Study On The Relationship Between Intestinal Barrier Function And The Ratio Of Neutrophil To Lymphocyte In Peritoneal Dialysis Patients

Objective By analyzing the data of patients with continuous ambulatory peritoneal dialysis and patients with chronic kidney disease without dialysis in our hospital,the intestinal barrier function and gastrointestinal symptoms of patients were understood,and the correlation between the ratio of neutrophil to lymphocyte（NLR）and the intestinal barrier function of patients with peritoneal dialysis and patients without dialysis was explored.Methods From September 2016 to August 2020,peritoneal dialysis patients（PD group）and CKD stage 3 to 5 non-dialysis patients（CKD non-dialysis group）with regular followup at the second Affiliated Hospital of Anhui Medical University were selected.Intestinal barrier function was evaluated by quantitative detection of diamine oxidase（DAO）,Dlactic acid and bacterial endotoxin levels in human serum using DAO/D-lactic acid/bacterial endotoxin detection kit（enzymatic method）.Meanwhile,gastrointestinal symptom,such as abdominal distention,constipation,diarrhea,abdominal pain,nausea,vomiting and poor appetite symptoms,which occurred within 2 weeks before admission were obtained by consulting the patient’s medical records.The differences of NLR,age,sex,body mass index,primary disease composition,serum creatinine,hemoglobin,DAO,D-lactic acid,bacterial endotoxin and gastrointestinal symptoms were compared between the two groups,and the correlation between NLR and DAO,D-lactic acid and bacterial endotoxin levels was analyzed by multiple linear regression model.Results（1）A total of 121 cases in PD group and 69 cases in CKD group were included in this study.The median level of serum DAO in CKD group and PD group was [8.83（7.24,10.69）U/L] and [9.61（7.28,12.60）U/L],respectively,and the difference was not statistically significant（X~2=1.289,P=0.197）.The median d-lactic acid level in the non-dialysis group [17.42（14.54,19.21）mg/L] was lower than that in the PD group[18.79（14.37,31.62）mg/L],the difference was statistically significant（X~2=1.2.323,P=0.02）.The median bacterial endotoxin level in the non-dialysis group [10.25（9.09,12.32）U/L] was lower than that in the PD group [16.79（10.45,18.45）U/L],and the difference was statistically significant（X~2=5.519,P<0.001）.（2）73 patients（60.3%）on peritoneal dialysis had at least one gastrointestinal symptom and 37 patients（53.6%）on non-dialysis had at least one gastrointestinal symptom.The level of NLR in PD group was higher than that in CKD group,and the difference was statistically significant（Z=2.223,P=0.026）.（3）Multiple linear regression analysis showed that NLR in PD group was positively correlated with bacterial endotoxin（β=0.308,P=0.003）,DAO（β=-0.154,P=0.108）,D-lactic acid（β=0.173,P=0.068）and age（β=-0.177,P=0.068）.P=0.058)had no statistical correlation;NLR in the non-dialysis group was positively correlated with age（β=0.311,P=0.012）,but not with D-lactic acid（β=0.162,P=0.197）,bacterial endotoxin（β=0.234,P=0.072）,DAO（β=-0.160,P=0.224）.Conclusion In our hospital,60.3% of peritoneal dialysis patients had at least one gastrointestinal symptom.The level of d-lactic acid and bacterial endotoxin in peritoneal dialysis patients is higher than that in non-dialysis patients,and bacterial endotoxin in peritoneal dialysis patients is positively correlated with NLR,it is suggested that the intestinal barrier function may affect the inflammatory response in peritoneal dialysis patients.