義(P0.05),但與G-菌組比較差異無統(tǒng)計學(xué)意義(P0.05);G-菌組腹膜透析引出液中的NGAL、多個核細(xì)胞百分比明顯高于培養(yǎng)陰性組,差異有統(tǒng)計學(xué)意義(P0.05)。4.腹膜炎組腹膜透析引出液中的NGAL與WBC呈正相關(guān)(r=0.492,P0.05);而IL-6與WBC無相關(guān)性(r=0.034,P0.05)。5.應(yīng)用二分類logistic回歸分析對腹膜透析引出液中的NGAL、IL-6及WBC 3項指標(biāo)預(yù)測腹膜炎發(fā)生的作用大小及預(yù)測腹膜透析引出液培養(yǎng)陽性和培養(yǎng)陰性、G+菌性腹膜炎與G-菌性腹膜炎的作用大小進行方程擬合,NGAL與腹膜炎發(fā)生顯著相關(guān)(OR值=1.028,P0.05),與培養(yǎng)陽性顯著相關(guān)(OR值=0.998,P0.05),在預(yù)測G+菌性腹膜炎與G-菌性腹膜炎的作用中無明顯相關(guān)性(P0.05)。結(jié)論腹膜透析引出液中NGAL可作為PDAP發(fā)生的可靠指標(biāo),有助于區(qū)分培養(yǎng)陽性腹膜炎及菌陰性腹膜炎的發(fā)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.
【學(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R692.5

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本文編號：2009036