| Objective:Chronic kidney disease(CKD)has become an important public health problem and affects human health seriously.Peritoneal dialysis is one of the most important renal replacement treatments for patients with end-stage renal disease.Currently,peritoneal dialysis related peritonitis is still one of the most common complications in patients with peritoneal dialysis.Accurate diagnosis and timely and effective treatment of peritonitis are particylarly important to improve the prognosis of patients,improve the quality of life of patients and reduce the economic burden of society and family.Serum amyloid A(SAA)is an acute phase response protein secreted by liver.Considering that SAA can be induced up to 1000 times in the process of infectious and inflammatory diseases,SAA has become an effective biomarker for clinical diagnosis of infection related diseases.Peritoneal dialysis related peritonitis is a special abdominal infection disease,but the diagnostic values and efficacy evaluation value of SAA on peritoneal dialysis related peritonitis are not clear.Therefore,this study aims to explore the clinical diagnostic values and efficacy evaluation value of SAA on peritoneal dialysis related peritonitis,providing a theoretical basis for clinical diagnosis and treatment.Meanwhile,as pathogenic bacteria and drug sensitivity are an important part of clinical research on peritonitis,the description of drug sensitivity of pathogenic bacteria in this study can better provide powerful guidance for the diagnosis and treatment of peritonitis in our regional peritoneal dialysis center.Methods:According to the inclusion and exclusion criteria,68 patients with peritoneal dialysis related peritonitis diagnosed in the 11 th Clinical College Affiliated to Qingdao University,Linyi Central Hospital and surrounding hospitals from January 2018 to December 2020 were included.In addition,68 patients with maintenance peritoneal dialysis without peritonitis(all patients with long-term follow-up and complete clinical data in our dialysis center)with the same age,gender,underlying diseases and time of peritoneal dialysis were selected as the control group.The history and clinical data of all the subjects were collected,including basic data(gender,age,BMI,age of dialysis [years],past history[such as hypertension and diabetes])and hemoglobin(Hb),white blood cell(WBC),neutrophils(NEUT),albumin(ALB),uric acid(UA),C-reactive protein(CRP)and serum ferritin.The treatment strategy was comprehensively determined according to the prevention and treatment guidelines of peritoneal dialysis related infection and the comprehensive evaluation of ascites culture and drug sensitivity test.After treatment,the efficacy(cure,persistent infection and treatment failure)was evaluated,and the serum SAA level was measured by ELISA method.Finally,the data were analyzed by SPSS20.0software for statistical analysis.Results:1.Compared with that of patients without peritoneal dialysis related peritonitis,the levels of serum ferritin,CRP and UA in peritoneal dialysis related peritonitis increased significantly(all P < 0.05).Meanwhile,the levels of hemoglobin and serum albumin decreased significantly(all P < 0.05).There was no significant difference in age,gender,BMI,the ratio of hypertension and diabetes,age of dialysis,WBC and NEUT between the two groups(all P > 0.05).2.Pathogens were cultured from ascites of 54 patients with peritoneal dialysis related peritonitis,of which 57.41% were Gram-positive bacteria,mainly Staphylococcus epidermidis,Staphylococcus aureus,coagulase negative Staphylococcus and Streptococcus;29.63% of the patients were Gram-negative bacteria,mainly Escherichia,Klebsiella,Enterobacter and Pseudomonas.In addition,9.26% of patients had mixed infection.3.The sensitivity of Gram-positive bacteria to vancomycin and linezolid was the highest,both of which were 100%;Followed by teicoplanin and rifampicin,the sensitivity rates were 94.29% and 91.18% respectively;The sensitivity rates to oxacillin,erythromycin and penicillin were 35.29%,27.78% and 19.44% respectively.4.Gram negative bacteria were most sensitive to carbapenems,and the sensitivity rates to imipenem and meropenem were 90.48% and 80.95% respectively,followed by cefoperazone/sulbactam,piperacillin//tazobactam,ceftazidime and amikacin,with the sensitivity rates of 76.19%,73.68%,70.0% and 61.90% respectively;The sensitivity rates to cefuroxime,piperacillin and ampicillin were only 42.86%,38.10% and 33.33%.5.Compared with that of patients without peritoneal dialysis related peritonitis,the SAA level in patients with peritoneal dialysis related peritonitis increased significantly(49.79± 22.47 vs 13.60±8.34 mg/L,P < 0.01).6.The Area under curve(AUC)for SAA in predicting peritoneal dialysis related peritonitis was 0.9389(95% CI:0.9014-0.9764).And the sensitivity and specificity of SAA in diagnosing peritoneal dialysis related peritonitis were 85.29% and 88.24%,respectively.7.In our study,12 patients with peritoneal dialysis related peritonitis manifested atypical clinical symptoms.Interestingly,the level of SAA in this group also increased significantly(44.17±15.04 vs 13.60±8.34 mg/L,P < 0.01).8.This study found that there was no significant difference in SAA level between peritoneal dialysis associated peritonitis caused by gram-positive and gram-negative bacteria(P > 0.05).9.Among the 68 patients with peritoneal dialysis related peritonitis in this study,54 cases were cured,8 cases were persistent infection and 6 cases were failed.The level of SAA in the cured group was significantly reduced,as was the SAA level in the persistent infection group,but it did not fall below normal,while the level of SAA in the treatment failure group continued to be high.The difference was statistically significant(all P <0.05).Conclusion:1.The level of SAA was significantly increased in patients with peritoneal dialysis associated peritonitis,and its sensitivity and specificity were high in predicting peritoneal dialysis associated peritonitis,which could be used as a potential biomarker for peritoneal dialysis patients to develop peritoneal dialysis associated peritonitis and provide an important theoretical basis for improving clinical diagnosis and treatment.The diagnostic value is also important for patients with atypical peritoneal dialysis-associated peritonitis.2.Peritoneal dialysis patients with hypoproteinemia,anemia are associated with peritoneal dialysis-related peritonitis,thus,attention should be paid to the management of related diseases in clinical diagnosis and treatment.3.The results of pathogenic microorganisms and drug sensitivity of peritonitis in peritoneal dialysis centers in this region are different from those in other peritoneal dialysis centers,so the empirical treatment strategy should be adjusted according to the characteristics of pathogenic bacteria and drug sensitivity in clinical treatment. |
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