免疫法粪便隐血试验预测慢性肾脏病患者预后的意义

目的 探讨免疫法粪便隐血试验(IFOBT)在慢性肾脏病患者发生结直肠病变的预测意义及作为慢性肾脏病患者预后指标的临床价值.方法 前瞻性纳入176例慢性肾脏病(CKD)患者和180例健康人作为对照.使用免疫法粪便隐血试验进行检测,比较两组粪便隐血阳性发生率.同时对CKD患者随访4.5年,分析各项临床、生化指标,并以患者接受肾脏替代治疗或死亡为终点事件.采用Logistic回归进行危险因素分析,采用Kaplan-Meier分析和COX回归模型进行生存分析.结果 176例CKD患者IFOBT阳性率17％,高于健康对照组5.3％(x2=13.236,P＜ 0.01).与IFOBT阴性的CKD患者相比,IFOBT阳性的CKD患者年龄较大(62.030±15.544)岁比(48.660±19.018)岁,P＜0.01]、红细胞沉降率明显升高(71.800±31.657) mm/h比(57.210±32.712) mm/h,P＜0.05]、C反应蛋白明显升高6.230 (3.000～14.148) mg/L比3.000(3.000 ～6.833)mg/L,P＜0.05]、Scr明显升高419.100(103.200～546.625) μmol/L比175.100 (68.150～462.950) μmol/L,P＜0.05],而血红蛋白(97.970±20.590 )g/L比(107.170±27.988)g/L,P＜0.05]及肾小球滤过率(eGFR)11.400 (8.671～53.544) ml· min-1· (1.73 m2)-1比35.274(10.961～82.145)ml·min-1.(1.73 m2)-1,P＜0.01]显著降低.相关法分析显示CKD患者IFOBT检测值与eGFR(r=-0.20,P＜0.01)呈负相关;与Scr呈正相关(r=0.171,P＜0.05);与年龄呈正相关(r=0.175,P＜0.05).Logistic回归和COX回归分析结果显示IFOBT检测值、eGFR和红细胞沉降率是CKD患者预后的重要影响因素.Kaplan-Meier分析显示IFOBT检测值＞100 μg/L是影响CKD患者生存率的重要因素.结论 慢性肾脏病患者易发生结直肠出血性疾病,粪便隐血阳性是影响CKD患者预后的重要危险因素,而免疫法粪便隐血试验是可行有效的检测方法,对于CKD患者结直肠病变的预测具有重要的临床意义.

Immunofecal occult blood test predicts the prognosis of patients with chronic kidney disease

Objective To evaluate the value of immunofecal occult blood test(IFOBT) as a prognostic indicator in CKD patients with colorectal impairment. Methods A total of 176 CKD patients and 180 healthy adults as control were enrolled. Serum biochemistry was measured at baseline and gastrointestinal bleeding was determined by IFOBT. All the CKD patients were followed up for 4.5 years. Renal replacement therapy or death was defined as end-point event. The Logistic regression analysis was used for risk factors. Kaplan-Meier analysis and COX regression model were used for survival analysis. Results The positive rate of IFOBT in CKD patients was significantly higher than healthy control (17% vs 5.3%, χ2=13.236, P<0.01). When comparing with IFOBT negitive patients, IFOBT positive patients were older(62.030±15.544) years old vs (48.660±19.018)years old, P<0.01], had higher ESR (71.800±31.657) mm/h vs ( 57.210±32.712) mm/h, P<0.05], C-reactive protein6.230(3.000～14.148) mg/L vs 3.000(3.000～6.833) mg/L, P<0.05], serum creatinine 419.100(103.200～546.625) μmol/L vs 175.100（68.150～462.950） μmol/L, P<0.05], and had lower hemoglobin level(97.970±20.590) g/L vs (107.170±27.988) g/L, P<0.05] and eGFR 11.400 (8.671～53.544) ml?min-1?(1.73 m2)-1 vs 35.274 (10.961～82.145) ml?min-1?(1.73 m2)-1, P<0.01]. There was a negative correlation between IFOBT value and eGFR in CKD patients (r=-0.20, P<0.01). Positive correlations of IFOBT value with age (r=0.175, P<0.05) and serum creatinine (r=0.171, P<0.05) were found. Logistic regression and COX regression analysis showed that IFOBT value, eGFR and ESR were important factors that influenced the prognosis of CKD patients. Kaplan-Meier analysis revealed that IFOBT value >100 μg/L predicted progression of renal function. Conclusions The prevalence of gastrointestinal bleeding disorder is high in patients with CKD. Value of IFOBT independently predicts decline in renal function of CKD patients.