单糖特征分析在腹膜透析相关性腹膜炎病原菌诊断中的价值

doi:10.3969/j.issn.1004-583X.2022.11.009

摘要/Abstract

摘要：

目的单糖是病原菌的重要组成成分,不同类型的病原菌具有不同的单糖特征。本研究拟通过高效液相色谱法测定腹膜透析液中单糖的水平,探讨单糖检测对腹膜炎及引起腹膜炎的病原菌的诊断价值。方法收集2020年10月01日至2021年10月31日到青岛大学附属医院西海岸肾病科住院的腹膜透析患者的腹膜透析液样本90例,其中包括无腹膜炎样本52个,腹膜炎样本38个,腹膜炎样本中革兰阳性菌腹膜炎腹透液样本24个,革兰阴性菌腹膜炎腹透液样本14个。利用高效液相色谱法测定所有样本中降解的甘露糖、葡萄糖、岩藻糖浓度,比较无腹膜炎组腹透液样本与革兰阳性菌腹膜炎组、革兰阴性菌腹膜炎组腹透液样本在甘露糖、葡萄糖、岩藻糖水平上的差异;采用Logistic回归分析各单糖水平与腹膜炎发生的关系,采用受试者工作特征(ROC)曲线评估各单糖水平对腹膜炎不同病原菌的诊断价值。结果 3组各单糖水平差异有统计学意义( $P$ <0.01)。与无腹膜炎组相比,腹膜炎组的葡萄糖浓度和岩藻糖浓度均显著下降( $P$ <0.01)。与革兰阴性菌腹膜炎组相比,革兰阳性菌腹膜炎组甘露糖浓度显著下降( $P$ <0.01)。Logistic回归分析表明,腹膜透析液岩藻糖浓度是腹膜炎发生的独立危险因素( $P$ <0.01);腹膜透析液甘露糖浓度是革兰阳性菌腹膜炎发生的独立危险因素( $P$ <0.01)。ROC曲线分析结果显示,岩藻糖浓度对腹膜炎发生有较高的诊断价值,AUC面积是0.820,95% $C I$ (0.732,0.908),敏感度为71.05%,特异度为84.62%,最佳截断值为3.045 μmol/L。甘露糖浓度对革兰阳性菌腹膜炎有较高的诊断价值,AUC面积是0.863, 95% $C I$ (0.740,0.986),敏感度为78.57%,特异度为83.33%,最佳截断值为0.345 μmol/L。结论腹膜透析液中降解的岩藻糖浓度是腹膜透析相关性腹膜炎发生的独立危险因素,腹膜透析液中降解的甘露糖浓度是革兰阳性菌腹膜炎发生的独立危险因素。腹膜透析液中岩藻糖浓度显著降低,可以用于提示腹膜炎的发生,腹膜透析液中降解的甘露糖浓度降低对临床上早期诊断革兰阳性菌腹膜炎感染和指导抗生素的选择有一定的诊断价值。

关键词: 腹膜透析, 腹膜炎, 单糖, 高效液相色谱法

Abstract:

Objective Based on the fact that monosaccharide as an important component of pathogenic bacteria, this study investigated the diagnostic value of monosaccharide in peritoneal dialysate(PD)- associated peritonitis using high performance liquid chromatography (HPLC). Methods Peritoneal dialysate fluid samples were collected from 90 peritoneal dialysis patients hospitalized in the West Coast Nephrology Department, Affiliated Hospital of Qingdao University from October 1, 2020 to October 31, 2021, including 52 normal samples(non-peritonitis group) and 38 peritonitis samples(24 in Gram-positive bacteria[GPB] peritonitis group and 14 in Gram-negative bacteria [GNB] peritonitis group). HPLC was used to determine the concentration of degraded mannose, glucose and fucose in the samples. The concentrations of mannose, glucose and fucose were analyzed. Logistic regression was used to analyze the relationship between monosaccharides and peritonitis, and receiver operating characteristic (ROC) curve was drawn to evaluate the diagnostic value of monosaccharides for peritonitis. Results Monosaccharide differences levels were significant among the three groups ( $P$ <0.01). Compared with the non-peritonitis group, the glucose concentration and fucose concentration in both peritonitis groups were significantly decreased ( $P$ <0.01). Mannose concentration was different between peritonitis groups ( $P$ <0.01). Logistic regression analysis showed that fucose concentration was a risk factor for peritonitis ( $P$ <0.01), with Mannose concentration for a risk factor of GPB( $P$ <0.01).ROC curve analysis showed that the fucose concentration had high diagnostic value for PD-associated peritonitis, AUC area is 0.820, 95% $C I$ (0.732, 0.908), sensitivity is 71.05%, specificity is 84.62%, and the optimal cut-off value is 3.045 μmol/L. Similar diagnostic value for mannose concentration to GPB, AUC area for 0.863, 95% $C I$ (0.740, 0.986), sensitivity for 78.57%, specificity for 83.33%, and the optimal cut-off valuefor 0.345 μmol/L. Significant decreased mannose concentration was in GPB. Conclusion The degraded fucose concentration and mannose concentration were independent risk factors for PD-associated dialysis and GPB, respectively. The significant decreased fucose concentration can indicate the risk of peritonitis. Meanwhile, the significant decreased mannose concentration might be a certain diagnostic value for early GPB infection and guide treatment options for antibiotic use.

Key words: peritoneal dialysis, peritonitis, monosaccharide, HPLC

中图分类号:

R572.2

公智卿, 陈怿鹏, 卢冬梅, 辛丽丽, 郭菁, 邢广群. 单糖特征分析在腹膜透析相关性腹膜炎病原菌诊断中的价值[J]. 临床荟萃, 2022, 37(11): 1012-1016.

Gong Zhiqing, Chen Yipeng, Lu Dongmei, Xin Lili, Guo Jing, Xing Guangqun. Diagnostic value of monosaccharide in peritoneal dialysis-associated peritonitis[J]. Clinical Focus, 2022, 37(11): 1012-1016.

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链接本文: https://huicui.hebmu.edu.cn/CN/10.3969/j.issn.1004-583X.2022.11.009

https://huicui.hebmu.edu.cn/CN/Y2022/V37/I11/1012

图/表 8

表1 3组临床资料比较

项目	无腹膜炎组 ( $n$ =52)	革兰阳性菌腹膜炎组 ( $n$ =24)	革兰阴性菌腹膜炎组 ( $n$ =14)	$F$ 值/ $H$ 值/ χ²值	$P$ 值
男[例(%)]	27(51.92)	9(37.50)	13(92.86)	11.240	0.004
年龄(岁)	44.90±15.58	50.96±16.91	64.71±6.88	9.759	<0.01
BMI(kg/m²)	25.54±4.40	22.92±2.73^*	22.96±5.42^*	4.227	0.018
总蛋白(g/L)	57.60±8.40	52.25±8.40	55.60±7.91	3.333	0.04
白蛋白(g/L)	32.57±5.91	26.39±5.58^*	24.24±6.92^*	15.476	<0.01
尿素(mmol/L)	23.45±8.73	18.07±4.00	16.29±4.86	7.891	0.01
肌酐(μmol/L)	875.14±364.85	606.70±336.05	439.17±114.01	12.025	<0.01
尿酸(μmol/L)	388.66±131.35	302.85±66.01	367.23±164.61	3.944	0.023
血钾(mmol/L)	4.16±0.68	3.83±0.45	4.50±0.60	5.439	0.006
血钠(mmol/L)	141.20±2.47	139.24±3.16^*	136.33±2.36^*	19.691	<0.01
血钙(mmol/L)	2.07±0.20	1.97±0.16^*	1.89±0.21^*	5.837	0.004
血磷(mmol/L)	1.96±0.64	1.63±0.47^*	1.09±0.35^*	13.673	<0.01
血糖空腹(mmol/L)	4.73±1.02	5.36±1.38	9.95±3.36	51.203	<0.01
血红蛋白(g/L)	98.10±19.58	97.21±11.13	106.64±18.15	1.523	0.224
淋巴细胞计数(10⁹/L)	1.41±0.62	1.10±0.52	1.08±0.50	3.361	0.039
血小板计数(10⁹/L)	181.00±77.52	228.46±91.64	221.43±106.19	3.005	0.055
CRP(mg/L)	1.03(0.50,8.17)	39.63(18.81,61.22)^*	61.85(36.78,93.60)^*	47.045	<0.01
PTH(pg/ml)	356.00±394.15	194.47±163.49	188.92±107.73	2.543	0.085
甘油三酯(mmol/L)	1.86±1.25	1.97±1.62	1.21±0.69	1.247	0.293
总胆固醇(mmol/L)	4.88±1.71	4.90±1.40	4.07±2.73	0.791	0.457

表1 3组临床资料比较

项目	无腹膜炎组 ( $n$ =52)	革兰阳性菌腹膜炎组 ( $n$ =24)	革兰阴性菌腹膜炎组 ( $n$ =14)	$F$ 值/ $H$ 值/ χ²值	$P$ 值
男[例(%)]	27(51.92)	9(37.50)	13(92.86)	11.240	0.004
年龄(岁)	44.90±15.58	50.96±16.91	64.71±6.88	9.759	<0.01
BMI(kg/m²)	25.54±4.40	22.92±2.73^*	22.96±5.42^*	4.227	0.018
总蛋白(g/L)	57.60±8.40	52.25±8.40	55.60±7.91	3.333	0.04
白蛋白(g/L)	32.57±5.91	26.39±5.58^*	24.24±6.92^*	15.476	<0.01
尿素(mmol/L)	23.45±8.73	18.07±4.00	16.29±4.86	7.891	0.01
肌酐(μmol/L)	875.14±364.85	606.70±336.05	439.17±114.01	12.025	<0.01
尿酸(μmol/L)	388.66±131.35	302.85±66.01	367.23±164.61	3.944	0.023
血钾(mmol/L)	4.16±0.68	3.83±0.45	4.50±0.60	5.439	0.006
血钠(mmol/L)	141.20±2.47	139.24±3.16^*	136.33±2.36^*	19.691	<0.01
血钙(mmol/L)	2.07±0.20	1.97±0.16^*	1.89±0.21^*	5.837	0.004
血磷(mmol/L)	1.96±0.64	1.63±0.47^*	1.09±0.35^*	13.673	<0.01
血糖空腹(mmol/L)	4.73±1.02	5.36±1.38	9.95±3.36	51.203	<0.01
血红蛋白(g/L)	98.10±19.58	97.21±11.13	106.64±18.15	1.523	0.224
淋巴细胞计数(10⁹/L)	1.41±0.62	1.10±0.52	1.08±0.50	3.361	0.039
血小板计数(10⁹/L)	181.00±77.52	228.46±91.64	221.43±106.19	3.005	0.055
CRP(mg/L)	1.03(0.50,8.17)	39.63(18.81,61.22)^*	61.85(36.78,93.60)^*	47.045	<0.01
PTH(pg/ml)	356.00±394.15	194.47±163.49	188.92±107.73	2.543	0.085
甘油三酯(mmol/L)	1.86±1.25	1.97±1.62	1.21±0.69	1.247	0.293
总胆固醇(mmol/L)	4.88±1.71	4.90±1.40	4.07±2.73	0.791	0.457

表2 腹膜透析液降解单糖浓度比较(μmol/L)

组别	例数	甘露糖	葡萄糖	岩藻糖
无腹膜炎组	52	0.50(0.32,0.73)	9.30(5.74,15.64)	5.19(3.59,8.53)
革兰阳性菌腹膜炎组	24	0.24(0.18, 0.30)^*#	5.02(2.69, 8.52)^*	2.01(1.07, 4.04)^*
革兰阴性菌腹膜炎组	14	0.46(0.33, 0.74)	3.24(1.98, 6.31)^*	2.48(0.79, 3.17)^*
$H$ 值		24.010	19.875	26.918
$P$ 值		<0.01	<0.01	<0.01

表2 腹膜透析液降解单糖浓度比较(μmol/L)

组别	例数	甘露糖	葡萄糖	岩藻糖
无腹膜炎组	52	0.50(0.32,0.73)	9.30(5.74,15.64)	5.19(3.59,8.53)
革兰阳性菌腹膜炎组	24	0.24(0.18, 0.30)^*#	5.02(2.69, 8.52)^*	2.01(1.07, 4.04)^*
革兰阴性菌腹膜炎组	14	0.46(0.33, 0.74)	3.24(1.98, 6.31)^*	2.48(0.79, 3.17)^*
$H$ 值		24.010	19.875	26.918
$P$ 值		<0.01	<0.01	<0.01

表3 腹膜透析相关性腹膜炎病原菌构成情况

病原菌种类	例数	构成比(%)
革兰阳性菌	24	63.16
耳葡萄球菌	1	2.63
表皮葡萄球菌	5	13.16
金黄色葡萄球菌	2	5.26
人葡萄球菌	3	7.89
苏云金芽孢杆菌	3	7.89
头状葡萄球菌	1	2.63
解没食子酸链球菌解没食子酸亚种	2	5.26
鹑鸡肠球菌	3	7.89
戈登链球菌	2	5.26
唾液链球菌	1	2.63
革兰阳性菌	1	2.63
革兰阴性菌	14	36.84
大肠埃希菌	3	7.89
革兰阴性菌	6	15.79
肺炎克雷伯菌肺炎亚种	2	5.26
铜绿假单胞菌	3	7.89

表4 腹膜炎影响因素的logistic回归分析

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
葡萄糖浓度	-0.046	0.069	0.435	0.509	0.955	0.834	1.094
岩藻糖浓度	-0.405	0.155	6.822	0.009	0.667	0.492	0.904

表4 腹膜炎影响因素的logistic回归分析

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
葡萄糖浓度	-0.046	0.069	0.435	0.509	0.955	0.834	1.094
岩藻糖浓度	-0.405	0.155	6.822	0.009	0.667	0.492	0.904

表5 变量赋值说明

因素	赋值说明
甘露糖浓度	0=≤0.345,1=>0.345

表6 革兰阳性菌腹膜炎影响因素的logistic回归分析

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
甘露糖浓度	-2.187	0.791	7.639	0.006	0.112	0.024	0.529

表6 革兰阳性菌腹膜炎影响因素的logistic回归分析

因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	95% $C I$
因素	回归系数	标准误	Wald χ²值	$P$ 值	$O R$ 值	下限	上限
甘露糖浓度	-2.187	0.791	7.639	0.006	0.112	0.024	0.529

图1 降解的岩藻糖诊断腹膜炎的ROC曲线

图2 降解的甘露糖诊断革兰阳性菌腹膜炎的ROC曲线

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