Mizuno Masashi, Suzuki Yasuhiro, Higashide Keiko, Sei Yumi, Iguchi Daiki, Sakata Fumiko, Horie Masanobu, Maruyama Shoichi, Matsuo Seiichi, Morgan B Paul, Ito Yasuhiko
Renal Replacement Therapy, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Division of Nephrology, Nagoya University Graduate School of Medicine, Nagoya, Japan.
PLoS One. 2017 Jan 3;12(1):e0169111. doi: 10.1371/journal.pone.0169111. eCollection 2017.
We searched for indicators to predict the prognosis of infectious peritonitis by measuring levels of complement proteins and activation products in peritoneal dialysis (PD) fluid (PDF) of patients at early stages of peritonitis. We retrospectively analyzed the relationship between the levels of sC5b-9, C3 and C4 in PDF and the subsequent clinical prognosis.
We measured levels of sC5b-9, C3 and C4 in PDF on days 1, 2 and 5 post-onset of peritonitis in 104 episodes of infectious peritonitis in PD patients from 2008 and retrospectively compared levels with clinical outcomes. Further analysis for the presence of causative microorganisms or to demonstrate bacterial culture negative peritonitis was performed and correlated with change of levels of sC5b-9 in PDF.
When PD patients with peritonitis were divided into groups that either failed to recover from peritonitis and were finally withdrawn from PD (group 1; n = 25) or recovered (group 2; n = 79), levels of sC5b-9, C3 and C4 in PDF were significantly higher in group 1 patients compared to those in group 2 on day5. Analysis of microorganisms showed significantly higher sC5b-9 levels in PDF of peritonitis cases caused by culture negative peritonitis in group 1 compared with group 2 when we analyzed for individual microorganisms. Of note, on day5, the sC5b-9 levels in PDF were similarly high in peritonitis caused by fungi or other organisms.
Our results suggested that levels of complement markers in PDF, especially sC5b-9, have potential as surrogate markers to predict prognosis of PD-related peritonitis.
我们通过测量腹膜炎早期患者腹膜透析（PD）液（PDF）中补体蛋白和激活产物的水平，寻找预测感染性腹膜炎预后的指标。我们回顾性分析了PDF中sC5b-9、C3和C4水平与随后临床预后之间的关系。
我们测量了2008年PD患者104例感染性腹膜炎发作后第1、2和5天PDF中sC5b-9、C3和C4的水平，并回顾性地将这些水平与临床结果进行比较。对致病微生物的存在进行了进一步分析，或证明为细菌性培养阴性腹膜炎，并与PDF中sC5b-9水平的变化相关联。
当将患有腹膜炎的PD患者分为未能从腹膜炎中康复并最终退出PD的组（第1组；n = 25）或康复的组（第2组；n = 79）时，第5天第1组患者PDF中sC5b-9、C3和C4的水平显著高于第2组。微生物分析显示，在分析单个微生物时，第1组中由培养阴性腹膜炎引起的腹膜炎病例的PDF中sC5b-9水平显著高于第2组。值得注意的是，在第5天，由真菌或其他生物体引起的腹膜炎中PDF中的sC5b-9水平同样很高。
我们的结果表明，PDF中的补体标志物水平，尤其是sC5b-9，有潜力作为预测PD相关腹膜炎预后的替代标志物。
