Diagnostic value of monosaccharide in peritoneal dialysis-associated peritonitis

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

Abstract

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

CLC Number:

R572.2

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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URL: https://huicui.hebmu.edu.cn/EN/10.3969/j.issn.1004-583X.2022.11.009

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

Figures/Tables 8

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

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

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

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

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

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

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

因素	赋值说明
甘露糖浓度	0=≤0.345,1=>0.345

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

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

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