中国血液净化

中国血液净化 ›› 2020, Vol. 19 ›› Issue (11): 734-737.doi: 10.3969/j.issn.1671-4091.2020.11.004

• 临床研究 • 上一篇    下一篇

24 例腹膜透析相关真菌性腹膜炎临床分析

倪军1,余瑾1,周柳沙1,童孟立1,陈洪宇1   

  1. 1浙江省杭州市中医院肾内科；浙江省肾脏病防治技术研究重点实验室
  • 收稿日期:2020-04-23 修回日期:2020-08-18 出版日期:2020-11-12 发布日期:2020-11-05
  • 通讯作者: 倪军 nijun40@sina.com E-mail:64857260@qq.com

Fungal peritonitis in peritoneal dialysis patients: retrospective analysis of 24 cases

  1.  1Department of Nephrology, Hangzhou Hospital of Traditional Chinese Medicine and 2Key Laboratory of Prevention and Treatment of Kidney Diseases in Zhejiang Province, Hangzhou 310007, China
  • Received:2020-04-23 Revised:2020-08-18 Online:2020-11-12 Published:2020-11-05

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摘要： 【摘要】目的探讨腹膜透析(peritoneal dialysis,PD)相关真菌性腹膜炎(fungal peritonitis，FP)的临床特点。方法回顾分析2010.1～2019.12 在杭州市中医院住院的PD 相关FP 患者，收集人口学资料及包括体温、心率、血压、血白细胞、血红蛋白、超敏C 反应蛋白、血白蛋白、血钾、透出液白细胞、腹透液培养等临床资料(FP 组)。并以同期住院的PD 相关细菌性腹膜炎(bacterial peritonitis, BP)患者按1:4 抽取作为对照组(BP 组)。结果FP 患者24 例，占同期住院治疗PD 相关腹膜炎4.43%(24/542)，其中男性8 例，女性16 例，平均年龄62.5(53.5,69.5)岁，平均透析龄65.50(27.75,96.25)月。10 例在起病前4 周曾使用抗生素，20 例既往有腹膜炎病史。24 例FP 共培养出25 株真菌，其中单一真菌感染19 例，混合感染5 例；混合感染中真菌合并细菌4 例，两株真菌混合感染1 例。25 株真菌中近平滑念珠菌9 株，白色念珠菌6 株，光滑假丝酵母4 株，非念珠菌3 株。与BP 组比较，FP 组性别存在差异，病程更长。22 例拔除腹透管，2 例拒绝拔管，其中12 例行外科探查术。6 例患者(25%)病情恶化自动出院死亡，1 例患者拔管后3 周重新置管行PD，其余均改行血液透析。结论FP 是PD 严重的并发症，临床容易出现低钾血症及低白蛋白血症，PD 退出率高，临床预后差，本院FP 病原学以近平滑念珠菌及白色念珠菌为主。

关键词: 腹膜透析, 腹膜炎, 真菌

Abstract: 【Abstract】Objective To explore the clinical characteristics of fungal peritonitis (FP) in peritoneal dialysis (PD) patients. Methods We retrospectively reviewed the FP episodes (FP group) diagnosed from January 2010 to December 2019 in Hangzhou Hospital of Traditional Chinese Medicine. Their demographic data and clinical information including temperature, heart rate, blood pressure, white blood cells, hemoglobin, hypersensitive C-reactive protein, serum albumin, serum potassium, white blood cell count in dialysis effluent fluid and culture results of peritoneal fluid were recruited. PD patients diagnosed with bacterial peritonitis (BP
group) and matched in a ratio of 1:4 were used as the controls. Results There were 24 FP episodes including 8 males and 16 females with an average age of 62.5 (53.5, 69.5) years and an average PD duration of 65.50 (27.75, 96.25) months, and accounting for 4.43% (24/542) of hospitalized PD-associated peritonitis in the same period. Ten patients were treated with antibiotics 4 weeks before the onset of FP, and 20 patients had a history of peritonitis. A total of 25 strains of fungi were isolated from the 24 FP patients, including C. parapsilosis 9 strains, C. albicans 6 strains, C. glabrata 4 strains, and non-candida species 3 strains. Single fungal infection was found in 19 FP patients and mixed infection was detected in 5 cases including 4 cases of mixed
fungal and bacterial infection and one case of mixed two fungal strains infection. Compared to BP group, FP group had a different gender ratio and a longer disease course. Peritoneal catheters were removed in 22 cases, and removal of the peritoneal catheters was refused by the patients in 2 cases. Surgical exploration was performed in 12 cases. Six patients (25%) discharged from the hospital due to exacerbation, one case was re-catheterized for PD after extubation for 3 weeks, and the rest of the patients were changed to hemodialysis. Conclusions FP is a severe complication of PD. FP is frequently complicated with hypokalemia and hypoalbuminemia, a higher withdrawal rate and an unfavorable outcome. C. parapsilosis and C. albicans were the main pathogens in this series of FP patients.

Key words: Peritoneal dialysis, Peritonitis, Fungus

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