腹膜透析相关性腹膜炎并发症的早期预示指标研究

摘要

目的 临床诊断腹膜透析相关性腹膜炎的时间和周期比较长,早期预警判断感染的并发需要实验室的辅助.方法 收集46例腹膜透析并发腹膜炎患者,其中28例治愈,18例治疗失败.比较不同预后腹膜透析患者,血清C反应蛋白(CRP)、清蛋白(Alb)、前清蛋白(Pre-alb)水平和腹膜炎前透析液/血浆肌酐(D/P)比值等;留取腹膜透析后在应用观察抗生素治疗的第0天～第7天的腹腔透出液,比较不同预后患者腹膜透析后的不同时间点,腹腔透出液白细胞计数(WBC)、微量清蛋白和总蛋白水平.结果 ①治疗失败组72 h内血清CRP显著高于治愈组(171.5 vs 89.1 mg/dl,t=2.409,P=0.023),清蛋白、前清蛋白浓度和腹膜炎前透析液/血浆肌酐(D/P)比值等指标在二组间差异无统计学意义(P>0.05);②治疗失败组腹膜透析后第4～7天腹腔透出液WBC显著升高(P<0.01);③治愈组第5天腹腔透出液微量清蛋白及总蛋白水平明显低于治疗失败组(P=0.021,P=0.040);ROC曲线确定第5天微量清蛋白的cut-off值为618.5 mg/dl(敏感度和特异度分别为80.0%,56.2%),曲线下面积0.825(95% CI:0.607～1);微量总蛋白的cut-off值为885.5 mg/dl(敏感度85.7%,特异度55.6%),曲线下面积0.746 (95% CI:0.527～0.965).结论 除外腹膜炎的严格诊断指标,选择监测第5天的腹腔透出液WBC、微量蛋白水平、透析3天后的血清CRP水平,能够早期预示腹膜透析相关性腹膜炎并发症的发生,为及时干预、改善预后提供有效的实验室辅助.%Objective There are some difficulties in early diagnosing the peritonitis occurrence of peritoneal dialysis patients. Methods 46 patients were separated into the cured group & the failure one according to their treatments. Evaluated the ser um C reactive protein(CRP) , albumin, pre albumin, dialysate over plasma (D/P) creatinine ratio before the occurrence of peritonitis and calculated the white blood cells (WBC) , analyzed micro protein levels of the peritoneal dialysate at different points of time during their peritoneal dialysis. Results ①Serum CRP within 72 hours were higher in the failure group than that in the cured one(171. 5 vs 89. 1 mg/dl, t=2. 409, P=0. 023) ,however albumin,pre albumin and the D/P ratio had no difference between them (P>0. 05) ; ②WBC in the dialysate showed no difference within the first 3 days,but changed ap parently in the fourth seventh days (P<0. 01) ;③The 5th point of peritoneal dialysis,the cured group showed lower levels of all micro total protein & micro albumin in the dialysate than the failure one (P=0. 021, P= 0. 040). By ROC curve the cut off value of micro albumin was 618. 5 mg/dl (sensitivity & specific were 80. 0% & 56. 2%) ,the under area was 0. 825 (95% CI:0. 607 ~ 1) ,also the cut off value of micro total protein was 885. 5 mg/dl (sensitivity & specific were 85. 7% & 55. 6%) ,the under area was 0. 746 (95% CI:0. 527 ~ 0. 965). Conclusion Identify the 5th day of the peritoneal dialysis pa tients,evaluate their peritoneal dialysate WBC,levels of micro proteins & within 72 hours serum CRP can early give valuable prognostic of peritonitis and therapeutic implications for patients who undergoing the peritoneal dialysis.