标题：慢性肾脏病血液透析期间合并感染患者血清PCT、HCT、ALB水平变化及其临床意义

      作者：荆堂堂，沈冬明，严春霞    上海市宝山区罗店医院检验科，上海 201908

      卷次： 2023年34卷6期

      【摘要】 目的 探讨慢性肾脏病血液透析期间合并感染患者血清降钙素原(PCT)、红细胞压积(HCT)、白蛋白(ALB)水平变化及其临床意义。方法 回顾性分析2020年3月至2021年5月上海市宝山区罗店医院收治的206例慢性肾脏病5期血液透析患者的临床资料，将其中96例在透析期间感染的患者作为观察组，无感染的110例患者作为对照组。比较两组患者的血清PCT、HCT、ALB水平。通过广义的线性回归分析模型(Logistic)回归分析确定慢性肾脏病5期患者血液透析期间并发感染的危险因素，并通过受试者工作特征曲线(ROC)评估PCT、HCT、ALB的诊断价值。结果 观察组患者的血清PCT、HCT水平分别为(19.23±3.56) ng/mL、(39.78±6.19)%，明显高于对照组的(0.84±0.06) ng/mL、(35.23±4.23)%，ALB水平为(27.23±6.82) g/L，明显低于对照组的(33.65±7.72) g/L，差异均有统计学意义(P<0.05)；经Logistic回归分析结果显示，PCT、HCT、ALB均是慢性肾脏病患者血液透析间并发感染的独立危险因素(P<0.05)；PCT、HCT、ALB用于诊断慢性肾脏病患者血液透析期间并发感染的ROC曲线下面积分别为0.870、0.563、0.864；血清 PCT预测感染的敏感性 79.2%，特异性为 97.3%，HCT及ALB预测感染的敏感性分别为48.6%、78.6%，特异性分别为 73.2%、93.2%，三者联合预测的特异性为 96.0%，敏感性为71.2%。结论 血清PCT、HCT、ALB在慢性肾脏病血液透析期间合并感染患者中表达水平明显升高，是慢性肾脏病患者血液透析间并发感染的独立危险因素，检测PCT、HCT、ALB的动态变化对患者透析期间感染的诊疗具有重要价值。
      【关键词】 慢性肾脏病；细菌感染；血液透析；降钙素原；白蛋白；红细胞压积
      【中图分类号】 R692 【文献标识码】 A 【文章编号】 1003—6350（2023）06—0845—04

Changes of serum PCT, HCT, and ALB levels in patients with chronic kidney disease complicated with infectionduring hemodialysis and their clinical significance.
JING Tang-tang, SHEN Dong-ming, YAN Chun-xia. Departmentof Clinical Laboratory, Luodian Hospital of Shanghai Baoshan District, Shanghai 201908, CHINA
【Abstract】 Objective To investigate the changes of serum procalcitonin (PCT), hematocrit (HCT), albumin(ALB) levels in patients with chronic kidney disease complicated with infection during hemodialysis and their clinicalsignificance. Methods Retrospective analysis was made on the clinical data of 206 patients with chronic kidney dis-ease (CKD) treated in Luodian Hospital of Shanghai Baoshan District from March 2020 to May 2021. Among them, 96patients with infection during hemodialysis were enrolled as the observation group, and 110 patients without infectionwere enrolled as the control group.The levels of PCT, HCT, and ALB were compared between the two groups. The gener-alized linear regression analysis model (Logistic) was used to determine the independent predictors of infection duringhemodialysis in patients with stage 5 chronic kidney disease, and the receiver operating characteristic curve (ROC) wasused to evaluate the diagnostic value of PCT, HCT, and ALB. Results The serum PCT and HCT levels in the observa-tion group were (19.23±3.56) ng/mL and (39.78±6.19)%, which were significantly higher than (0.84±0.06) ng/mL and(35.23±4.23)% in the control group (P<0.05). The ALB level in the observation group was (27.23±6.82) g/L, which wassignificantly lower than (33.65±7.72) g/L in the control group (P<0.05). Logistic regression analysis showed that PCT,HCT, and ALB were independent risk factors for infection during hemodialysis in patients with chronic kidney disease(P<0.05). The area under the ROC curve of serum PCT, HCT, and ALB for the diagnosis of infections during hemodialy-sis were 0.870, 0.563, and 0.864; the sensitivity and specificity in predicting infection were 79.2% and 97.3% for serumPCT, 48.6% and 73.2% for HCT, 78.6% and 93.2% for ALB, and 96.0% and 71.2% for combined detection of the threeindexes. Conclusion The expression levels of serum PCT, HCT, and ALB in patients with chronic kidney disease com-plicated with infection during hemodialysis were significantly increased, which were independent risk factors for compli-cation of infection during hemodialysis in patients with chronic kidney disease, and the detection of the dynamic chang-es of PCT, HCT, and ALB were of great value for the diagnosis and treatment of infection during hemodialysis.
      【Key words】 Chronic kidney disease; Bacterial infections; Hemodialysis; Procalcitonin; Albumin; Hematocrit