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目的对2型糖尿病肾病血液透析患者感染病原菌分布进行分析,探讨感染对患者肾功能的影响,为临床相关治疗提供参考。方法对医院2008年5月-2014年11月诊治92例2型糖尿病肾病血液透析感染患者进行研究,设为感染组,采用BD公司的PHOENIXTM100全自动微生物鉴定系统对病原菌进行鉴定,酶联免疫吸附测定法检测患者感染后血清中肌酐、尿素氮、尿微量白蛋白及胱抑素(CysC)、脑钠肽前体(NT-proBNP)、C-反应蛋白(CRP)以及内皮素水平的变化;选取医院同期健康体检者110名为对照组,以未感染2型糖尿病肾病血液透析患者100例为未感染组。结果 92例感染患者共分离病原菌110株,其中革兰阳性菌59株,占53.6%,以表皮葡萄球菌16株,占14.5%,革兰阴性菌51株,占46.4%,以鲍氏不动杆菌13株,占11.8%;感染组患者血肌酐、尿素氮及微量尿蛋白水平明显高于同期健康体检者和未感染患者,差异有统计学意义(P<0.05);感染组患者胱抑素、脑钠肽前体、C-反应蛋白及内皮素水平明显升高,且与对照组和未感染组患者相比差异有统计学意义(P<0.01)。结论 2型糖尿病肾病血液透析患者容易受到病原菌感染,且能加剧肾损伤并增加血清中胱抑素、脑钠肽前体、C-反应蛋白及内皮素水平。
Objective To analyze the distribution of pathogenic bacteria in type 2 diabetic nephropathy patients with hemodialysis and explore the influence of infection on renal function in patients with type 2 diabetic nephropathy and provide reference for clinical treatment. Methods A total of 92 patients with type 2 diabetic nephropathy hemodialysis were diagnosed and treated in the hospital from May 2008 to November 2014. The patients were infected. The pathogenic bacteria were identified by BD PHOENIXTM100 automatic microbe identification system. Enzyme linked immunosorbent assay Serum creatinine, blood urea nitrogen, urine microalbumin, cystatin C, NT-proBNP, C-reactive protein (CRP) and endothelin levels in patients after infection were detected by the assay. One hundred and seventy healthy subjects in the same period of hospital were selected as the control group, and 100 patients without type 2 diabetic nephropathy hemodialysis were selected as uninfected group. Results A total of 110 pathogenic bacteria were isolated from 92 infected patients, of which 59 were Gram-positive bacteria, accounting for 53.6%, 16 strains were Staphylococcus epidermidis, accounting for 14.5% and 51 strains were Gram-negative bacteria, accounting for 46.4% 13 strains of bacteria accounted for 11.8%. Serum creatinine, urea nitrogen and microalbuminuria in patients with infection were significantly higher than those in healthy subjects and uninfected patients (P <0.05). Cystatin , Brain natriuretic peptide precursor, C-reactive protein and endothelin levels were significantly increased, and compared with the control group and non-infected patients, the difference was statistically significant (P <0.01). Conclusions Hemodialysis patients with type 2 diabetic nephropathy are susceptible to pathogen infection and may exacerbate renal damage and increase serum levels of cystatin, brain natriuretic peptide, C-reactive protein and endothelin.