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  • 顾峰,吴艳芬,王志宏,等.降钙素原在维持性血液透析合并慢性心力衰竭患者诊断中的价值[J].同济大学学报(医学版),2020,41(5):617-624.    [点击复制]
  • GU Feng,WU Yan-feng,WANG Zhi-hong,et al.Diagnostic value of procalcitonin in maintenance hemodialysis patients with chronic heart failure[J].同济大学学报(医学版),2020,41(5):617-624.   [点击复制]
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降钙素原在维持性血液透析合并慢性心力衰竭患者诊断中的价值
顾峰,吴艳芬,王志宏,侯照远,朱爱国,齐华林
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(上海市浦东新区人民医院检验科,上海201200;上海市浦东新区人民医院肾内科,上海201200;上海交通大学医学院基础医学院,上海200025)
摘要:
目的探讨降钙素原(procalcitonin, PCT)在维持性血液透析(maintenance hemodialysis, MHD)合并慢性心力衰竭(chronic heart failure, CHF)患者诊断中的价值。方法选取2019年1月至2019年12月在上海市浦东新区人民医院血液透析中心收治的MHD患者147例,同期在肾内科收治的慢性肾脏病5期非透析(chronic kidney disease stage 5, CKD G5)患者50例及健康体检者50例作为正常对照组。根据研究目的将研究对象分为MHD合并CHF组、MHD不合并CHF组、慢性肾脏病5期组和正常对照组,采用化学发光方法检测所有研究对象的PCT,比较各组之间PCT水平的差异,并运用受试者工作曲线(ROC)分析探讨PCT在诊断MHD合并CHF患者中的价值,Logistic回归分析MHD合并CHF患者的主要影响因素。结果4组间PCT水平差异均有统计学意义(P<0.05),并且PCT水平依次降低;MHD合并CHF不同心功能分级患者之间PCT水平差异有统计学意义(P<0.01),并且随着心力衰竭等级的增加,其水平升高;PCT诊断MHD合并CHF患者的灵敏度为77.6%,特异度为77.6%,最大约登指数为0.551ng/mL;PCT诊断MHD合并CHF不同心功能分级患者的灵敏度为84.9%,特异度为82.2%,最大约登指数:0.671ng/mL;Logistic回归分析结果显示年龄、透析龄、PCT、肌酐是MHD合并CHF的危险因素。结论PCT是MHD合并CHF的独立危险因素,且随着心力衰竭程度的加重,其水平呈升高趋势,可能是协助评估心力衰竭严重程度的潜在标志物;当PCT≥0.551、0.671ng/mL时分别提示MHD患者早期出现心力衰竭和心力衰竭程度加重。
关键词:  降钙素原  维持性血液透析  慢性心力衰竭  心功能分级
DOI:10.16118/j.1008-0392.2020.05.013
投稿时间:2020-02-25
基金项目:
Diagnostic value of procalcitonin in maintenance hemodialysis patients with chronic heart failure
GU Feng,WU Yan-feng,WANG Zhi-hong,HOU Zhao-yuan,ZHU Ai-guo,QI Hua-lin
(Clinical Laboratory, Shanghai Pudong New Area People’s Hospital, Shanghai 201200, China;Dept. of Nephrology, Shanghai Pudong New Area People’s Hospital, Shanghai 201200, China;School of Basic Medicine, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China)
Abstract:
ObjectiveTo explore the diagnostic value of procalcitonin(PCT) in maintenance hemodialysis(MHD) patients with chronic heart failure(CHF). MethodsFrom January 2019 to December 2019, 147 MHD patients were enrolled in the Hemodialysis Center of Pudong New Area People’s Hospital of Shanghai, including 98 cases with CHF(MHD with CHF group) and 49 cases without CHF(MHD without CHF group); 50 non-hemodialytic patients with chronic kidney disease stage 5(CKD G5 group) and 50 healthy subjects(normal control group) were also enrolled in the same period. The PCT levels of all subjects were detected by chemiluminescence method, and the differences between the groups were compared. The value of PCT in the diagnosis of MHD with CHF was analyzed by ROC curve method. The influencing factors of MHD with CHF were analyzed by Logistic regression. ResultsThere were significant differences in PCT levels among the four groups(P<0.05), and PCT levels decreased in turn. There were significant differences in PCT levels among MHD patients with different CHF functional grades(P<0.01), and their levels increased with the increase of heart failure grades. The sensitivity of PCT in the diagnosis of MHD with CHF was 77.6% and the specificity was 77.6% with a cut-off value of 0.551ng/mL; the sensitivity and specificity of PCT in the diagnosis of MHD patients with CHF with different cardiac function classification were 84.9% and 82.2% with a cut-off value of 0.671ng/mL. Logistic regression analysis showed that age, age at starting dialysis, PCT and creatinine were the risk factors of MHD combined with CHF. ConclusionPCT is an independent risk factor of MHD combined with CHF. With the aggravation of heart failure, the level of PCT tends to increase, which may be a potential marker to assess the severity of heart failure. When PCT≥0.551ng/mL and 0.671ng/mL indicate that MHD patients have early heart failure and increased severity of heart failure, respectively.
Key words:  procalcitonin  maintenance hemodialysis  chronic heart failure  cardiac function classification

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