血清YKL-40、NGAL、PTM与尿毒症血透患者导管相关性感染的关系及预测价值研究

Correlation and predictive value of serum YKL-40 and NGAL and PTM with and for catheter-related infection in uremic patients undergoing hemodialysis

摘要:

目的 探讨尿毒症血透患者血清几丁质酶3样蛋白1（YKL-40）、中性粒细胞明胶酶相关载脂蛋白（NGAL）、血栓调节蛋白（PTM）与导管相关性感染的关系及预测价值。方法 回顾性分析2021年6月—2022年6月海南医学院第一附属医院收治的150例尿毒症血透患者的临床资料，根据患者是否发生导管相关性感染分为感染组（36例）和未感染组（114例）。比较两组患者性别、年龄、体质量指数（BMI）、尿毒症病程、血透时间、居住地区、插管次数、置管时间、置管部位、有无糖尿病及高血压等临床资料，检测血红蛋白（Hb）、铁蛋白（SF）、总胆固醇（TC）、甘油三酯（TG）、高密度脂蛋白胆固醇（HDL-C）、低密度脂蛋白胆固醇（LDL-C）、YKL-40、NGAL、PTM水平。采用一般多因素Logistic回归性模型分析尿毒症血透患者发生导管相关性感染的危险因素，通过受试者工作特征（ROC）曲线分析导管相关性感染模型预测尿毒症血透患者发生导管相关性感染的效能。结果 感染组与未感染组性别构成、BMI、尿毒症病程、血透时间、居住地区、插管次数、高血压、Hb、SF、TC、TG、HDL-C和LDL-C水平比较，差异均无统计学意义（P >0.05）；感染组年龄≥ 60岁、置管时间≥ 4 d、股静脉置管、有糖尿病的患者占比高于未感染组，YKL-40、NGAL、PTM水平高于未感染组（P <0.05）。ROC曲线分析结果表明，YKL-40、NGAL、PTM预测尿毒症血透患者发生导管相关性感染的曲线下面积（AUC）分别为0.821、0.874和0.853，临界值分别为45.705 ng/mL、69.390 ng/mL和34.845 ng/L，敏感性分别为72.2%、80.6%和77.8%，特异性分别为78.1%、90.4%和86.0%。一般多因素Logistic回归分析结果显示，年龄≥ 60岁［O^R=2.189（95% CI：1.211，3.957）］、置管时间≥4 d ［O^R=3.276（95% CI：1.408，7.622）］、股静脉置管［O^R=3.007（95% CI：1.285，7.037）］、糖尿病［O^R=2.343（95% CI：1.305，4.207）］、YKL-40≥ 45.705 ng/mL ［O^R=1.967（95% CI：1.174，3.296）］、NGAL≥ 69.390 ng/mL ［O^R=2.259（95% CI：1.318，3.872）］、PTM≥ 34.845 ng/L ［O^R=2.070（95% CI：1.229，3.486）］是尿毒症血透患者发生导管相关性感染的危险因素（P <0.05）。根据一般多因素Logistic回归分析结果建立导管相关性感染预测模型，Logit（P）=-35.912+0.783X_年龄+ 1.187X_置管时间+1.101X_置管部位+0.851X_糖尿病+0.677X_YKL-40+0.815X_NGAL+0.728X_PTM。ROC曲线结果表明，模型预测导管相关性感染发生的AUC为0.959，标准误为0.019，临界值为9.865，敏感性为94.4%（95% CI：0.897，0.983），特异性为86.0%（95% CI：0.818，0985）。导管相关性感染预测模型敏感性优于YKL-40、NGAL、PTM单独预测。结论 尿毒症血透患者血清YKL-40、NGAL、PTM与导管相关性感染有关，血清YKL-40、NGAL、PTM对尿毒症血透患者导管相关性感染有较好的预测价值，且各项指标联合预测的敏感性优于各指标单独预测。

Abstract:

Objective To investigate the correlation and predictive value of serum chitinase-3-like protein 1 (YKL-40) and neutrophil gelatinase-associated lipocalin (NGAL), and plasma thrombomodulin (PTM) with and for catheter-related infection in uremic patients undergoing hemodialysis.Methods The clinical data of 150 uremic patients undergoing hemodialysis admitted to our hospital from June 2021 to June 2022 were retrospectively analyzed. According to whether the patients had catheter-related infection, they were divided into infection group (n = 36) and non-infection group (n = 114). The clinical data including sex, age, body mass index (BMI), duration of uremia, time to hemodialysis, place of residence, number of intubation, duration of catheterization, location of catheterization, and the history of diabetes mellitus and hypertension were compared between the two groups. The levels of hemoglobin (Hb), ferritin (SF), total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), YKL-40, NGAL and PTM were detected. Multivariable Logistic regression analysis was performed to determine the risk factors of catheter-related infection in uremic patients undergoing hemodialysis. The efficacy of the catheter-related infection model in predicting catheter-related infection in uremic patients undergoing hemodialysis was analyzed via the receiver operating characteristic (ROC) curve.Results There was no difference in the sex composition, BMI, duration of uremia, time to hemodialysis, place of residence, number of intubation, the history of hypertension, and the levels of Hb, SF, TC, TG, HDL-C, and LDL-C between the infection group and the non-infection group (P > 0.05). The infection group had a higher proportion of patients with the age ≥ 60 years old, the duration of catheterization ≥ 4 d, femoral veinous catheterization and history of diabetes mellitus relative to the non-infection group, and the levels of YKL-40, NGAL and PTM were higher in the infection group than those in the non-infection group (P < 0.05). The ROC curve analysis revealed that the areas under the ROC curves of YKL-40, NGAL and PTM for predicting the catheter-related infection in uremic patients undergoing hemodialysis were 0.821, 0.874 and 0.853, with the cut-off values being 45.705 ng/mL, 69.390 ng/mL and 34.845 ng/L, the sensitivities being 72.2%, 80.6% and 77.8%, and the specificities being 78.1%, 90.4% and 86.0%, respectively (P < 0.05). The multivariable Logistic regression analysis demonstrated that age ≥ 60 years old [O^R = 2.189 (95% CI: 1.211, 3.957) ], duration of catheterization ≥ 4 days [O^R = 3.276 (95% CI: 1.408, 7.622) ], femoral veinous catheterization [O^R = 3.007 (95% CI: 1.285, 7.037) ], history of diabetes mellitus [O^R = 2.343 (95% CI: 1.305, 4.207) ], the level of YKL-40 ≥ 45.705 ng/mL [O^R = 1.967 (95% CI: 1.174, 3.296) ], the level of NGAL ≥ 69.390 ng/mL [O^R = 2.259 (95% CI: 1.318, 3.872) ], and the level of PTM ≥ 34.845 ng/L [O^R = 2.070 (95% CI: 1.229, 3.486) ] were risk factors for catheter-related infection in uremic patients undergoing hemodialysis (P < 0.05). The prediction model of catheter-related infection was established according to the multivariable Logistic regression analysis, and was expressed as Logit (P) = -35.912 + 0.783 X _age +1.187 X _{duration of catheterization} + 1.101 X _{location of catheterization} + 0.851 X _{history of diabetes mellitus} +0.677 X _YKL-40 + 0.815 X _NGAL + 0.728 X _PTM. The ROC curve analysis showed that the area under the ROC curve of the prediction model for catheter-related infection was 0.959, with the standard error being 0.019, the cut-off value being 9.865, the sensitivity being 94.4% (95% CI: 0.897, 0.983), and the specificity being 86.0% (95% CI: 0.818, 0985) (P < 0.05). In addition, the sensitivity of the prediction model was higher than that of YKL-40, NGAL and PTM alone for predicting the catheter-related infection.Conclusions The levels of serum YKL-40 and NGAL and PTM are correlated with and exhibit great predictive values for catheter-related infection in uremic patients undergoing hemodialysis, and the sensitivity of the combined detection of all indicators is higher than that of each indicator alone for predicting the catheter-related infection.