中国血液净化

中国血液净化 ›› 2022, Vol. 21 ›› Issue (11): 790-794.doi: 10.3969/j.issn.1671-4091.2022.11.002

• 临床研究 • 上一篇    下一篇

不同透析龄腹膜透析患者首次腹膜透析相关性腹膜炎的临床特征及预后

梁琦晨   赵慧萍   武 蓓   芦丽霞   乔 婕   门春翠   何玉婷   楚新新   左 力   王 梅   

  1. 100044 北京，1北京大学人民医院肾内科
  • 收稿日期:2022-07-05 修回日期:2022-08-27 出版日期:2022-11-11 发布日期:2022-11-12
  • 通讯作者: 赵慧萍 E-mail:huipingzhao2009@163.com
  • 基金资助:
    北京市首都市民健康培育专项基金(Z161100000116070)

Clinical characteristics and prognosis of the first episode of peritoneal dialysis-associated peritonitis in patients with different peritoneal dialysis duration 

LIANG Qi-chen , ZHAO Hui-ping, WU Bei, LU Li-xia, QIAO Jie, MEN Chun-cui, HE Yu-ting, CHU Xin-xin, ZUO Li, WANG Mei   

  1. Department of Nephrology, Peking University People’s Hospital, Beijing 100044, China
  • Received:2022-07-05 Revised:2022-08-27 Online:2022-11-11 Published:2022-11-12
  • Contact: 100044 北京，北京大学人民医院肾内科 E-mail:huipingzhao2009@163.com

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摘要： 目的  探讨不同透析龄患者首次发生腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis，PDAP)的临床特征及治疗效果。 方法  回顾分析2007年1月1日～2021年10月31日在北京大学人民医院肾内科规律随诊的腹膜透析患者发生首次腹膜炎的诊治情况。按透析龄3年、5年为界，将所有首次PDAP分为长透析龄组(≥60月)、中透析龄组(36～59月)以及短透析龄组(＜36月)，对比不同透析龄患者首次PDAP的临床特征与治疗预后。 结果  ①近15年期间，166名患者发生了首次PDAP，其中男性83例(占50%)，发病时年龄(63.33±12.14)岁，中位透析龄30(13，57)月。主要原发病为糖尿病肾病59例(35.5%)。②长透析龄组36例(占21.7%)，发生首次腹膜炎时的中位透析龄79(68，102)月。随着透析龄延长，3组患者中合并糖尿病占比逐渐下降(62.1%、45.7%、30.6%，χ2=11.068，P=0.004)，首次PDAP的治疗失败率、腹膜炎相关死亡率逐渐升高(χ2=10.095、11.171，P=0.005、0.003)。多因素Logistic回归分析结果显示：透析龄是首次PDAP治疗失败(OR =1.291，95% CI：1.048～1.591，P =0.016)和PDAP相关死亡(OR=1.675，95% CI：1.262～2.222，P＜0.001)的独立危险因素。透析龄每增加1年，PDAP治疗失败及死亡的风险增加1.291和1.675倍。 结论  透析龄60月及以上的长透析龄患者发生首次PDAP时治疗失败率和PDAP相关死亡率更高，预后更差。透析龄是首次PDAP治疗失败及死亡的独立危险因素。应积极加强对长透析龄腹膜透析患者腹膜炎的相关预防。

关键词: 腹膜透析, 腹膜透析相关性腹膜炎, 长透析龄

Abstract: Objectives   To investigate the clinical characteristics and prognosis of peritoneal dialysis-associated peritonitis (PDAP) in patients with different dialysis duration.  Method  A total of 166 peritoneal dialysis (PD) patients who experienced the first episode of PDAP in Peking University People's Hospital from January 2007 to October 2021 were retrospectively reviewed. According to PD duration, patients were divided into long PD duration group (≥60 months), medium PD duration group (36-59 months) and short PD duration group (＜36 months). Clinical characteristics and PDAP prognosis were collected and analyzed. Results  Among 166 patients，83(50%) were male and the mean age was (63.33±12.14) years. The major primary renal diseases were diabetic nephropathy(35.5%).There were 36 patients (21.7%) in long PD duration group. With the extension of PD duration, the proportion of patients with diabetes gradually decreased (62.1%, 45.7%, 30.6%, χ2=11.068, P=0.004), and the treatment failure rate and PDAP-related mortality gradually increased(χ2=10.095、11.171，P=0.005, 0.003). Logistic multivariate regression analysis showed that PD duration was not only independent risk factor for the treatment failure of the first-episode PDAP (OR1.291，95%CI : 1.048～1.591,P=0.016) , but also independent risk factor for first-episode PDAP death (OR: 1.675, 95%CI:1.262～2.222, P＜0.001).   Conclusion   Patients with PD duration of ≥60 months had the highest rate of treatment failure and PDAP-related mortality when they first experienced PDAP. PD duration is an independent risk factor for the first episode of PDAP treatment failure and death. The prevention of peritonitis in PD patients with long PD duration should be actively strengthened.

Key words: Peritoneal dialysis, Peritoneal dialysis-associated peritonitis, Long dialysis duration

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