中性粒细胞/淋巴细胞比值和血小板/淋巴细胞比值对腹膜透析患者腹主动脉钙化的评估价值

目的 探讨中性粒细胞/淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)与血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)对腹膜透析患者腹主动脉钙化(abdomi-nal aortic calcification,AAC)的评估价值.方法 选取2...     

血小板/淋巴细胞比值与腹膜透析患者频发性腹膜透析相关性腹膜炎的关系

目的:探讨血小板/淋巴细胞比值（platelet/lymphocyte ratio,PLR）与腹膜透析患者发生频发性腹膜透析相关性腹膜炎（peritoneal dialysis-associated peritonitis,PDAP）的关系。方法:回顾性研究2015年1月至2019年6月于贵州省人民医院住院诊断为PDA...     

血小板/淋巴细胞比值、中性粒细胞/淋巴细胞比值与慢性肾脏病关系的研究进展

中性粒细胞/淋巴细胞比值(NLR)、血小板/淋巴细胞比值(PLR)是近年来研究炎症标志物的热点,较其他白细胞成分具有更高的稳定性。研究发现,PLR、NLR在慢性肾脏病(CKD)中有广泛的应用,参与炎症反应、心血管并发症、肾性贫血等,影响着CKD的发生、发展及预后,同时在高血压肾损伤、糖尿病肾损伤、狼疮肾炎等疾病中都有相关研究。本文拟对PLR、NLR在CKD中的研究进展作一综述,以期为PLR、NLR用于CKD及相关并发症的预测提供依据,并为进一步开展PLR、NLR在CKD中的作用机制研究提供思路和参考。     

维持性血液透析患者中性粒细胞/淋巴细胞比值与左心室肥厚的关系

目的检测维持性血液透析(maintenance hemodialysis,MHD)患者中性粒细胞/淋巴细胞比值(neutrophil/lymphocyte ratio,NLR)水平,探讨其与左心室肥厚(left ventricular hypertrophy,LVH)相关性。方法选择2018年1月至2019年8月于凉山州第一人民医院肾脏内科行MHD患者96例,获取所有患者NLR中位数并将其分为高NLR组(NLR3.31,n=47)和低NLR组(NLR≤3.31,n=49),比较2组基线资料、心脏超声指标[左房舒张末内径(LAEDd)、左室收缩末内径(LVEDs)、射血分数(EF)、左心室质量指数(LVMI)]、实验室检测指标[NLR、脑钠肽、Hb、白蛋白(Alb)、血钙]、血脂水平,统计LVH发生率;根据是否发生LVH分为LVH组和非LVH组,多因素分析LVH发生高危因素,ROC曲线分析NLR对LVH发生的预测价值。结果 NLR与SBP、LAEDd、LVEDs、LVMI、NLR、BNP、Alb、LDL-C、胆固醇、非高密度脂蛋白胆固醇、Cr均呈正相关(P0.05),与DBP呈负相关(P0.05)。经彩色多普勒超声检查结果确定高NLR组LVH发生率高于低NLR组LVH发生率;年龄、SBP、LAEDd、LVEDs、LVMI、NLR、脑钠肽、Alb、LDL-C、胆固醇、非高密度脂蛋白胆固醇、Cr是LVH发生高危因素(P0.05),且NLR相对危险比(OR)最大。NLR是预测LVH发生的预测因子(P0.05)。结论 NLR值与MHD患者LVH的发生和发展密切相关,关注NLR变化对防治LVH具有较高价值。     

前列腺癌患者中性粒细胞与淋巴细胞比值检测的意义

目的探讨中性粒细胞和淋巴细胞比值(neutrophil-to-lymphocyte ratio,NLR)对前列腺癌(prostate cancer,PCa)分期和分级的价值.方法对180例 PCa 患者进行外周血细胞计数检查,计算 NLR 值,比较不同危险度、不同侵犯范围、不同血清 PSA 水平、不同病理分期和是否存在骨转移患者的 NLR 值,探讨 PCa 患者 NLR 值与危险度、侵犯范围和血清 PSA 水平的相关性.结果随着危险度的增加、肿瘤侵犯范围的扩大和血清 PSA 水平的增加,NLR 值和高 NLR 率均呈增加趋势(P ＜0．05,P ＜0．01);存在骨转移及 TNM 分期Ⅲ~Ⅳ期患者 NLR 值分别高于无骨转移和 TNM 分期Ⅰ~Ⅱ期患者(P ＜0．01).相关性分析显示 PCa 患者 NLR 值与危险度、侵犯范围、血清 PSA 水平均呈正相关(P ＜0．05).结论 NLR 值与血清 PSA 水平、肿瘤侵犯范围及危险度有一定的相关性,可作为 PCa 分期和分级的有效指标.     

血清中性粒细胞/淋巴细胞比值与胃肠间质瘤患者预后的关系及其临床意义

目的检测中性粒细胞/淋巴细胞比值（NLR）在胃肠间质瘤（GIST）患者术前血清中的高低情况并分析其与预后的关系。方法采用回顾性的方法分析符合纳入条件的42例GIST患者术前3 d血常规中NLR及其病理切片中各免疫组织化学检测结果,并通过生存分析了解NLR与GIST患者预后的关系。结果 42例GIST患者中有22例NLR≥2.5（高NLR组）,20例NLR〈2.5（低NLR组）。NLR与GIST患者临床病理特征中核分裂像（χ2=9.45,P=0.002）和肿瘤大小有关（P=0.041）。高NLR组的GIST患者的3年生存率明显低于低NLR组的患者,其差异有统计学意义（χ2=5.44,P=0.022）。单因素分析结果显示,NLR、核分裂像及肿瘤大小与患者3年生存率有关（P〈0.05）;多因素分析结果显示,NLR和核分裂像是GIST患者3年生存率的独立危险因素（P=0.018,P=0.000）。结论 NLR和细胞核分裂像是影响GIST患者预后的独立危险因素,其对GIST患者的预后有一定预测价值。     

中性粒细胞/淋巴细胞比值在肌层浸润性膀胱癌预后评估中的价值

目的探讨术前外周血中性粒细胞与淋巴细胞比值(NLR)是否可以作为肌层浸润性膀胱癌(MIBC)患者术后的预后评价指标。方法回顾性分析2008年1月至2011年12月行膀胱癌根治术的214例MIBC患者的临床资料,根据患者术前外周血NLR大小分为低NLR组(NLR<3,92例)和高NLR组(NLR≥3,122例),比较两组患者的5年生存率并进行预后危险因素分析。结果低NLR组和高NLR组MIBC患者5年生存率分别为70.9%和55.8%(P<0.01)。单因素分析显示,术前NLR、吸烟史、病理T分期、肿瘤分级、围手术期输血、淋巴结转移、淋巴结密度及切缘阳性与MIBC患者预后有关(P<0.05);Cox回归分析证实,NLR是影响MIBC患者预后的独立危险因素(HR=2.142,95%CI:1.212~3.786,P<0.01)。结论术前NLR是影响MIBC患者术后生存时间的独立危险因素,可作为MIBC患者的预后指标。     

中性粒细胞/淋巴细胞比值与手足口病患儿重症化的相关性

目的探讨中性粒细胞/淋巴细胞比值（NLR）预测手足口病（HFMD）患儿重症化的临床价值。 方法回顾性分析2008年5月至2017年12月西安交通大学第二附属医院和西安市儿童医院收治的1 593例手足口病患儿,根据病情程度分为普通病例组（929例）和重症病例（664例）。利用受试者工作特征曲线（ROC工作曲线）计算中性粒细胞/淋巴细胞比值（NLR）预测HFMD重症化的最佳临界值,根据NLR将1 593例患儿分为高NLR组和低NLR组;多因素二分类Logistic回归分析各相关因素与手足口病患儿重症化的相关性。 结果重症手足口病组与普通病例组患儿的发热、高热、神经系统症状、循环系统症状、白细胞（WBC）、NLR、降钙素原（PCT）、血糖、肠道病毒71型IgM抗体（EV71-IgM）阳性、合并Epstein-Barr病毒（EBV）感染等差异均有统计学意义（P均< 0.05）。利用受试者工作特征曲线（ROC工作曲线）确定NLR比值预测重症化的最佳临界值为1.59;多因素Logistic回归分析显示,高热（> 39 ℃）、EV71-IgM阳性、合并EBV感染、血糖> 8.3 mmol/L、PCT > 0.1 ng/ml和NLR > 1.59均为HFMD重症化的危险因素[比值比（OR）值分别为1.557、5.124、3.533、7.323、1.727和2.031,P均< 0.01]。 结论NLR> 1.59与HFMD重症化密切相关,具有重要的预测价值。NLR为指导HFMD初诊患儿临床决策和治疗方案的临床指标之一。     

中性粒细胞与淋巴细胞比值与阴茎癌预后的关联性

目的中性粒细胞与淋巴细胞比值(NLR)与恶性肿瘤预后的关联性越来越受到研究人员的关注。本研究即分析NLR与阴茎癌患者预后的关联性。方法回顾性分析了21例在我院接受手术治疗的阴茎癌患者的有关数据,包括术前血常规数据、有无淋巴结转移、术后生存时间,绘制患者生存曲线,使用Log-rank test进行单变量生存分析,比较不同水平NLR的生存曲线,并以是否有淋巴结转移将患者分层后再次进行分析。结果 NLR2.5与NLR≥2.5对患者预后的影响有显著差异(P0.05)。分层分析后,无淋巴结转移时,NLR较高的患者预后较差。结论 NLR对接受手术治疗的阴茎癌患者的预后有提示意义,NLR较高的患者预后较差。     

腹膜透析相关性腹膜炎的防治

腹膜透析(PD)相关性腹膜炎是腹膜透析患者的严重并发症,降低腹膜透析相关感染的风险应该是每个PD中心的重要工作目标。对于出现感染者,应在早期进行经验性治疗,并高质量留取标本,进行有效的微生物学诊断和药敏试验,以保证抗感染治疗的准确性和有效性。腹膜透析中心应积极开展团队质量改进,包括持续进行感染监测、分析感染发生的根本原因。建立全面的腹膜炎风险评估机制,尤其要重点加强主动预防理念,在开始腹膜透析治疗的同时,对高龄、糖尿病患者等高危人群进行重点预防,有意识地加强操作正规培训和再培训、积极防止腹泻和(或)便秘以及加强隧道和出口处护理等主动预防措施,尽可能降低腹膜透析相关性腹膜炎的发生概率。     

Sclerosing encapsulating peritonitis in a child secondary to peritoneal dialysis

Sclerosing encapsulating peritonitis, or “abdominal cocoon,” is a rare but serious complication of continuous ambulatory peritoneal dialysis. It is characterized by the diffuse appearance of marked sclerotic thickening of the peritoneal membrane resulting in intestinal obstruction.A 14-year-old adolescent boy with a history of end-stage renal failure on continuous ambulatory peritoneal dialysis presented with symptoms of acute intestinal obstruction. A computed tomography scan of the abdomen revealed distended small bowel loops clustered and displaced to the right upper quadrant. The overlying peritoneum was markedly thickened and calcified. Laparotomy confirmed the diagnosis of sclerosing encapsulating peritonitis and the patient was treated with excision of the fibrocollagenous membrane. Postoperatively, he had prolonged ileus requiring parenteral nutritional support and peritoneal dialysis was restarted on postoperative day 10.A high degree of cognizance is needed to facilitate diagnosis and treatment of this uncommon and potentially life-threatening condition.     

Fungal peritonitis in children treated with peritoneal dialysis and gastrostomy feeding

Feeding gastrostomies were placed in three children treated with chronic peritoneal dialysis at our center because of persistent, severe malnutrition and inadequate growth. Two had frequent fungal infections of the gastrostomy site and all three developedCandida peritonitis which occurred at 1 month, 2 months and 2 years after insertion of gastrostomy. Complications included multiple intra-abdominal adhesions, abscess formation and loss of peritoneal function necessitating transfer to hemodialysis. The presence of a gastrostomy may predispose to the development of fungal peritonitis with its high morbidity and should be avoided in children on chronic peritoneal dialysis.     

Sclerosing encapsulating peritonitis in pediatric peritoneal dialysis patients

The aim of this study was to define the incidence and characteristics of sclerosing encapsulating peritonitis (SEP) in pediatric peritoneal dialysis (PD) patients in Japan. A questionnaire was sent to all dialysis units with at least two pediatric PD patients. Among 687 patients registered, 11 cases (1.6%) of SEP were diagnosed. The mean age of patients with SEP at the start of PD was 9.7±3.6 years and at SEP diagnosis, 19.1±3.8 years. All patients had undergone PD for more than 5 years, and the mean PD duration was 9.6±3.3 years. SEP was diagnosed in 6.6% and 12% of patients dialyzed for >5 years and >8 years, respectively. The incidence of peritonitis among patients with SEP was not different from that among the Japanese pediatric registry. All patients had virtually no residual urine volume and 9 had impaired peritoneal ultrafiltration. Peritoneal calcification was the most-frequent radiological finding. Peritoneal biopsy was performed in 7 patients and confirmed sclerotic peritonitis in all. Ten patients transferred to hemodialysis, and only 1 patient underwent surgery. Three patients died. We recommend that patients on PD for more than 5 years who have impaired peritoneal ultrafiltration or peritoneal calcification should be carefully managed as presumptive cases of SEP. Received: 25 February 1999 / Revised: 9 July 1999 / Accepted: 13 July 1999     

Relationship between serum 25-hydroxycholecalciferol deficiency and the risk of peritoneal dialysis associated peritonitis

Objective To investigate the relationship between serum 25-hydroxycholecalciferol[25(OH)D3] deficiency and the risk of peritoneal dialysis associated peritonitis. Methods Baseline clinical data (before the peritoneal dialysis catheter insertion) of peritoneal dialysis patients treated with CAPD in the First Affiliated Hospital of Guangxi Medical University from May 1, 2013 to February 1, 2016 were retrospective analyzed. All the patients were followed-up until July 31, 2016. According to the baseline serum 25(OH)D3 levels, patients were divided into deficiency group (25(OH)D3＜15 ng/ml) and non deficiency group (25(OH)D3 ≥15 ng/ml), the baseline clinical data of the two groups were also analyzed. Kaplan-Meier method was used to compare the time-to-peritonitis of two groups. Cox proportional hazard model was used to analyze the relationship between the 25(OH)D3 deficiency and the risk of peritonitis. ROC curve was used to analyze the predictive value of the baseline serum 25(OH)D3 for the risk of PDAP in peritoneal dialysis patients. Results Compared with the 25(OH)D3 non deficiency group, 25(OH)D3 deficiency group had a significant increase incidence of peritonitis, high diastolic blood pressure and mean arterial pressure, but serum albumin, total serum protein decreased significantly (P＜0.05). Kaplan-Meier survival analysis showed that, compared with 25(OH)D3 non deficiency group, the time-to-peritonitis episode of patients with 25(OH)D3 deficiency were shorter (P＜0.05). Cox proportional hazard model showed that after adjusting for age, sex, hemoglobin, serum albumin, C-reactive protein, total Kt/V, eGFR, diabetes or not, 25(OH)D3 deficiency is the independent risk factor of peritoneal dialysis associated peritonitis (HR 5.247, 95%CI 1.180-23.340, P＜0.05). ROC curve showed the area under the curve that baseline serum 25(OH)D3 deficiency predict the occurrence of PDAP was 0.714, and the best cut-off point of baseline serum 25(OH)D3 was 11.35 ng/ml (sensitivity 75%, specificity 63%). Conclusions Peritoneal dialysis associated peritonitis occurred earlier in peritoneal dialysis patients whose baseline serum 25(OH)D3 deficiency. Baseline serum 25(OH)D3 deficiency is the independent risk factor of peritoneal dialysis associated peritonitis, which may predict the incidence of peritoneal dialysis associated peritonitis.     

Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis

BackgroundPeritoneal dialysis has become commonly used for renal replacement therapy; however, some patients withdraw from peritoneal dialysis due to complications, including peritoneal dialysis-related peritonitis, resulting in the low number of patients on peritoneal dialysis. Risk factors for peritoneal dialysis withdrawal due to peritoneal dialysis-related peritonitis are less certain. This retrospective study aimed to investigate these risk factors.MethodsWe retrospectively analyzed clinical characteristics, laboratory data, and causative microorganisms of 204 episodes of peritoneal dialysis-related peritonitis between 2007 and 2018 at our institution.ResultsOf the 204 episodes, 38 resulted in withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis. The number of peritonitis episodes per patient-year and the incidence of cardiovascular disease were significantly higher in the withdrawal group. Similarly, this group had low levels of serum creatinine, urea nitrogen, serum albumin, alanine aminotransferase, cholinesterase and high C-reactive protein, and second dialysate cell counts after antibiotic administration. Multivariate logistic regression analysis revealed that serum albumin (odds ratio: 0.465; 95% confidence interval: 0.249–0.868; P = 0.016) and cardiovascular disease (odds ratio: 2.508; 95% confidence interval: 1.184–5.315; P = 0.016) exhibited significant differences.ConclusionsThe results of this study suggest that hypoalbuminemia and the presence of cardiovascular disease were independent risk factors for withdrawal from peritoneal dialysis due to peritoneal dialysis-related peritonitis.     

Non-tuberculous and tuberculous mycobacterial peritonitis in peritoneal dialysis patients

Introduction: Peritoneal dialysis (pd)-associated mycobacterium peritonitis is an important clinical entity in patients with end stage renal disease. They present a significant diagnostic and therapeutic challenge for clinicians because clinical findings and laboratory investigations can not be differentiated from symptoms caused by non-tuberculous mycobacterium (ntm), Mycobacterium tuberculosis (tb) or other bacteria. The aim of the present article is to know the differences between the clinical manifestations and laboratory investigations, the appropriate diagnosis, treatment strategies and prognosis for tb and ntm disease in patients with pd-associated mycobacterial infections. Methods: This was a retrospective observational study conducted over a period of 25 years. Out of 1737 patients, only 7 were diagnosed with mycobacterial peritonitis. Result: Evaluable data showed that there were three patients diagnosed with ntm peritonitis and four patients with tuberculous peritonitis. The mean age of the patients was 53.9?±?11.8 years. Although all patients developed abdominal pain and cloudy dialysate, only four patients (57.1%) had fever. Two patients (28.6%) suffered severe sepsis and septic shock. Therefore, the patient survival rates for ntm and tuberculous peritonitis were 100.0% and 75.0%, respectively. Two patients were shifted to long-term hemodialysis; therefore, the technical survival rates for ntm and tuberculous peritonitis were 66.7% and 50.0%, respectively. Notably, recurrence of mycobacterial infection was found in one patient with both pulmonary tuberculosis and tuberculous peritonitis. Conclusion: The diagnosis of mycobacterial peritonitis remains a challenge to medical staffs because of its insidious nature, the variability of its presentation and the limitations of available diagnostic test.     

Effects of seasonal changes on peritoneal dialysis associated peritonitis in peritoneal dialysis patients

Objectives To investigate the effects of seasonal changes on peritoneal dialysis associated peritonitis (PDAP) in patients on peritoneal dialysis (PD), and to provide evidence for clinical prevention and treatment of PDAP. Methods All episodes of PD-related peritonitis during clinic follow-up in maintenance PD patients from Jan 1st, 2007 to Dec 31st, 2015 in Peking University People's Hospital were reviewed. The incidence of peritonitis, laboratory indexes, pathogens and clinical outcomes in different seasons were recorded and analyzed. One-way ANOVA and chi square test were employed to compare the incidence of PDAP and related data in different seasons, and Pearson correlation was used to analyze correlations between PDAP rate and monthly mean temperature and mean humidity. Results During nine years, a total of 119 PD patients occurred 190 times of peritonitis during home PD. The PDAP rate in summer was the highest, 0.21 episodes/year, followed by spring (0.16 episodes/year) and autumn (0.16 episodes/risk year), but there was no significant difference among peritonitis rates in four seasons. There were significant positive correlation between monthly mean temperature, monthly mean humidity and the peritonitis rate (mean temperature: r=0.828, P＜0.01; mean humidity r=0.657, P＜0.05). (2) As for bacteria, in Summer the PDAP rate caused by Staphylococcus aureus and Coagulase negative staphylococcus (CoNS), and Gram-negative bacteria was higher than that in other seasons, but there was no statistical difference. There were significant positive correlation between monthly mean temperature, mean humidity and the rate of CoNS peritonitis (mean temperature: r=0.704, P＜0.05; mean humidity: r=0.607, P＜0.05). (3) There were no statistical difference among results of PD related peritonitis in different seasons about general situation, clinical manifestation, causes of peritonitis and laboratory index before peritonitis episodes. PD procedure-related problems were the main cause of peritonitis in summer and autumn. (4) The cure rate of all peritonitis was 90%. The highest cure rate was in autumn and winter, while the lowest cure rate was in summer, but no statistical difference. Among the peritonitis episodes with treatment failure, 52.6% occurred in summer. Conclusions There is some correlation between the rate of PDAP and seasons. Higher temperature and higher humidity were significantly correlated with higher peritonitis rate, especially the rate of CoNS peritonitis. The prognosis of PDAP in summer was relatively poor, with higher proportion of hospitalization and lower cure rate.