免疫球蛋白 G 浓度低与腹膜透析相关性腹膜炎的风险增加无关。

Low immunoglobulin G concentrations are not associated with an increased risk of peritoneal dialysis-related peritonitis.

出版信息

Clin Nephrol. 2023 Apr;99(4):180-186. doi: 10.5414/CN110966.

Abstract

BACKGROUND

Peritonitis is a common and severe complication of peritoneal dialysis (PD) and is associated with high morbidity and sometimes also with mortality. Identification of risk factors, as well as protective mechanisms for peritonitis, is important to reduce peritonitis-induced morbidity. According to the current literature, IgG concentrations might be associated with peritonitis in PD-treated patients. In this study, we aimed to investigate possible associations between dialysate or serum IgG concentration and peritonitis risk in a longitudinal cohort of PD-treated patients.

MATERIALS AND METHODS

We analyzed prospectively collected data obtained during the first standard peritoneal permeability analysis (SPA), performed in incident PD patients, aged > 18 years who started PD treatment in our tertiary-care university hospital from January 1, 1994 until December 31, 2008. Patients were divided in groups according to dialysate or serum IgG concentrations and according to peritonitis incidence. A possible association between low dialysate or serum IgG concentrations and time to the first peritonitis episode was investigated using cox proportional hazard models.

RESULTS

120 patients were included in our analyses with a median follow-up time of 36 (16 - 92) months. No significant association between dialysate, nor serum IgG and time to peritonitis was found (HR 0.27 (95% CI 0.65 - 1.62), p = 0.911 and HR 0.87 (95% CI 0.70 - 1.68), p = 0.708, respectively). Moreover, IgG concentrations were not associated with peritonitis incidence, nor with the recurrence of peritonitis. Finally, we found no significant difference in dialysate or serum IgG concentrations between patients who remained peritonitis-free (58.0 ± 35.6 mg/L in dialysate, 11.1 ± 4.4 g/L in serum), and those who experienced a peritonitis episode during follow-up (59.5 ± 41.9 mg/L in dialysate, 10.3 ± 4.3 g/L in serum), respectively.

CONCLUSION

Dialysate or serum IgG are not major determinants of local peritoneal defense against peritonitis.

摘要

背景

腹膜炎是腹膜透析（PD）的常见且严重的并发症，与高发病率有关，有时还与死亡率有关。确定腹膜炎的危险因素以及保护机制对于降低腹膜炎引起的发病率很重要。根据目前的文献，IgG 浓度可能与 PD 治疗患者的腹膜炎有关。在这项研究中，我们旨在调查 PD 治疗患者的透液或血清 IgG 浓度与腹膜炎风险之间的可能关联。

材料和方法

我们分析了前瞻性收集的数据，这些数据是在我们的三级护理大学医院于 1994 年 1 月 1 日至 2008 年 12 月 31 日期间开始 PD 治疗的 18 岁以上的首发 PD 患者的首次标准腹膜通透性分析（SPA）中获得的。根据透液或血清 IgG 浓度以及腹膜炎发生率，将患者分为不同组。使用 cox 比例风险模型，研究低透液或血清 IgG 浓度与首次腹膜炎发作时间之间的可能关联。

结果

我们的分析包括 120 名患者，中位随访时间为 36（16-92）个月。未发现透液或血清 IgG 与腹膜炎发生时间之间存在显著相关性（HR 0.27（95% CI 0.65-1.62），p = 0.911 和 HR 0.87（95% CI 0.70-1.68），p = 0.708）。此外，IgG 浓度与腹膜炎发生率或腹膜炎复发均无相关性。最后，我们发现腹膜炎患者和无腹膜炎患者的透液或血清 IgG 浓度无显著差异（透液中分别为 58.0±35.6mg/L 和 59.5±41.9mg/L，血清中分别为 11.1±4.4g/L 和 10.3±4.3g/L）。