«上一篇/Previous Article|本期目录/Table of Contents|下一篇/Next Article»

《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:

29卷

期数:

2023年02期

页码:

183-187

栏目:

临床医学

出版日期:

2023-03-20

文章信息/Info

Title:

Predictive value of NLR and PLR for peritonitis in peritoneal dialysis patients

文章编号:

1006-8147（2023）02-0183-05

作者:

贾成玮; 王荔; 杨虎; 薛志杰

天津医科大学第二医院肾 内科，天津 300211

Author(s):

JIA Cheng-wei; WANG Li; YANG Hu; XUE Zhi-jie

Department of Nephrology，The Second Hospital，Tianjin Medical University，Tianjin 300211，China

关键词:

腹膜透析; 腹膜炎; 中性粒细胞/淋巴细胞比值; 血小板/淋巴细胞比值

Keywords:

peritoneal dialysis; peritonitis; neutrophil/lymphocyte ratio; platelet/lymphocyte ratio

分类号:

R692.5

DOI:

-

文献标志码:

A

摘要:

目的：通过分析影响腹膜透析患者腹膜炎患病特征，探究血清中性粒细胞/淋巴细胞比值（NLR）和血小板/淋巴细胞比值（PLR）对腹膜透析患者腹膜炎的预测价值。方法：纳入2020年1月—2021年10月首次接受腹膜透析患者共203例为研究对象，随访6个月，诊断腹膜炎41例。比较腹膜炎组与无腹膜炎组性别、年龄、体重指数、原发肾脏疾病、基础疾病、吸烟、透析龄、肺炎和肠道感染情况，实验室指标包括白细胞计数、中性粒细胞计数、淋巴细胞计数、血小板计数、血红蛋白、血肌酐、血钾、血钙、白蛋白、总胆固醇、低密度脂蛋白、空腹血糖、C反应蛋白（CRP）和降钙素原（PCT），计算NLR、PLR和估算的肾小球滤过率（eGFR）。结果：41例患者发生1次腹膜炎34例，两次及以上7例，发生时间为透析后1~6个月，中位时间3.5个月。病原学检查发现，41例患者革兰阳性菌（G+）感染22例，革兰阴性菌（G-）感染17例，真菌2例。单因素比较发现，腹膜炎组比无腹膜炎组年龄增加，糖尿病和肠道感染增多，透析龄延长，白细胞计数、中性粒细胞计数、血小板计数、血肌酐、总胆固醇、空腹血糖、CRP和PCT、NLR和PLR水平升高，而白蛋白降低，差异均有统计学意义（χ2＝12.433～5.968；t＝4.526～22.325，均P＜0.05）。多因素Logistic回归分析显示，肠道感染（OR=3.652，95%CI：2.485~5.023，P＜0.001）、透析龄（OR=5.524，95%CI：3.896~7.215，P＜0.001）、高NLR（OR=4.425，95%CI：2.967~5.632，P＜0.001）和高PLR（OR=4.021，95%CI：2.536~5.021，P＜0.001）是腹膜透析患者发生腹膜炎的独立危险因素。受试者工作特征（ROC）曲线显示，NLR和PLR预测腹膜炎的曲线下面积（AUC）分别为0.852和0.813，临界值分别为2.8和106.7，敏感性分别为85.6%和80.7%，特异性分别为77.9%和86.4%。结论：腹膜透析有较高的腹膜炎发生率，发生峰值在3.5个月，以G+或G-感染为主，肠道感染、透析龄延长、高NLR和高PLR水平是腹膜炎的独立危险因素，血清NLR和PLR监测对早期预测腹膜炎有重要的应用潜力。

Abstract:

Objective：To explore the predictive value of serum neutrophil/lymphocyte ratio（NLR）and platelet/lymphocyte ratio（PLR） for peritonitis in patients with peritoneal dialysis by analyzing the characteristics affecting peritonitis in patients with peritoneal dialysis. Methods：A total of 203 patients who underwent peritoneal dialysis for the first time from January 2020 to October 2021 were included，41 cases of peritonitis were diagnosed after 6 months of follow-up. The gender，age，body mass index，primary kidney disease，basic disease， smoking，dialysis period，catheter infection，pneumonia and intestinal infection were compared between peritonitis group and non-peritonitis group. Laboratory indicators including leukocyte count，neutrophil count，lymphocyte count，blood plate count，hemoglobin， serum creatinine，blood potassium，blood calcium，albumin，total cholesterol，low-density lipoprotein，fasting blood glucose，C-reactive protein（CRP）and procalcitonin（PCT）were compared，NLR，PLR and estimated glomerular filtration rate（eGFR）were calculated. Results：Among the 41 patients，34 cases had peritonitis once and 7 cases had peritonitis twice or more，the occurrence time was 1-6 months after dialysis，and the median time was 3.5 months. Etiological examination showed that 22 cases were Gram-positive bacteria（G+） infection，17 cases were Gram-negative bacteria（G-）infection and 2 cases were fungi. Univariate comparison showed that the age in peritonitis group was older than the non-peritonitis group，diabetes and intestinal infection were more，dialysis period was longer，leukocyte count，neutrophil count，platelet count，serum creatinine，total cholesterol，fasting blood glucose，CRP，PCT，NLR and PLR were higher， while albumin was less（χ2＝12.433-5.968；t＝4.526-22.325；all P＜0.05）. Multivariate Logistic regression analysis showed that intestinal infection（OR=3.652，95%CI：2.485-5.023，P<0.001），dialysis period（OR=5.524，95%CI：3.896-7.215，P<0.001），high NLR（OR=4.425，95% CI：2.967-5.632，P<0.001）and high PLR（OR=4.021，95% CI：2.536-5.021，P<0.001）were the independent risk factors for peritonitis in peritoneal dialysis patients. Receiver operating characteristic（ROC）curve showed that area under the curve（AUC）of NLR and PLR for predicting peritonitis were 0.852 and 0.813，respectively，the cut-off values were 2.8 and 106.7，sensitivity were 85.6% and 80.7%，and specificity were 77.9% and 86.4%. Conclusion：Peritoneal dialysis has a high incidence of peritonitis，with a peak of 3.5 months，mainly G+or G-infection. Intestinal infection，longer dialysis period，high NLR and high PLR levels are the independent risk factors to peritonitis.Serum NLR and PLR monitoring have important potential for early prediction of peritonitis.

参考文献/References:

[1] 胡学芹，王畅，田园.腹膜透析相关性腹膜炎临床特点和病原学及其预后[J].中华医院感染学杂志，2019，29（14）：2125-2129.
[2] HAMADA S，TAKATA T，KITAURA T，et al. Peritoneal dialysis-as－sociated peritonitis caused by Mycobacteroidesmassiliense：the first case and review of the literature[J]. BMC Nephrol，2021 ，22（1）：90.
[3] SAHLAWI M A，WILSON G，STALLARD B，et al. Peritoneal dialy－sis-associated peritonitis outcomes reported in trials and observa－tional studies：a systematic review [J]. Perit Dial Int，2020，40（2）：132-140.
[4] XU L C，ZHOU F F，LI M，et al. Predictive value of peripheral blood neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on patient survival with peritoneal dialysis[J]. Clin Lab，2021，67（9）：154-156.
[5] CHEN T，YANG M. Platelet-to-lymphocyte ratio is associated with cardiovascular disease in continuous ambulatory peritoneal dialysis patients[J]. Int Immunopharmacol，2020，2（1）：102-104.
[6] ASIK Z. The role of the NLR and PLR in urinary tract infection[J]. Clin Lab，2021，67（10）：152-154.
[7] MANDALIYA H，JONES M，OLDMEADOE C，et al. Prognostic biomarkers in stageⅣ non-small cell lung cancer（NSCLC）：neu－trophil to lymphocyte ratio（NLR），lymphocyte to monocyte ratio （LMR），platelet to lymphocyte ratio（PLR）and advanced lung can－cer inflammation index（ALI）[J]. Transl Lung Cancer Res，2019，8（6）：886-894.
[8] 王萍，俞雨生. 2016 ISPD关于腹膜透析相关腹膜炎防治指南的解读[J].肾 脏病与透析肾 移植杂志，2017，26（3）：282-286.
[9] 马东红，吕玉敏，刘云，等.腹膜透析相关性腹膜炎临床特点与危险因素分析[J].中国血液净化，2018，17（2）：73-77.
[10]王璐瑶，窦艳娜，肖静，等.早发性腹膜透析相关性腹膜炎的危险因素研究[J].中国全科医学，2017，20（4）：454-458.
[11] AL ASHLAWI M，BARGMAN J M，PERL J. Peritoneal dialysis-as－sociated peritonitis：suggestions for management and mistakes to avoid[J]. Kidney Med，2020，2（4）：467-475.
[12] SZETO C C，LI P K. Peritoneal dialysis-associated peritonitis [J]. Clin J Am Soc Nephrol，2019，14（7）：1100-1105.
[13] HE P，HE L J，HUANG C，et al. Neutrophil-to-lymphocyte ratio and treatment failure in peritoneal dialysis-associated peritonitis [J]. Front Med（Lausanne），2021 ，8（7）：699502.
[14] LIU S，YANG M，ZHAO Q，et al. Platelet-to-lymphocyte ratio is as－sociated with the mortality in peritoneal dialysis patients[J]. Iran J Kidney Dis，2021，15（3）：206-212.
[15] DJORDJEVIC D，RONDOVIC G，SURBATOVIC M，et al. Neutrophil-to-lymphocyte ratio，monocyte-to-lymphocyte ratio，platelet-to-lymphocyte ratio，and mean platelet volume-to-platelet count ratio as biomarkers in critically ill and injured patients：which ratio to choose to predict outcome and nature of bacteremia? [J]. Mediators Inflamm，2018，7（2）：1546-1548.
[16]方 味味，刘桂凌，李庆根，等. NLR和PLR在腹膜透析相关性感染中的诊断价值探讨[J].临床肾 脏病杂志，2020，15（3）：12-18.
[17]吴岳春，黄庆龙，杨明榴，等. NLR与MLR对 腹膜透析患者腹腔感染的诊断及预后评估价值[J].中华医院感染学杂志，2021，31（6）：852-856.
[18]林蓉宇，陈文.外周血NLR，PLR，CRP检测在老年腹膜透析相关性感染诊断中的价值分析[J].川北医学院学报，2022，37（6）：734-737.

相似文献/References:

[1]林美华,郭小云,李洪钧,等.腹膜透析患者血清NGAL水平与微炎症状态的关系[J].天津医科大学学报,2013,19(05):396.
[2]孙 鹏,夏 天.持续性非卧床腹膜透析患者EPO低反应发生机制探讨[J].天津医科大学学报,2013,19(06):478.
　SUN Peng,XIA Tian.Investigation on pathogenesis of erythropoietin hyporesponsiveness in patients with continuous ambulatory peritoneal dialysis[J].Journal of Tianjin Medical University,2013,19(02):478.
[3]王冰月,姜埃利,李春红,等.西沙比利对不同透析方式患者的消化道症状及胃肠激素影响研究[J].天津医科大学学报,2020,26(01):28.
　WANG Bing-yue,JIANG Ai-li,LI Chun-hong,et al.Effects of Cisapride on symptoms of digestive and gastrointestinal hormones in patients with different dialysis modes[J].Journal of Tianjin Medical University,2020,26(02):28.

备注/Memo

备注/Memo:

作者简介：贾成玮（1984-），女，主管护师，研究方向：肾内科护理；
通信作者：王荔，E-mail：winniewangli1977@163.com。

常用功能

更新日期/Last Update: 2023-04-30