维持性血液透析患者血清转铁蛋白饱和度与透析导管相关性感染及预后的相关性分析

    Relationship between serum transferrin saturation and catheter-related blood stream infection and prognosis in maintenance hemodialysis patients

      摘要
    • 摘要: 目的 检测维持性血液透析（maintenance hemodialysis，MHD）患者血清转铁蛋白饱和度（transferin saturation，TSAT）水平，探讨TSAT与透析导管相关性感染及预后的相关性。方法 选取2017年9月至2019年9月陕西省人民医院收治的行静脉置管血液透析治疗的肾衰竭患者183例作为研究对象，根据是否发生导管相关性感染（catheter-related bloodstream infection，CRBSI）将研究对象分为感染组（42例）和非感染组（141例），选取同期入院体检的健康志愿者50名作为对照组。采用Ferene法检测血清铁（serum iron，SI）、总铁结合力（total iron binding capacity，TIBC）水平，并计算TSAT值；根据患者30 d预后情况，好转为预后良好组（26例），拔管或死亡为预后不良组（共16例），比较两组患者血清TSAT水平；Logistic回归分析MHD合并CRBSI患者预后不良的危险因素；受试者工作特性曲线（receiver operator characteristic curves，ROC）分析血清TSAT水平对MHD合并CRBSI患者预后不良的诊断价值。结果 感染组患者血清SI、TSAT水平显著低于对照组、未感染组（P<0.05），TIBC水平显著高于对照组、未感染组（P<0.05），未感染组患者血清SI、TSAT水平显著低于对照组（P<0.05），TIBC水平显著高于对照组（P<0.05）。预后不良组患者糖尿病比例、白细胞（white blood cell，WBC）、C反应蛋白（C reactive protein，CRP）水平均显著高于预后良好组（P<0.05），血清TSAT、SI水平显著低于预后良好组（P<0.05）。Logistic回归分析结果显示，糖尿病、WBC、CRP水平为MHD合并CRBSI患者预后不良的危险因素，TSAT水平为保护因素。ROC结果显示，血清TSAT水平对MHD合并CRBSI患者预后不良诊断的曲线下面积（area under the cure，AUC）为0.853，敏感度为87.5%，特异性为76.9%。结论 MHD合并CRBSI患者血清TSAT水平显著降低，且血清TSAT水平是MHD合并CRBSI患者预后不良的保护因素，对其预后情况具有一定诊断价值，可作为预测预后情况的潜在生物学指标。

       

      Abstract: Objective To detect the serum level of transferrin saturation(TSAT) and explore the correlation between TSAT and catheter-related bloodstream infection(CRBSI) and prognosis in maintenance hemodialysis(MHD) patients.Methods A total of 183 patients with renal failure undergoing venous catheterization hemodialysis from September 2017 to September 2019 were selected as research subjects.According to the occurrence of CRBSI,they were divided into two groups of infection(n=42) and uninfected(n=141).And 50 healthy volunteers were selected as control group.The levels of serum iron(SI) and total iron binding capacity(TIBC) were measured by Ferene method and the value of TSAT was calculated.Based upon the 30-day prognostic status,the outcomes were improvement(n=26) and extubation/death(n=16).And the serum level of TSAT was compared between two groups.Logistic regression analysis was performed for examining the risk factors of poor prognosis.Also curve of receiver operator characteristic(ROC) was plotted for determining the diagnostic value of serum level of TSAT in MHD patients with CRBSI.Results The serum levels of SI and TSAT were significantly lower in infected group than those in control and uninfected groups(P<0.05).And the level of TIBC was significantly higher than that in control and uninfected groups(P<0.05).The serum levels of SI and TSAT were significantly lower in uninfected group than those in control group(P<0.05) and the level of TIBC was significantly higher than that in control group(P<0.05).Proportion of diabetes mellitus,levels of white blood cell(WBC) and C-reactive protein(CRP) were significantly higher in poor prognosis group than those in good prognosis group(P<0.05).And serum levels of TSAT and SI were significantly lower than those in good prognosis group(P<0.05).Logistic regression analysis indicated that diabetes mellitus and WBC/CRP level were risk factors for poor prognosis while the level of TSAT was a protective factor.Furthermore,ROC results showed that the area under the cure(AUC) of serum level of TSAT in the diagnosis of poor prognosis was 0.853,the sensitivity 87.5% and the specificity 76.9%.Conclusion In MHD patients with CRBSI,serum level of TSAT declines markedly.As a protective factor for poor prognosis,it may be used as a potential biological index for predicting the prognosis.

       

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