摘要
目的 研究外周血CD4^(+)/CD8^(+)、人中性粒细胞明胶酶相关脂质运载蛋白(neutrophil gelatinase associated lipocalin,NGAL)和淀粉样蛋白A(serum amyloid A protein,SAA)与接受维持性血液透析(maintenance hemodialysis,MHD)治疗的老年慢性肾衰竭(chronic renal failure,CRF)患者细菌感染的相关性及其诊断价值。方法 选取2019年10月—2021年10月在海南省中医院接受MHD治疗的老年CRF患者合并细菌感染者61例(感染组)和未合并感染者104例(非感染组)为样本开展横断面研究,检测2组CD4^(+)/CD8^(+)、NGAL和SAA表达水平并进行比较,建立Logistics回归模型分析各指标与老年CRF患者MHD治疗期间细菌感染的关系并作受试者工作特征(ROC)曲线分析其诊断价值。结果 感染组CD8^(+)(t=2.573,P=0.011)、NGAL(t=6.670,P<0.001)和SAA(t=10.116,P<0.001)表达水平高于非感染组,CD4^(+)(t=8.514,P<0.001)、CD4^(+)/CD8^(+)(t=3.904,P<0.001)表达水平低于非感染组。校正年龄、性别和透析龄等基本资料后进行Logistics回归分析(因变量赋值感染组=1,非感染组=0)显示CD4^(+)/CD8^(+)(OR=0.586,95%CI:0.440~0.780,P<0.001)、NGAL(OR=1.324,95%CI:1.149~1.525,P<0.001)和SAA(OR=1.419,95%CI:1.251~1.610,P<0.001)均与老年CRF患者MHD治疗期间细菌感染存在密切联系;ROC曲线分析显示CD4^(+)/CD8^(+)、NGAL和SAA用于老年MHD患者细菌感染诊断的曲线下面积(AUC)分别为0.576、0.738和0.838,敏感度分别为54.10%、62.30%和77.05%,特异度分别为63.46%、83.65%和77.88%,将3项指标建立Logistics回归模型进行综合判断,结果显示AUC为0.886,敏感度为85.25%,特异度为79.81%。结论 接受MHD治疗的老年CRF患者外周血CD4^(+)/CD8^(+)、NGAL和SAA与细菌感染存在密切联系,检测CD4^(+)/CD8^(+)、NGAL和SAA表达水平变化可为细菌感染早期准确诊断提供参考依据。
Objective To study the correlation of peripheral blood CD4^(+)/CD8^(+),human neutrophil gelatinase-associated lipocalin(NGAL)and serum amyloid A protein(SAA)to bacterial infection and their diagnostic value in elderly patients with chronic renal failure(CRF)undergoing maintenance hemodialysis(MHD).Methods This was a cross-sectional study,which enrolled the elderly CRF patients treated with MHD in the hospital between October 2019 and October 2021.They were divided into infected group(n=61)and non-infected group(n=104)according to the presence or absence of bacterial infection.Blood CD4^(+)/CD8^(+),NGAL and SAA were measured and compared between the two groups.Logistic regression model was established to analyze the relationship between the three blood indicators and bacterial infection in elderly CRF patients undergoing MHD.Receiver operating characteristic(ROC)curve was used to evaluate the diagnostic value of the three blood indicators.Results In infected group,CD8^(+)(28.54±2.48%vs.27.61±2.09%,t=2.573,P=0.011),NGAL[(203.85±39.46)ng/ml vs.(149.71±26.84)ng/ml,t=6.670,P<0.001]and SAA[(21.83±4.75)ng/ml vs.(15.37±3.38)ng/ml,t=10.116,P<0.001]were higher,while CD4^(+)[(38.27±4.86)%vs.(45.18±5.13)%,t=8.514,P<0.001]and CD4^(+)/CD8^(+)(1.26±0.42 vs.1.57±0.53,t=3.904,P<0.001)were lower,as compared with those in non-infected group.After adjusting age,gender and dialysis age(The dependent variable assignment was set at 1 in infected group and at 0 in non-infected group),logistic regression results showed that CD4^(+)/CD8^(+)(OR=0.586,95%CI:0.440~0.780,P<0.001),NGAL(OR=1.324,95%CI:1.149~1.525,P<0.001)and SAA(OR=1.419,95%CI:1.251~1.610,P<0.001)were closely related to bacterial infection in elderly CRF patients undergoing MHD(P<0.05).Receiver operating characteristic(ROC)curve displayed that the area under curve(AUC)values of CD4^(+)/CD8^(+),NGAL and SAA for the diagnosis of bacterial infection were 0.576,0.738 and 0.838 respectively,with the sensitivities of 54.10%,62.30%and 77.05%respectively,and the specificities of 63.46%,83.65%and 77.88%respectively.Logistic regression model for comprehensive application of the three indicators was established and showed the AUC,sensitivity and specificity were 0.886,85.25%and 79.81%respectively.Conclusion In elderly CRF patients undergoing MHD,the levels of peripheral blood CD4^(+)/CD8^(+),NGAL and SAA were closely related to bacterial infection.Therefore,assays of CD4^(+)/CD8^(+),NGAL and SAA can provide references for accurate and early diagnosis of bacterial infection.
作者
莫芳妮
胡基杨
李莉
MO FANG-ni;HU Ji-yang;LI Li(Department of Clinical Laboratory,Hainan Traditional Chinese Medicine Hospital,Haikou 570100,China;Department of Clinical Laboratory,The First Affiliated Hospital of Hainan Medical University,Haikou 570100,China;Department of Blood Purification,The First Affiliated Hospital of Hainan Medical University,Haikou 570100,China)
出处
《中国血液净化》
CSCD
2024年第2期102-105,124,共5页
Chinese Journal of Blood Purification
基金
海南省卫生计生行业科研项目(18A200051)。
