摘要
目的探究腹膜透析(PD)合并感染性腹膜炎患者病原菌分布及血清T淋巴细胞免疫球蛋白黏蛋白3(TIM-3)、信号传导与转录激活因子3(STAT3)、嗅素结构域家族蛋白4(OLFM4)水平变化的临床意义。方法选取2023-2024年在本院进行PD治疗的肾功能衰竭患者194例作为研究对象,另纳入同一时期在本院进行体检的健康志愿者170例作为健康对照组;采用细菌鉴定仪完成细菌种属鉴定;采用ELISA法检测样本中血清TIM-3、STAT3、OLFM4水平;多组间比较采用F检验,组间比较采用SNK-q检验;Logistic回归及森林图分析相关因素;交叉表分析相对危险度;ROC分析预测效能;Hosmer-Lemeshow检验分析拟合优度。结果腹膜透析液阳性培养检出病原菌41株,其中革兰阴性菌21株,革兰阳性菌18株,真菌2株。腹膜炎组血清TIM-3、STAT3、OLFM4水平高于非腹膜炎组与健康对照组(P<0.05),非腹膜炎组血清TIM-3、STAT3、OLFM4水平高于健康对照组(P<0.05)。高水平的血清TIM-3、STAT3、OLFM4是患者透析期间并发感染性腹膜炎的危险因素(P<0.05)。高水平血清TIM-3、STAT3、OLFM4患者并发感染性腹膜炎的风险是低水平患者的7.096倍、5.271倍、9.938倍(P<0.05)。血清TIM-3、STAT3、OLFM4水平及联合预测患者并发感染性腹膜炎的曲线下面积(AUC)分别为0.722、0.749、0.826、0.882,联合方案预测效能优于单一指标预测(Z_(TIM-3-联合预测)=4.465、Z_(STAT3-联合预测)=3.723、Z_(OLFM4-联合预测)=2.036,均P<0.05)。Hosmer-Lemeshow显示联合检测方案拟合优度为χ^(2)=0.798,P=0.999。结论PD合并感染性腹膜炎患者血清TIM-3、STAT3、OLFM4水平升高,检测其表达水平可用于预测PD治疗患者并发感染性腹膜炎的风险。
Objective Investigating the clinical significance of the distribution of pathogenic bacteria in patients with peritoneal dialysis(PD)complicated by infectious peritonitis and the changes in serum levels of T lymphocyte immunoglobulin mucin 3(TIM-3),signal transducer and activator of transcription 3(STAT3),and olfactomedin 4(OLFM4).Methods Select 194 patients with renal failure undergoing PD treatment in our hospital from 2023 to 2024 as the study subjects,and include 17o healthy volunteers undergoing physical examinations in our hospital during the same period as the healthy control group;use a bacterial identification instrument to complete bacterial species identification;measure serum TIM-3,STAT3,and OLFM4 levels in the samples using ELISA;use F-test for comparison between multiple groups,and SNK-q test for comparison between groups;perform Logistic regression and forest plot analysis for relevant factors;analyze relative risk using cross-tabulation;analyze predictive effectiveness with ROC;and use Hosmer-Lemeshow test to analyze goodness of fit.Results A positive culture of peritoneal dialysis fluid detected 4l strains of pathogenic bacteria,including 21 strains of Gram-negative bacteria,18 strains of Gram-positive bacteria,and 2 strains of fungi.The levels of TIM-3,STAT3,and OLFM4 in the peritonitis group were higher than those in the non-peritonitis group and the healthy control group.(P<0.05),while the non peritonitis group had higher serum TIM-3,STAT3,and OLFM4 than the healthy control group(P<0.05).High levels of serum TIM-3,STAT3,and OLFM4 were risk factors for infectious peritonitis during dialysis in patients(P<0.05).The risk of developing infectious peritonitis in patients with high levels of serum TIM-3,STAT3,and OLFM4 was 7.096 times,5.271 times,and 9.938 times higher than in patients with low levels(P<0.05).The area under the curve(AUC)values of serum TIM-3,STAT3,OLFM4 levels and their joint in predicting complicated infectious peritonitis in patients were 0.722,0.749,0.826,and 0.882,respectively,the predictive performance of the joint scheme was better than that of single indicator prediction(Z_(TIM3-joint prediction)=4.65,Z_(STAT3-joint prediction)=3.723,Z_(OLFM4-joint prediction)=2.036,P<0.05).Hosmer-Lemeshow shwed that the goodness of fit of the joint detection scheme showed χ^(2)=0.798,P=0.999.Conclusion Serum TIM-3,STAT3,and OLFM4 are elevated in patients with PD complicated by infectious peritonitis.Detecting their expression levels can be used to predict the risk of complicated infectious peritonitis in PD treated patients.
作者
刘俊芬
郭宝珠
程志华
卫志锋
刘圣君
LIU Junfen;GUO Baozhu;CHENG Zhihua;WEI Zhifeng;LIU Shengjun(Department of Nephrology,No.1 Hospital of Hebei Medical University,Zhangjiakou 075000,Hebei,China;Key Laboratory of Systems Biology and Gene Regulation of Hebei Province;Department of Ultrasound,No.1 Hospital of Hebei North Medical University,Zhangjiakou 075000,Hebei,China)
出处
《中国病原生物学杂志》
北大核心
2025年第12期1562-1566,共5页
Journal of Pathogen Biology
基金
河北省医学科学研究项目(No.20220619)。
