血清和透出液sICAM-1、PCT、CA125与腹膜透析相关细菌性腹膜炎的关系及预测价值

Correlation and clinical predictive value of serum and dialysate sICAM-1, PCT and CA125 with peritoneal dialysis-associated spontantaneous bacterial peritonitis

摘要:

目的 探讨血清和透出液可溶性细胞间黏附分子-1（sICAM-1）、降钙素原（PCT）、糖类抗原125（CA125）与腹膜透析相关细菌性腹膜炎的关系，以及其预测腹膜透析相关细菌性腹膜炎的价值。方法 选取辽宁省人民医院肾病学科2017年1月—2019年6月疑似腹膜透析相关细菌性腹膜炎119例患者作为研究对象。根据临床诊断结果分为研究组（有细菌性腹膜炎者66例）与对照组（无细菌性腹膜炎者53例）。比较两组血清和透出液sICAM-1、PCT、CA125水平，并探究各指标对腹膜透析相关细菌性腹膜炎的预测价值。研究组给予抗感染治疗，比较治疗后感染控制者与未控制者血清、透出液sICAM-1、PCT、CA125水平。结果 研究组血清和透出液sICAM-1、PCT、CA125水平高于对照组（P <0.05）；血清sICAM-1水平［O^R=1.123（95% CI：1.051，1.200）］、透出液sICAM-1水平［O^R=2.006（95% CI：1.352，2.975）］、血清PCT水平［O^R=2.134（95% CI：1.292，3.525）］、透出液PCT水平［O^R=3.025（95% CI：1.628，5.621）］及透出液CA125水平［O^R=1.227（95% CI：1.065，1.414）］均是腹膜透析细菌性腹膜炎的危险因素（P <0.05）；血清sICAM-1、PCT联合预测腹膜透析细菌性腹膜炎的曲线下面积（AUC）为0.898（95% CI：0.829，0.946），大于血清sICAM-1单独预测的AUC 0.750（95% CI：0.662，0.824）和血清PCT单独预测的AUC 0.810（95% CI：0.728，0.876），联合预测的敏感性为84.85%（95% CI：0.734，0.921）、特异性为84.91%（95% CI：0.719，0.928）；透出液sICAM-1、PCT、CA125联合预测腹膜透析细菌性腹膜炎的AUC为0.926（95% CI：0.863，0.966），大于透出液sICAM-1单独预测的AUC 0.798（95% CI：0.714，0.866）、透出液PCT单独预测的AUC 0.819（95% CI：0.738，0.884）及透出液CA125单独预测的AUC 0.794（95% CI：0.711，0.863），联合预测的敏感性为86.36%（95% CI：0.752，0.932）、特异性为88.68%（95% CI：0.763，0.953）；感染控制者血清和透出液sICAM-1、PCT及透出液CA125水平均低于感染未控制者（P <0.05）。结论 随着血清和透出液sICAM-1、PCT及透出液CA125水平的升高，腹膜透析相关细菌性腹膜炎的发生风险增加，各指标对腹膜透析细菌性腹膜炎具有预测价值，且能辅助临床评估感染控制情况。

Abstract:

Objective To explore the association between serum and dialysate soluble intercellular adhesion molecule-1 (sICAM-1), procalcitonin (PCT), carbohydrate antigen 125 (CA125), and peritoneal dialysis-associated bacterial peritonitis, and to predict the value of bacterial peritonitis related to peritoneal dialysis.Methods From January 2017 to June 2019 in our hospital, 119 patients with suspected peritoneal dialysis-related bacterial peritonitis were selected as the research object, and were divided into a study group (66 patients with bacterial peritonitis) and a control group (53 patients without bacterial peritonitis) according to the clinical diagnosis results. Serum and dialysate sICAM-1, PCT, CA125 levels of the two groups were compared, the correlation between the above indicators and bacterial peritonitis related to peritoneal dialysis was analyzed, and the value of each index to predict bacterial peritonitis related to peritoneal dialysis was explored. Anti-infection treatment was given to the study group, and the levels of serum and dialysate sICAM-1, PCT, and CA125 in infection-controllers and uncontrollers were compared after treatment, and the correlation between the above indicators and infection control was evaluated.Results The levels of sICAM-1, PCT, and CA125 in serum and dialysate of the study group were higher than those of the control group (P < 0.05). Serum sICAM-1 level [O^R = 1.123 (95% CI: 1.051, 1.200) ], dialysate sICAM-1 level [O^R = 2.006 (95% CI: 1.352, 2.975) ], Serum PCT level [O^R = 2.134 (95% CI: 1.292, 3.525) ], dialysate PCT level [O^R = 3.025 (95% CI: 1.628, 5.621) ], as well as the level of CA125 in dialysate [O^R = 1.227 (95% CI: 1.065, 1.414) ] were all risk factors for SBP on peritoneal dialysis (all P < 0.05). The area under the curve (AUC) of serum sICAM-1 and PCT combined to predict SBP of peritoneal dialysis was 0.898 (95% CI: 0.829, 0.946), which was greater than the AUC predicted by the two alone [0.750 (95% CI: 0.662, 0.824), 0.810 (95% CI: 0.728, 0.876) ]. The best sensitivity and specificity of the combined prediction were 84.85% (95% CI: 0.734, 0.921) and 84.91% (95% CI: 0.719, 0.928). The AUC predicted by the combination of dialysate sICAM-1, PCT, and CA125 for peritoneal dialysis SBP was 0.926 (95% CI: 0.863, 0.966), which was greater than the AUC predicted by each index alone [0.798 (95% CI: 0.714, 0.866), 0.819 (95% CI: 0.738, 0.884), and 0.794 (95% CI: 0.711, 0.863) ]. The best sensitivity and specificity of the combined prediction were 86.36% (95% CI: 0.752, 0.932) and 88.68% (95% CI：0.763, 0.953). The levels of serum, dialysate sICAM-1, PCT, and dialysate CA125 of people with infection control were lower than those of people without infection control (P < 0.05).Conclusion With the increase in serum and dialysis fluid sICAM-1, PCT, and dialysis fluid CA125 levels, the risk of bacterial peritonitis related to peritoneal dialysis increases. Each index has important value in predicting the occurrence of bacterial peritonitis in peritoneal dialysis, and can assist in clinical evaluation of infection control.