摘要
目的分析腹膜透析患者发生腹膜透析相关性腹膜炎的危险因素,建立有效的腹膜透析相关性腹膜炎预测模型。方法选择2015年1月至2020年3月新乡医学院第一附属医院肾内科收治的441例行腹膜透析的慢性肾脏病患者为研究对象,根据规律腹膜透析后有无发生腹膜透析相关性腹膜炎将患者分为腹膜炎组(n=96)和非腹膜炎组(n=345),收集患者的性别、年龄、透析龄及血红蛋白(Hb)、血糖(Glu)、总蛋白(TP)、白蛋白(ALB)、丙氨酸转氨酶(ALT)、天门冬氨酸氨基转移酶(AST)、胆固醇(CHO)、三酰甘油(TG)、肌酐(Cr)、血尿素氮(BUN)、钙(Ca^2+)、磷(P)、全段甲状旁腺素(iPTH)、碱性磷酸酶(ALP)、总胆红素(TBIL)、结合胆红素(DBIL)、红细胞沉降率(ESR)、超敏C反应蛋白(hs-CRP)、降钙素原(PCT)水平等临床资料,分析发生腹膜透析相关性腹膜炎的相关危险因素,对有统计学意义的变量进行多因素logistic回归分析,分析发生腹膜透析相关性腹膜炎的独立危险因素;根据危险因素制定腹膜透析相关性腹膜炎风险预测模型,并通过计算受试者工作特征(ROC)曲线下面积对模型进行评价。结果腹膜炎组患者的透析龄、Glu、ESR、CRP和PCT水平显著高于非腹膜炎组(P<0.05),Hb、TP、ALB和Ca^2+水平显著低于非腹膜炎组(P<0.05)。2组患者的年龄、性别及ALT、AST、CHO、TG、Cr、BUN、P、PTH、ALP、TBIL和DBIL水平比较差异无统计学意义(P>0.05)。多因素logistic回归分析显示,Glu、Ca^2+、ESR、CRP和PCT水平是发生腹膜透析相关性腹膜炎的独立危险因素(P<0.05),根据5个危险因素及其彼此的回归系数,建立预测腹膜炎的概率模型P=1/[1+exp(6.108-2.037×Glu-1.108×Ca^2+-1.249×ESR-2.355×CRP-2.239×PCT)],拟合优度检验显示回归方程拟合可行(χ2=6.980,P=0.539)。综合考虑Glu、Ca^2+、ESR、CRP和PCT这5个因素,得出其联合预测因子。联合预测因子及Glu、Ca^2+、ESR、CRP、PCT诊断腹膜透析相关性腹膜炎的ROC显示,联合预测因子的ROC下面积最大、最靠近左上角,ROC曲线下面积为0.910,95%置信区间(0.857,0.963),模型的敏感度为87.30%,特异度为89.70%,有较高的预测价值。结论Glu、Ca^2+、ESR、CRP和PCT是腹膜透析相关性腹膜炎发生的独立危险因素;腹膜炎预测模型的建立可以有效评估腹膜透析患者发生腹膜炎的风险程度。
Objective To analyze the risk factors of peritoneal dialysis-related peritonitis(PDRP),and establish an effective prediction model of PDRP.Methods A total of 441 patients with chronic kidney disease who underwent peritoneal dialysis in the Department of Nephrology,the First Affiliated Hospital of Xinxiang Medical University from January 2015 to March 2020 were selected as the research objects.The patients were divided into peritonitis group(n=96)and non-peritonitis group(n=345)according to whether PDRP occured after peritoneal dialysis.The gender,age,dialysis time and the levels of hemoglobin(Hb),blood glucose(Glu),total protein(TP),albumin(ALB),alanine transaminase(ALT),aspartate aminotransferase(AST),cholesterol(CHO),triglyceride(TG),creatinine(Cr),blood urea nitrogen(BUN),calcium ion(Ca^2+),phosphorus(P),intact parathyroid hormone(iPTH),alkaline phosphatase(ALP),total bilirubin(TBIL),direct bilirubin(DBIL),erythrocyte sedimentation rate(ESR),hypersensitive-C reactive protein(hs-CRP)and procalcitonin(PCT)of all patients were collected.The risk factors of PDRP were analyzed by univariate analysis first,and then the significant variables were analyzed by multivariate logistic regression analysis.The risk prediction model of PDRP was established according to the risk factors,and the model was evaluated by calculating the area under the receiver operating characteristic(ROC)curve.Results The dialysis time and the levels of Glu,ESR,CRP and PCT of patients in the peritonitis group were significantly higher than those in the non-peritonitis group(P<0.05);the Hb,TP,ALB,Ca^2+levels of patients in the peritonitis group were significantly lower than those in the non-peritonitis group(P<0.05).There was no significant difference in the age,gender and the levels of ALT,AST,CHO,TG,Cr,BUN,P,PTH,ALP,TBIL,DBIL papatients between the two groups(P>0.05).Multivariate logistic regression analysis showed that the Glu,Ca^2+,ESR,CRP and PCT levels were independent risk factors of PDRP(P<0.05).According to the above five risk factors and their regression coefficients,the prediction model was established:P=1/[1+exp(6.108-2.037×Glu-1.108×Ca^2+-1.249×ESR-2.355×CRP-2.239×PCT)].The result of goodness of fit test showed that the fitting effect of the model was good(χ2=6.980,P=0.539).According to the above risk factors,the combined predictive factors were obtained.The ROC curve results of combined predictive factors,Glu,Ca^2+,ESR,CRP and PCT showed that the area under the curve(AUC)of the combined predictive factors was the largest and closest to the upper left corner.The AUC of the combined predictive factors was 0.910,95%confidence interval(0.857,0.963).The sensitivity and specificity of the model were 87.30%and 89.70%,respectively.The combined predictive factors had high predictive value.Conclusions The Glu,Ca^2+,ESR,CRP and PCT are independent risk factors of PDRP.The establishment of the model can effectively evaluate the risk of peritonitis in peritoneal dialysis patients.
作者
马东红
曹子彧
吕玉敏
黎妞
王路路
刘云
郭明好
MA Donghong;CAO Ziyu;LYU Yumin;LI Niu;WANG Lulu;LIU Yun;GUO Minghao(Department of Nephrology,the First Affiliated Hospital of Xinxiang Medical University,Weihui 453100,Henan Province,China)
出处
《新乡医学院学报》
CAS
2020年第12期1168-1172,共5页
Journal of Xinxiang Medical University
关键词
腹膜透析
腹膜透析相关性腹膜炎
危险因素
预测
模型
peritoneal dialysis
peritoneal dialysis-related peritonitis
risk factor
prediction
model
