新型炎症指标与腹膜透析相关性腹膜炎

Novel Inflammatory Markers and Peritoneal Dialysis-Associated Peritonitis

摘要: 腹膜透析相关性腹膜炎(PDAP)是终末期肾脏病患者接受腹膜透析治疗过程中的主要并发症，严重影响患者的治疗结局、技术存活率及生活质量。目前，PDAP的诊断主要依赖于临床表现以及传统的实验室指标，如腹透液有核细胞计数和血清C反应蛋白等，但这些指标在诊断的及时性、特异性及临床实用性方面存在局限。近年来，源自全血细胞计数的新型炎症标志物——中性粒细胞与淋巴细胞比率(NLR)、血小板与淋巴细胞比率(PLR)及单核细胞与淋巴细胞比率(MLR)，因其经济、便捷且能综合反映机体全身性炎症与免疫状态而备受关注。本文将从PDAP的流行病学特征等各方面介绍。阐述NLR、PLR和MLR的生物学基础，并系统梳理它们在慢性肾脏病、透析患者，特别是PDAP患者中的诊断价值、严重程度评估及预后预测相关的研究进展。以进一步验证其临床应用价值，并为实现PDAP的个体化精准防治提供新的策略。

Abstract: Peritoneal dialysis-associated peritonitis (PDAP) represents a primary complication for patients with end-stage kidney disease receiving peritoneal dialysis, profoundly affecting clinical outcomes, technique survival, and quality of life. The current diagnostic approach for PDAP depends on clinical manifestations and conventional laboratory markers, including peritoneal fluid nucleated cell count and serum C-reactive protein. However, these traditional indices are limited by their suboptimal timeliness, specificity, and practical clinical utility. Recently, novel inflammatory markers derived from the complete blood count—specifically, the neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), and monocyte-to-lymphocyte ratio (MLR)—have attracted considerable attention. These indices are cost-effective, readily available, and offer a comprehensive reflection of the body’s systemic inflammatory and immune status. This review will first outline the epidemiological features of PDAP, followed by an elaboration on the biological rationale of NLR, PLR, and MLR. We will then systematically synthesize the existing evidence on their diagnostic, severity assessment, and prognostic value in patients with chronic kidney disease, dialysis populations, and especially those with PDAP. This work aims to further validate the clinical utility of these markers and to inform new strategies for the personalized and precise prevention and treatment of PDAP.