腹膜透析相關(guān)性腹膜炎腹透液CRP、PCT及CA125水平與臨床意義
發(fā)布時(shí)間：2018-08-09 14:50
【摘要】：目的通過(guò)檢測(cè)腹膜透析相關(guān)性腹膜炎(Peritoneal dialysis related peritonitis,PDAP)患者腹膜透析液中的C-反應(yīng)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(xiàng)臨床資料相比,探討CRP、PCT及CA-125水平變化在腹膜透析相關(guān)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(jù)腹膜透析液培養(yǎng)結(jié)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(duì)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(biāo)本(腹腔內(nèi)至少保留2小時(shí)),用顆粒增強(qiáng)免疫透射比濁法檢測(cè)患者腹透液中CRP表達(dá)水平,用酶聯(lián)免疫熒光法檢測(cè)患者腹透液中PCT表達(dá)水平,用電化學(xué)發(fā)光法檢測(cè)患者CA-125表達(dá)水平,同時(shí)留取腹透液送我院檢驗(yàn)科行細(xì)菌學(xué)培養(yǎng)。結(jié)果(1)腹膜炎組患者與穩(wěn)定腹透的對(duì)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(wú)統(tǒng)計(jì)學(xué)意義(p0.05);腹膜炎組的血白細(xì)胞計(jì)數(shù)、中性粒細(xì)胞百分比顯著高于穩(wěn)定透析的對(duì)照組,且兩者差異有統(tǒng)計(jì)學(xué)意義(p0.05);腹膜炎組的血肌酐、血白蛋白、轉(zhuǎn)鐵蛋白、轉(zhuǎn)鐵蛋白飽和度均較對(duì)照組降低,兩者差異有統(tǒng)計(jì)學(xué)意義(p0.05);(2)與對(duì)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(jì)學(xué)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(duì)照組相比:三組腹膜透析液中的PCT、CA-125及白細(xì)胞計(jì)數(shù)、多個(gè)核細(xì)胞百分比均明顯升高,且p0.05,差異有統(tǒng)計(jì)學(xué)意義;而腹透液CRP在G-菌組與對(duì)照組之間差異無(wú)統(tǒng)計(jì)學(xué)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(gè)核細(xì)胞百分比差異有統(tǒng)計(jì)學(xué)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(xiàng)指標(biāo)之間差異無(wú)統(tǒng)計(jì)學(xué)意義;(4).腹膜炎組腹透液PCT、CA125與腹透液WBC呈正相關(guān)(r分別為0.446和0.325,p0.05);腹膜液CRP與腹透液WBC之間無(wú)相關(guān)性(r=0.001,p0.05);(5)應(yīng)用二分類logistic回歸分析對(duì)腹透液CRP、PCT、CA125及腹透液白細(xì)胞計(jì)數(shù)4項(xiàng)指標(biāo)對(duì)腹膜炎發(fā)生預(yù)測(cè)作用大小及對(duì)腹透液培養(yǎng)預(yù)測(cè)作用大小進(jìn)行方程擬合,腹透液CA125與腹膜炎發(fā)生顯著相關(guān)(OR值=1.108,p0.05),與培養(yǎng)陽(yáng)性顯著相關(guān)(OR值=0.964,p0.05);但上述指標(biāo)對(duì)預(yù)測(cè)鑒別革蘭陽(yáng)性菌和革蘭陰性菌均沒有意義。結(jié)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(guān)性腹膜炎的可靠指標(biāo);其中CA-125水平升高是腹膜透析相關(guān)性腹膜炎培養(yǎng)陽(yáng)性的可靠預(yù)測(cè)指標(biāo)。
[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(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5
本文編號(hào)：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(xué)位授予單位】：安徽醫(yī)科大學(xué)
【學(xué)位級(jí)別】：碩士
【學(xué)位授予年份】：2017
【分類號(hào)】：R692.5
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