血清 DcR3 水平升高与接受慢性腹膜透析患者发生腹膜炎有关。

High serum DcR3 levels are associated with the occurrence of peritonitis in patients receiving chronic peritoneal dialysis.

机构信息

Division of Infectious Disease, Wei Gong Memorial Hospital, Miaoli, Taiwan, ROC.

出版信息

J Chin Med Assoc. 2012 Dec;75(12):644-8. doi: 10.1016/j.jcma.2012.09.009. Epub 2012 Nov 29.

DOI:10.1016/j.jcma.2012.09.009

PMID:23245480

Abstract

BACKGROUND

Peritoneal dialysis (PD)-related peritonitis is a serious complication that typically leads to hospitalization, catheter loss, and even mortality. Previous studies of the risk factors for peritonitis are discordant. To date, no biomarker associated with PD-related peritonitis has been investigated. However, it has been shown that serum decoy receptor 3 (DcR3) is a valuable marker in predicting the outcome of several inflammatory diseases. The aim of this study was to investigate whether serum DcR3 is a predictor of peritonitis in chronic PD patients.

METHODS

We conducted a prospective cohort study of PD patients in the PD unit of a tertiary referral center from March 1 to November 30, 2007, and followed up until December 31, 2009. Clinical and laboratory parameters were recorded and serum DcR3 was measured to assess risk factors for developing PD-related peritonitis.

RESULTS

A total of 77 patients (38 men and 39 women; mean age 58 ± 13 years) were enrolled in this study. The average time on PD was 24.5 months and 46 patients (60%) were diabetic. The mean follow-up duration was 499 ± 17 days. The rate of peritonitis incidence was 0.17 episodes per patient-year. Baseline serum DcR3 in 77 patients was 1.94 ± 1.23 ng/mL. Kaplan-Meier survival analysis showed that patients with serum DcR3 > 1.8 ng/mL had a higher risk of peritonitis than those with serum DcR3 < 1.8 ng/mL (p = 0.016). The Cox proportional hazard model further showed that high serum DcR3 (>1.8 ng/mL) was an independent risk factor for subsequent peritonitis (hazard ratio 3.61, 95% CI 1.17-11.08; p = 0.03).

CONCLUSION

Serum DcR3 was associated with increased risk of PD-related peritonitis.

摘要

背景

腹膜透析（PD）相关性腹膜炎是一种严重的并发症，通常导致住院、导管丢失，甚至死亡。先前对腹膜炎危险因素的研究结果不一致。迄今为止，尚未研究与 PD 相关性腹膜炎相关的生物标志物。然而，已经表明血清诱饵受体 3（DcR3）是预测几种炎症性疾病结局的有价值标志物。本研究旨在探讨血清 DcR3 是否可预测慢性 PD 患者的腹膜炎。

方法

我们对 2007 年 3 月 1 日至 11 月 30 日在三级转诊中心 PD 病房进行的前瞻性队列研究中的 PD 患者进行了研究，并随访至 2009 年 12 月 31 日。记录临床和实验室参数，并测量血清 DcR3，以评估发生 PD 相关性腹膜炎的危险因素。

结果

共有 77 名患者（38 名男性和 39 名女性；平均年龄 58±13 岁）入组本研究。PD 时间平均为 24.5 个月，46 名患者（60%）患有糖尿病。平均随访时间为 499±17 天。腹膜炎发生率为 0.17 例/患者-年。77 例患者的基线血清 DcR3 为 1.94±1.23ng/mL。Kaplan-Meier 生存分析表明，血清 DcR3>1.8ng/mL 的患者发生腹膜炎的风险高于血清 DcR3<1.8ng/mL 的患者（p=0.016）。Cox 比例风险模型进一步表明，高血清 DcR3（>1.8ng/mL）是随后发生腹膜炎的独立危险因素（风险比 3.61，95%CI 1.17-11.08；p=0.03）。