Courivaud Cécile, Bardonnet Karine, Crepin Thomas, Bresson-Vautrin Catherine, Rebibou Jean-Michel, Ducloux Didier
INSERM UMR1098, Fédération Hospitalo-Universitaire INCREASE, 25020, Besançon, France.
J Nephrol. 2015 Aug;28(4):511-5. doi: 10.1007/s40620-015-0176-2. Epub 2015 Mar 11.
Peritonitis is a frequent and serious complication of peritoneal dialysis (PD). Whether low immunoglobulin level is associated with PD-related peritonitis is unknown.
We conducted a prospective study to assess whether immunoglobulin levels at PD onset could predict the occurrence of peritonitis. All patients starting peritoneal dialysis between 01/2005 and 12/2010 at the University hospital of Besançon, France, were included in the study.
Of 240 consecutive PD patients enrolled (mean follow-up 25 ± 12 months), 76 (32%) had at least one episode of peritonitis. Mean immunoglobulin (Ig)G level at PD start was lower in patients who subsequently experienced peritonitis (7.9 + 3.4 vs. 9.7 + 3.4 g/l, p = 0.005). An increased IgG level at PD onset was associated with a reduced risk of peritonitis [hazard ratio (HR) 0.88, 95% confidence interval (CI) 0.80-0.97 for each increase of 1 g/l in IgG, p = 0.008]. IgG level ≤6.4 g/l ("low IgG") was the best predictive value for the occurrence of subsequent peritonitis: 52 patients (24%) had low IgG levels. At multivariate analysis, both low IgG level (HR 2.49, 95% CI 1.32-4.69, p = 0.005) and diabetes (HR 2.78, 95% CI 1.49-5.20, p = 0.001) were predictive of the occurrence of peritonitis.
Low IgG levels predict the occurrence of PD-related peritonitis. Randomized studies should determine whether such patients could benefit from intravenous immunoglobulin administration.
腹膜炎是腹膜透析（PD）常见且严重的并发症。低免疫球蛋白水平是否与PD相关腹膜炎有关尚不清楚。
我们进行了一项前瞻性研究，以评估PD开始时的免疫球蛋白水平是否能预测腹膜炎的发生。法国贝桑松大学医院2005年1月至2010年12月期间开始腹膜透析的所有患者均纳入本研究。
在连续纳入的240例PD患者中（平均随访25±12个月），76例（32%）至少发生过一次腹膜炎。随后发生腹膜炎的患者在PD开始时的平均免疫球蛋白（Ig）G水平较低（7.9 + 3.4 vs. 9.7 + 3.4 g/l，p = 0.005）。PD开始时IgG水平升高与腹膜炎风险降低相关[IgG每增加1 g/l，风险比（HR）0.88，95%置信区间（CI）0.80 - 0.97，p = 0.008]。IgG水平≤6.4 g/l（“低IgG”）是后续腹膜炎发生的最佳预测值：52例患者（24%）IgG水平低。多因素分析显示，低IgG水平（HR 2.49，95% CI 1.32 - 4.69，p = 0.005）和糖尿病（HR 2.78，95% CI 1.49 - 5.20，p = 0.001）均为腹膜炎发生的预测因素。
低IgG水平可预测PD相关腹膜炎的发生。随机研究应确定此类患者是否能从静脉注射免疫球蛋白治疗中获益。
