血小板/淋巴细胞比值对频发性腹膜透析相关性腹膜炎的预测价值

doi:10.3969/j.issn.1004-583X.2026.06.007

摘要/Abstract

摘要：

目的探讨血小板/淋巴细胞比值(platelet-to-lymphocyte ratio,PLR)对频发性腹膜透析相关性腹膜炎(recurrent peritoneal dialysis-associated peritonitis,RPDAP,1年内发生2次及以上PDAP)的预测价值。方法本研究为单中心横断面回顾性研究,选取2017年1月-2022年12月于河北医科大学第一医院诊断为腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)的患者资料,根据随访过程中PDAP发生频率分为偶发性腹膜炎(idiopathic peritoneal dialysis-associated peritonitis,IPDAP,1年内仅发生1次PDAP)组和RPDAP组。收集患者的一般资料、实验室检查资料,应用logistic回归法分析PLR与RPDAP的关系,采用受试者工作特征曲线(receiver operating characteristic curve,ROC)分析PLR对RPDAP的预测价值。结果共纳入PDAP患者83例,其中IPDAP组56例,RPDAP组27例。与IPDAP组相比,RPDAP组体重指数(BMI)偏低、透析龄更长(均P<0.05),引起PDAP的主要原因是操作不当、肠道感染;RPDAP组耐药菌占比更高(P<0.05),治疗有效率(40.71%)明显低于IPDAP组(82.14%),治疗无效需要移除导管(44.44%)明显高于IPDAP(14.28%),差异有统计学意义(均P<0.05),2组死亡率差异无统计学意义(P>0.05)。与IPDAP组相比,RPDAP组PLR水平更高,血红蛋白及白蛋白水平更低(均P<0.05);单因素logistic回归模型显示,PD患者BMI下降、透析龄较长、PLR升高、血红蛋白及白蛋白水平较低是RPDAP发生的影响因素(均P<0.05);基线PLR预测RPDAP的ROC曲线下面积为0.611(95%CI:0.560~0.662,P<0.05),PLR的截断值为165.1,特异度为79.8%,敏感度为68.2%。结论 PLR水平对RPDAP有一定的预测价值,可作为PD患者发生RPDAP的潜在预测标志物。

Abstract:

Objective Platelet-to-lymphocyte ratio (PLR) is a biomarker for the prognosis of many diseases. Currently, there are no studies on patients with recurrent peritoneal dialysis-associated peritonitis (RPDAP, definedas ≥2 peritoneal dialysis-associated peritonitis [PDAP] episodes within 1 year). This study aims to explore the predictive value of the PLR for RPDAP. Methods This single-center, retrospective cross-sectional study reviewed patients diagnosed with PDAP at the First Hospital of Hebei Medical University from January 2017 to December 2022. Patients were categorized by PDAP frequency during follow-up into the idiopathic peritoneal dialysis-associated peritonitis group (IPDAP group; one PDAP episode within 1 year) and RPDAP group. Demographic and laboratory data were collected. Associations between PLR and RPDAP were assessed by univariate logistic regression, and the predictive performance of baseline PLR for RPDAP was evaluated using receiver operating characteristic (ROC) curve analysis. Results A total of 83 PDAP patients were included: 56 in the IPDAP group and 27 in the RPDAP group. Compared with the IPDAP group, the RPDAP group had lower body mass index (BMI) and longer dialysis vintage (both P<0.05). The main causes of PDAP were improper technique and enteric infections. The proportion of drug-resistant organisms was higher in the RPDAP group (P<0.05). Treatment effective rate in the RPDAP group was 40.71%, significantly lower than 82.14% in the IPDAP group (P<0.05). Treatment failure requiring catheter removal occurred in 44.44% of RPDAP patients, significantly higher than 14.28% in the IPDAP group (P<0.05). There was no significant difference in mortality between the two groups (P>0.05). Compared with the IPDAP group, the RPDAP group had higher PLR and lower hemoglobin and albumin levels (all P<0.05). Univariate logistic regression identified lower BMI, longer dialysis vintage, higher PLR, and lower hemoglobin and albumin as factors associated with RPDAP (all P<0.05). The ROC curve for baseline PLR predicting RPDAP yielded an area under the curve (AUC) of 0.611 (95%CI: 0.560-0.662, P<0.05). The optimal PLR cutoff was 165.1, with specificity 79.8% and sensitivity 68.2%. Conclusion PLR has modest predictive value for RPDAP and may serve as a potential predictive biomarker for RPDAP in peritoneal dialysis patients.

Key words: peritoneal dialysis, peritoneal dialysis-associated peritonitis, frequent, platelet-to-lymphocyte ratio

中图分类号:

R459.5

王涛, 高玉伟, 王兴华, 胡秀红, 崔红蕊, 徐保振, 杨洪娟. 血小板/淋巴细胞比值对频发性腹膜透析相关性腹膜炎的预测价值[J]. 临床荟萃, 2026, 41(6): 522-528.

Wang Tao, Gao Yuwei, Wang Xinghua, Hu Xiuhong, Cui Hongrui, Xu Baozhen, Yang Hongjuan. Predictive value of the platelet-to-lymphocyte ratio for recurrent peritoneal dialysis-associated peritonitis[J]. Clinical Focus, 2026, 41(6): 522-528.

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链接本文: https://www.lchc.cn/CN/10.3969/j.issn.1004-583X.2026.06.007

https://www.lchc.cn/CN/Y2026/V41/I6/522

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参考文献 32

[1]	Szeto CC, Li PK. Peritoneal dialysis-associated peritonitis[J]. Clin J Am Soc Nephrol, 2019, 14(7):1100-1105. doi: 10.2215/CJN.14631218.
[2]	Mehrotra R, Devuyst O, Davies SJ, et al. The current state of peritoneal dialysis[J]. J Am Soc Nephrol, 2016, 27(11):3238-3252.doi: 10.1681/ASN.2016010112. pmid: 27339663
[3]	Li PK, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations:2022 Update on prevention and treatment[J]. Perit Dial Int, 2022, 42(2):110-153.doi: 10.1177/08968608221080586.
[4]	田娜, 周启明, 余学清, 等. 2022版国际腹膜透析协会腹膜透析相关性腹膜炎防治指南更新重点内容[J]. 中华肾脏病杂志, 2022, 38(10):938-944.doi:10.3760/cma.j.cn441217-20220418-00135.
[5]	See EJ, Johnson DW, Hawley CM, et al. Risk predictors and causes of technique failure within the first year of peritoneal dialysis:an australia and new zealand dialysis and transplant registry(ANZDATA)study[J]. Am J Kidney Dis, 2018, 72(2):188-197.doi: 10.1053/j.ajkd.2017.10.019.
[6]	Li P, Xia C, Liu P, et al. Neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio in evaluation of inflammation in non-dialysis patients with end-stage renal disease(ESRD)[J]. BMC Nephrol, 2020, 21(1):511.doi: 10.1186/s12882-020-02174-0.
[7]	袁静, 杨宇齐, 刘璐, 等. 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[J]. 中华肾脏病杂志, 2021, 37(4):327-332.doi:10.3760/cma.j.cn441217-20200923-00045.
[8]	Burke M, Hawley CM, Badve SV, et al. Relapsing and recurrent peritoneal dialysis-associated peritonitis:A multicenter registry study[J]. Am J Kidney Dis, 2011, 58(3):429-436.doi: 10.1053/j.ajkd.2011.03.022.
[9]	吴爱华, 沐晓蝶, 巢文英, 等. CONUT评分和透析龄对腹膜透析相关性腹膜炎的预测价值[J]. 中华医学杂志, 2023, 103(10):720-726.doi:10.3760/cma.j.cn112137-20221017-02163.
[10]	Shi Y, Cai J, Shi C, et al. Low serum albumin is associated with poor prognosis in patients receiving peritoneal dialysis treatment[J]. J Healthc Eng, 2022, 2022:7660806.doi:10.1155/2022/7660806.
[11]	Grzegorzewskav AE. The role of nutritional status in the outcome of peritoneal dialysis patients[J]. Panminerva Med, 2009, 51(3):163-173. pmid: 19859051
[12]	Parikova A, Hruba P, Krediet RT, et al. Long-term peritoneal dialysis treatment provokes activation of genes related to adaptive immunity[J]. Physiol Res, 2019, 68(5):775-783.doi: 10.33549/physiolres.934158. pmid: 31424258
[13]	Liu X, Qin A, Zhou H, et al. Novel predictors and risk score of treatment failure in peritoneal dialysis-related peritonitis[J]. Front Med(Lausanne), 2021, 8:639744.doi: 10.3389/fmed.2021.639744.eCollection2021.
[14]	赵文曼, 李丹丹, 丛静静, 等. 频发性腹膜透析相关性腹膜炎的临床特征及危险因素分析[J]. 大连医科大学学报, 2021, 43(1):25-28+74.doi:10.11724/jdmu.2021.01.05.
[15]	van der Meijden PEJ, Heemskerk JWM. Platelet biology and functions:New concepts and clinical perspectives[J]. Nat Rev Cardiol, 2019, 16(3):166-179.doi: 10.1038/s41569-018-0110-0. pmid: 30429532
[16]	Feng J, Jang G, Esteva E, et al. Clonal barcoding of endogenous adult hematopoietic stem cells reveals a spectrum of lineage contributions[J]. Proc Natl Acad Sci U S A, 2024, 121(4):e2317929121.doi: 10.1073/pnas.2317929121.
[17]	Fang T, Wang Y, Yin X, et al. Diagnostic sensitivity of NLR and PLR in early diagnosis of gastric cancer[J]. J Immunol Res, 2020, 2020:9146042.doi: 10.1155/2020/9146042.
[18]	Koupenova M, Clancy L, Corkrey HA, et al. Circulating platelets as mediators of immunity, inflammation, and thrombosis[J]. Circ Res, 2018, 122(2):337-351.doi: 10.1161/CIRCRESAHA.117.310795. pmid: 29348254
[19]	Rossaint J, Margraf A, Zarbock A. Role of platelets in leukocyte recruitment and resolution of inflammation[J]. Front Immunol, 2018, 9:2712.doi: 10.3389/fimmu.2018.02712. pmid: 30515177
[20]	Wang DS, Luo HY, Qiu MZ, et al. Comparison of the prognostic values of various inflammation based factors in patients with pancreatic cancer[J]. Med Oncol, 2012, 29(5):3092-3100.doi: 10.1007/s12032-012-0226-8.
[21]	Hung SC, Lai YS, Kuo KL, et al. Volume overload and adverse outcomes in chronic kidney disease: Clinical observational and animal studies[J]. J Am Heart Assoc, 2015, 4(5):e001918.doi: 10.1161/JAHA.115.001918.
[22]	Obi Y, Qader H, Kovesdy CP, et al. Latest consensus and update on protein-energy wasting in chronic kidney disease[J]. Curr Opin Clin Nutr Metab Care, 2015, 18(3):254-262.doi: 10.1097/MCO.0000000000000171.
[23]	Yuan Q, Wang J, Peng Z, et al. Neutrophil-to-lymphocyte ratio and incident end-stage renal disease in Chinese patients with chronic kidney disease:Results from the Chinese Cohort Study of Chronic Kidney Disease(C-STRIDE)[J]. J Transl Med, 2019, 17(1):86. doi: 10.1186/s12967-019-1808-4.
[24]	Liu S, Yang M, Zhao Q, et al. Platelet-to-lymphocyte ratio is associated with the mortality in peritoneal dialysis patients[J]. Iran J Kidney Dis, 2021, 15(3):206-212. doi: 10.1212/12121 pmid: 33994380
[25]	Xu LC, Zhou FF, Li M, et al. Predictive value of peripheral blood neutrophil-to-lymphocyte ratio and platelet-to-lymphocyte ratio on patient survival with peritoneal dialysis[J]. Clin Lab, 2021, 67(9):e210124.doi: 10.7754/Clin.Lab.2021.210124.
[26]	Yan H, Ma D, Yang S, et al. Effluent lipopolysaccharide is a prompt marker of peritoneal dialysis-related gram-negative peritonitis[J]. Perit Dial Int, 2020, 40(5):455-461.doi: 10.1177/0896860819896134.
[27]	Liu G, Li X, Zhao W, et al. Development and validation of a nomogram for predicting gram-negative bacterial infections in patients with peritoneal dialysis-associated peritonitis[J]. Heliyon, 2023, 9(8):e18551.doi: 10.1016/j.heliyon.2023.e18551.
[28]	Mao Y, Xiao D, Deng S, et al. Development of a clinical risk score system for peritoneal dialysis-associated peritonitis treatment failure[J]. BMC Nephrol, 2023, 24(1):229.doi: 10.1186/s12882-023-03284-1. pmid: 37550622
[29]	Kantarcioglu B, Darki A, Siddiqui F, et al. Predictive role of blood cellular indices and their relationship with endogenous glycosaminoglycans as determinants of inflammatory biomarkers in pulmonary embolism[J]. Clin Appl Thromb Hemost, 2022, 28:10760296221104801.doi: 10.1177/10760296221104801.
[30]	Su N, Zheng Y, Zhang X, et al. Platelet-to-lymphocyte ratio and the first occurrence of peritonitis in peritoneal dialysis patients[J]. BMC Nephrol, 2022, 23(1):415.doi: 10.1186/s12882-022-03038-5. pmid: 36585653
[31]	Zhou D, Yang H, Zeng L, et al. Calculated inflammatory markers derived from complete blood count results, along with routine laboratory and clinical data, predict treatment failure of acute peritonitis in chronic peritoneal dialysis patients[J]. Ren Fail, 2023, 45(1):2179856.doi: 10.1080/0886022X.2023.2179856.
[32]	Ding Y, Tian H, Luo Q, et al. Analysis of risk factor for peritonitis in peritoneal dialysis patients[J]. Am J Transl Res, 2024, 16(11):6964-6971.doi: 10.62347/EDBZ3412. pmid: 39678542

组别	例数		男性 [例(%)]	年龄 (岁)		BMI (kg/m²)		透析龄 (月)	吸烟 [例(%)]		收缩压 (mmHg)	舒张压 (mmHg)		残余尿量 (ml)		原发病[例(%)]
组别	例数		男性 [例(%)]	年龄 (岁)		BMI (kg/m²)		透析龄 (月)	吸烟 [例(%)]		收缩压 (mmHg)	舒张压 (mmHg)		残余尿量 (ml)		慢性肾小球肾炎	糖尿病肾病	高血压肾病	狼疮性肾炎	其他
总体	83		56(67.47)	46.06±16.85		21.50±3.60		15.50±7.40	7(8.43)		143.30±24.70	89.30±13.50		385.00±158.00		44(53.01)	10(12.05)	3(3.61)	2(2.41)	24(28.92)
IPDAP组	56		37(66.07)	46.28±15.55		22.80±3.70		10.60±5.50	5(8.93)		136.70±27.30	87.70±15.40		360.00±156.00		29(51.78)	4(7.14)	2(3.57)	1(1.78)	20(35.71)
RPDAP组	27		19(70.37)	45.84±18.49		20.10±3.10		17.80±8.10	2(7.41)		149.50±21.20	90.70±10.80		413.00±181.00		15(55.55)	6(22.22)	1(3.71)	1(3.71)	4(14.81)
t/χ²/Z值			0.153	0.086		2.48		3.341	0.232		1.208	0.514		0.486		0.104	1.965	0.031	0.531	0.504
P值			0.695	0.936		0.016		0.003	0.816		0.242	0.613		0.639		0.747	0.045	0.967	0.595	0.547
组别		并发症[例(%)]											诱因[例(%)]
组别		高血压			糖尿病		高脂血症病史			心血管病史			操作不当		环境不达标		肠道感染		出口隧道感染
总体		62(74.69)			19(22.89)		5(6.02)			7(8.43)			37(44.58)		9(10.84)		34(40.96)		3(3.61)
IPDAP组		41(73.21)			12(21.43)		3(5.36)			4(7.14)			27(48.21)		4(7.14)		23(41.07)		2(3.57)
RPDAP组		21(77.78)			7(25.93)		2(7.41)			3(11.11)			10(37.04)		5(18.52)		11(40.74)		1(3.71)
t/χ²/Z值		0.173											0.279
P值		0.679											0.597

组别	例数		男性 [例(%)]	年龄 (岁)		BMI (kg/m²)		透析龄 (月)	吸烟 [例(%)]		收缩压 (mmHg)	舒张压 (mmHg)		残余尿量 (ml)		原发病[例(%)]
组别	例数		男性 [例(%)]	年龄 (岁)		BMI (kg/m²)		透析龄 (月)	吸烟 [例(%)]		收缩压 (mmHg)	舒张压 (mmHg)		残余尿量 (ml)		慢性肾小球肾炎	糖尿病肾病	高血压肾病	狼疮性肾炎	其他
总体	83		56(67.47)	46.06±16.85		21.50±3.60		15.50±7.40	7(8.43)		143.30±24.70	89.30±13.50		385.00±158.00		44(53.01)	10(12.05)	3(3.61)	2(2.41)	24(28.92)
IPDAP组	56		37(66.07)	46.28±15.55		22.80±3.70		10.60±5.50	5(8.93)		136.70±27.30	87.70±15.40		360.00±156.00		29(51.78)	4(7.14)	2(3.57)	1(1.78)	20(35.71)
RPDAP组	27		19(70.37)	45.84±18.49		20.10±3.10		17.80±8.10	2(7.41)		149.50±21.20	90.70±10.80		413.00±181.00		15(55.55)	6(22.22)	1(3.71)	1(3.71)	4(14.81)
t/χ²/Z值			0.153	0.086		2.48		3.341	0.232		1.208	0.514		0.486		0.104	1.965	0.031	0.531	0.504
P值			0.695	0.936		0.016		0.003	0.816		0.242	0.613		0.639		0.747	0.045	0.967	0.595	0.547
组别		并发症[例(%)]											诱因[例(%)]
组别		高血压			糖尿病		高脂血症病史			心血管病史			操作不当		环境不达标		肠道感染		出口隧道感染
总体		62(74.69)			19(22.89)		5(6.02)			7(8.43)			37(44.58)		9(10.84)		34(40.96)		3(3.61)
IPDAP组		41(73.21)			12(21.43)		3(5.36)			4(7.14)			27(48.21)		4(7.14)		23(41.07)		2(3.57)
RPDAP组		21(77.78)			7(25.93)		2(7.41)			3(11.11)			10(37.04)		5(18.52)		11(40.74)		1(3.71)
t/χ²/Z值		0.173											0.279
P值		0.679											0.597

组别	例数	白细胞计数 (×10⁹/L)		中性粒细胞 (×10⁹/L)	淋巴细胞 (×10⁹/L)	红细胞计数 (×10¹²/L)		血红蛋白 (g/L)		血小板计数 (×10⁹/L)		PLR		血尿素氮 (mmol/L)	血肌酐 (μmol/L)			血尿酸 (μmol/L)		血钙 (mmol/L)
总体	83	7.07±3.41		5.85±3.06	1.08±0.57	3.35±0.95		92.52±18.17		204.90±74.50		145.6(104.8,210.6)		14.47±7.21	838.70±310.80			344.30±87.90		1.96±0.34
IPDAP组	56	7.37±3.25		6.25±3.55	1.13±0.54	3.35±1.14		98.15±17.73		213.60±74.70		110.9(90.5,136.5)		14.59±8.06	898.60±334.40			373.60±101.20		1.87±0.38
RPDAP组	27	6.67±3.58		5.45±2.51	1.05±0.63	3.34±0.85		86.89±17.73		190.40±60.50		228.5(181.2,286.3)		14.34±6.45	778.90±290.40			313.80±64.50		2.05±0.29
t/Z值		0.661		0.824	0.407	0.007		2.306		1.079		4.012		0.108	0.855			1.574		1.676
P值		0.513		0.415	0.686	0.939		0.047		0.287		<0.01		0.914	0.403			0.132		0.102
实验室指标	血磷 (mmol/L)		血钾 (mmol/L)		血清总蛋白 (g/L)		血清白蛋白 (g/L)		iPTH (pg/ml)		CRP (mg/L)		总Kt/V			血糖 (mmol/L)	总胆固醇 (mmol/L)		甘油三脂 (mmol/L)
总体	1.49±0.56		4.16±0.65		55.67±9.06		23.34±5.49		178.8(84.5,290.6)		51.5(13.5,145.0)		1.73±0.41			4.77±0.63	4.25±0.74		1.31±0.48
IPDAP组	1.43±0.65		4.13±0.71		56.41±9.57		25.15±6.67		190.6(98.3,310.5)		46.1(11.5,133.5)		1.78±0.43			4.73±0.64	4.17±0.72		1.27±0.38
RPDAP组	1.55±0.45		4.19±0.62		54.75±9.97		21.54±3.23		158.2(03.5,265.5)		69.5(16.5,156.5)		1.69±0.37			4.82±0.62	4.31±0.76		1.34±0.57
t/Z值	0.656		0.285		0.535		2.179		0.579		0.565		0.779			0.395	0.594		0.482
P值	0.516		0.773		0.596		0.035		0.515		0.458		0.441			0.695	0.556		0.632

组别	例数	白细胞计数 (×10⁹/L)		中性粒细胞 (×10⁹/L)	淋巴细胞 (×10⁹/L)	红细胞计数 (×10¹²/L)		血红蛋白 (g/L)		血小板计数 (×10⁹/L)		PLR		血尿素氮 (mmol/L)	血肌酐 (μmol/L)			血尿酸 (μmol/L)		血钙 (mmol/L)
总体	83	7.07±3.41		5.85±3.06	1.08±0.57	3.35±0.95		92.52±18.17		204.90±74.50		145.6(104.8,210.6)		14.47±7.21	838.70±310.80			344.30±87.90		1.96±0.34
IPDAP组	56	7.37±3.25		6.25±3.55	1.13±0.54	3.35±1.14		98.15±17.73		213.60±74.70		110.9(90.5,136.5)		14.59±8.06	898.60±334.40			373.60±101.20		1.87±0.38
RPDAP组	27	6.67±3.58		5.45±2.51	1.05±0.63	3.34±0.85		86.89±17.73		190.40±60.50		228.5(181.2,286.3)		14.34±6.45	778.90±290.40			313.80±64.50		2.05±0.29
t/Z值		0.661		0.824	0.407	0.007		2.306		1.079		4.012		0.108	0.855			1.574		1.676
P值		0.513		0.415	0.686	0.939		0.047		0.287		<0.01		0.914	0.403			0.132		0.102
实验室指标	血磷 (mmol/L)		血钾 (mmol/L)		血清总蛋白 (g/L)		血清白蛋白 (g/L)		iPTH (pg/ml)		CRP (mg/L)		总Kt/V			血糖 (mmol/L)	总胆固醇 (mmol/L)		甘油三脂 (mmol/L)
总体	1.49±0.56		4.16±0.65		55.67±9.06		23.34±5.49		178.8(84.5,290.6)		51.5(13.5,145.0)		1.73±0.41			4.77±0.63	4.25±0.74		1.31±0.48
IPDAP组	1.43±0.65		4.13±0.71		56.41±9.57		25.15±6.67		190.6(98.3,310.5)		46.1(11.5,133.5)		1.78±0.43			4.73±0.64	4.17±0.72		1.27±0.38
RPDAP组	1.55±0.45		4.19±0.62		54.75±9.97		21.54±3.23		158.2(03.5,265.5)		69.5(16.5,156.5)		1.69±0.37			4.82±0.62	4.31±0.76		1.34±0.57
t/Z值	0.656		0.285		0.535		2.179		0.579		0.565		0.779			0.395	0.594		0.482
P值	0.516		0.773		0.596		0.035		0.515		0.458		0.441			0.695	0.556		0.632

组别	例数	革兰阳性菌	革兰阴性菌	真菌	培养阴性	耐药菌
总体	83	32(38.55)	17(20.48)	2(2.41)	32(38.55)	21(25.31)
IPDAP组	56	20(35.71)	10(17.86)	1(1.79)	25(44.64)	8(14.29)
RPDAP组	27	12(44.44)	7(25.93)	1(3.71)	7(25.93)	13(48.15)
χ²值		0.586	0.728	0.237	2.694	11.052
P值		0.444	0.394	0.428	0.107	0.009