腹膜透析相關性腹膜炎腹透液CRP、PCT及CA125水平與臨床意義
發(fā)布時間：2018-08-09 14:50
【摘要】：目的通過檢測腹膜透析相關性腹膜炎(Peritoneal dialysis related peritonitis,PDAP)患者腹膜透析液中的C-反應蛋白(C-reactive protein,CRP)、降鈣素原(procalcitonin,PCT)和癌抗原125(cancer antigen 125,CA-125)水平以及與患者各項臨床資料相比,探討CRP、PCT及CA-125水平變化在腹膜透析相關性腹膜炎中的臨床意義。方法收集我院2013年7月至2016年7月間明確診斷的PDAP患者作為腹膜炎組,共60例。根據腹膜透析液培養(yǎng)結果的不同將腹膜炎組分為三組,分別為G+菌組24例,G-菌組16例,和培養(yǎng)陰性組20例。另外選擇我院穩(wěn)定腹膜透析(Peritoneal dialysis,PD)患者30例作對照組。收集所有腹透患者的基本臨床資料,留取這些患者入院后第一次的腹膜透析濾出液標本(腹腔內至少保留2小時),用顆粒增強免疫透射比濁法檢測患者腹透液中CRP表達水平,用酶聯(lián)免疫熒光法檢測患者腹透液中PCT表達水平,用電化學發(fā)光法檢測患者CA-125表達水平,同時留取腹透液送我院檢驗科行細菌學培養(yǎng)。結果(1)腹膜炎組患者與穩(wěn)定腹透的對照組相比,年齡、血紅蛋白、甲狀旁腺激素、鐵蛋白兩組之間差異無統(tǒng)計學意義(p0.05);腹膜炎組的血白細胞計數、中性粒細胞百分比顯著高于穩(wěn)定透析的對照組,且兩者差異有統(tǒng)計學意義(p0.05);腹膜炎組的血肌酐、血白蛋白、轉鐵蛋白、轉鐵蛋白飽和度均較對照組降低,兩者差異有統(tǒng)計學意義(p0.05);(2)與對照組穩(wěn)定腹透患者相比,腹膜炎組患者的腹膜透析液中CRP、PCT及CA-125水平明顯升高,差異有統(tǒng)計學意義(p0.05);在腹膜炎組中G+菌組、G-菌組和培養(yǎng)陰性組分別與對照組相比:三組腹膜透析液中的PCT、CA-125及白細胞計數、多個核細胞百分比均明顯升高,且p0.05,差異有統(tǒng)計學意義;而腹透液CRP在G-菌組與對照組之間差異無統(tǒng)計學意義。(3)腹膜炎組的組間比較:G+菌組腹膜透析引出液中的CA-125明顯高于培養(yǎng)陰性組,G-菌組和培養(yǎng)陰性組腹膜透析引出液中的多個核細胞百分比差異有統(tǒng)計學意義(p0.05)。但G+菌組和G-菌組相比以及G-菌組和培養(yǎng)陰性組相比,上述的各項指標之間差異無統(tǒng)計學意義;(4).腹膜炎組腹透液PCT、CA125與腹透液WBC呈正相關(r分別為0.446和0.325,p0.05);腹膜液CRP與腹透液WBC之間無相關性(r=0.001,p0.05);(5)應用二分類logistic回歸分析對腹透液CRP、PCT、CA125及腹透液白細胞計數4項指標對腹膜炎發(fā)生預測作用大小及對腹透液培養(yǎng)預測作用大小進行方程擬合,腹透液CA125與腹膜炎發(fā)生顯著相關(OR值=1.108,p0.05),與培養(yǎng)陽性顯著相關(OR值=0.964,p0.05);但上述指標對預測鑒別革蘭陽性菌和革蘭陰性菌均沒有意義。結論腹膜透析濾出液中CRP、PCT和CA-125水平升高是診斷腹膜透析相關性腹膜炎的可靠指標;其中CA-125水平升高是腹膜透析相關性腹膜炎培養(yǎng)陽性的可靠預測指標。
[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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.5
本文編號：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.
【學位授予單位】：安徽醫(yī)科大學
【學位級別】：碩士
【學位授予年份】：2017
【分類號】：R692.5
【參考文獻】
相關期刊論文 前8條
1 張群;胡曉波;;降鈣素原在革蘭陽性菌和革蘭陰性菌感染鑒別診斷中的價值探討[J];檢驗醫(yī)學;2015年11期
2 陶瑾;申新宏;艾永紅;楊玉霞;;血清降鈣素原在患者腹膜透析感染性腹膜炎中的診斷價值[J];中華醫(yī)院感染學雜志;2015年16期
3 劉德玲;張苗;蔣春明;孫t$;王娟;;革蘭陰性菌與革蘭陽性菌致腹膜透析相關性腹膜炎的臨床特征[J];東南大學學報(醫(yī)學版);2015年03期
4 申新宏;陶瑾;王煥;;透出液癌胚抗原125在腹膜透析患者腹膜感染時的變化與病原菌分布[J];中華醫(yī)院感染學雜志;2015年09期
5 曹雪瑩;周建輝;蔡廣研;陳香美;;腹膜透析濾出液生物標志物的研究進展[J];中華腎病研究電子雜志;2015年01期
6 張宜明;劉雷;孟雪;魏明明;王棟;張昆;曲小菡;李新建;;培養(yǎng)陰性腹膜透析相關性腹膜炎的實驗室指標及預后分析[J];中華診斷學電子雜志;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 張濤;周虹;王用金;曹守冬;張劍梅;;降鈣素原在急診抗感染中的診斷意義[J];中華急診醫(yī)學雜志;2010年05期
，本文編號：2174434
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