中国血液净化

中国血液净化 ›› 2019, Vol. 18 ›› Issue (04): 226-229.doi: 10.3969/j.issn.1671-4091.2019.04.004

• 临床研究 • 上一篇    下一篇

腹膜透析患者难治性腹膜炎的危险因素分析

刘聪慧1,周晶晶1,史亚男1,蔡佳杰1,李忠心1   

  1. 1. 首都医科大学附属北京潞河医院肾病中心
  • 收稿日期:2018-09-13 修回日期:2019-01-15 出版日期:2019-04-12 发布日期:2019-04-12
  • 通讯作者: 李忠心 13621211613@139.com E-mail:13621211613@139.com
  • 基金资助:

    通州区科技计划项目(KJ2018CX009-57)

Risk factors for refractory peritonitis in peritoneal dialysis patients

  • Received:2018-09-13 Revised:2019-01-15 Online:2019-04-12 Published:2019-04-12

PDF

1108

摘要： 【摘要】目的探讨难治性腹膜炎的发病情况、临床特点及危险因素。方法回顾性分析首都医科大学附属北京潞河医院2013.1.1～2017.12.31 期间发生腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis，PDAP)患者的临床资料。根据ISPD 指南中PDAP 的定义，分为难治性腹膜炎(refractory peritonitis，RP)组及非难治性腹膜炎(non-refractory peritonitis，NRP)组，对比2 组患者PDAP 时发病特点及临床资料，应用Logistic 回归法分析难治性腹膜炎的危险因素。结果101 名患者纳入本研究，发生了178 例次PDAP。其中RP 组患者40 名，发生42 例次难治性腹膜炎。①RP 组患者从症状出现至就诊时间≥1 天的比例、肠梗阻发生率、透出液白细胞计数及血清C 反应蛋白水平均较NRP组显著升高(χ2/Z 值分别为4.722,25.591,-2.270，-2.322；P 值分别为0.030，＜0.001，0.023，0.020)，而血清白蛋白水平较NRP 组显著降低(t=2.507,P=0.015)。②致病菌方面，与NRP 组相比，RP 组患者革兰阳性球菌感染比例较低(χ2=7.370，P=0.007)，但金黄色葡萄球菌感染率较高(χ2=4.156，P=0.041)、凝固酶阴性葡萄球菌感染率低(χ2=10.233，P=0.001)。③多因素Logistic 回归分析提示，C 反应蛋白及肠梗阻是难治性腹膜炎的独立危险因素(OR 值分别为1.012，14.532；P 值分别为0.004，0.002)，白蛋白(OR =0.848，P=0.035)是保护性因素。结论PDAP 发生时高C 反应蛋白水平、合并肠梗阻是难治性腹膜炎的危险因素，而高白蛋白水平则为其独立保护因素。

关键词: 腹膜透析, 难治性腹膜炎, 危险因素

Abstract: 【Abstract】Objective To analyze the prevalence, clinical characteristics and risk factors of refractory peritoneal dialysis associated peritonitis in patients undergoing peritoneal dialysis (PD). Methods We recruited patients with peritoneal dialysis associated peritonitis (PDAP) treated in Beijing Luhe Hospital from January 2013 to December 2017. According to the definition of PDAP in the ISPD recommendations, the patients were divided into refractory peritonitis (RP) group and non-refractory peritonitis (NRP) group. Their morbidity characteristics and clinical data were retrospectively analyzed. Logistic regression was used to analyze the risk factors for refractory PDAP. Results A total of 101 PDAP patients were recruited in this study, and 178 episodes of PDAP happened in these PDAP patients. Forty patients presenting 42 episodes of refractory PDAP were divided into RP group. ①In RP group, patients had higher proportion of longer interval (＞one day) between the presence of symptoms and treatment (χ2=4.722, P=0.030), higher prevalence of intestinal obstruction (χ2=25.591, P＜0.001), more white blood cell count in fluid (Z=-2.270, P=0.023), higher serum C-reaction protein (Z=-2.322, P=0.020), and lower serum albumin (t=2.507, P=0.015), as compared with those in patients in NRP group. ②In RP group, the rate of Gram-positive bacterial infection was lower (χ2=7.370, P=0.007), but the rate of staphylococcus aureus infection was higher (χ2=4.156, P=0.041) and the rate of coagulase negative staphylococcus infection was lower (χ2=10.233, P=0.001). ③Logistic analysis showed that higher C-reaction protein (OR=1.012, P=0.004) and intestinal obstruction (OR=14.532, P=0.002) were the independent risk factors for refractory PDAP, and higher serum albumin level (OR=0.848, P=0.035) was the independent protection factor for refractory PDAP. Conclusions Higher C-reaction protein level and intestinal obstruction were the independently risk factors and higher serum albumin level was the independent protection factor for refractory PDAP.

Key words: Peritoneal dialysis, Refractory peritonitis, Risk factors