儿童慢性腹膜透析相关腹膜炎危险因素的病例对照研究

Risk factors of peritoneal dialysis related peritonitis in children:a case-control study

目的分析终末期肾病（ESRD）患儿慢性腹膜透析（CPD）相关腹膜炎（简称腹膜炎）发生的危险因素,为儿童腹膜炎防治提供依据。方法回顾性收集复旦大学附属儿科医院（我院）开展ESRD患儿CPD以来的全部病历,依据连续随访记录,以是否出现CPD分为腹膜炎组和非腹膜炎组,分析两组人口学指标、CPD指标和透析充分性指标。并行多因素分析探讨发生腹膜炎的危险因素。结果 2001年至2014年在我院接受CPD治疗的109例ESRD患儿进入本文分析,男60例（55%）、女49例。开始腹膜透析的中位年龄9.9岁,中位透析病程13.4月。连续性非卧床腹膜透析（CAPD）15例,自动腹膜透析（APD）94例（86.2%）。43例（39.4%）仍接受CPD治疗,50例（45.9%）成功行肾移植,7例（6.4%）转行血液透析治疗,6例（5.5%）死亡,3例（2.8%）失访。1、2、3和5年的生存率分别为97.1%、93.3%、90.1%和90.1%。33例发生57例次腹膜炎,平均腹膜炎发生率为1次/35.1病人月。单因素分析显示,开始透析时身高SDS（P=0.01）、透析病程（P1年（OR=8.162,95%CI：2.514-26.500,P1年是儿童CPD相关腹膜炎发生的独立危险因素。

Objective To evaluate the risk factors of chronic peritoneal dialysis（ CPD） related peritonitis in children. Methods All end-stage renal disease（ ESRD） patients who received the CPD in Children ＇s Hospital of Fudan University were collected retrospectively. The patients were grouped as peritonitis group and non-peritonitis group. According to the consecutive follow-up data,demographic factors,dialysis characteristics and main indicators of dialysis adequacy were analyzed. Results A total of 109 children who received the CPD from 2001 to 2014 in our hospital were enrolled in this study. 60 cases（ 55%） were boys and the other 49 were girls. The median age started CPD was 9. 9 years and median duration of dialysis was 13. 4 months. 15 cases（ 13.8%） received continuous ambulatory peritoneal dialysis（ CAPD） and the other 94 received automated peritoneal dialysis（ APD）.At the latest follow-up,43 cases（ 39. 4%） still received CPD,50 cases（ 45. 9%） received renal transplantation,7 cases（ 6.4%） were transferred to hemodialysis,6 cases（ 5. 5%） died and the other 3 cases（ 2. 8%） were lost to follow-up. 1-year,2-year,3 year and 5-year patient survival rate was 97. 1%,93. 3%,90. 1% and 90. 1%,respectively. Totally,33 patients suffered from 57 times of peritonitis. The incidence of peritoneal dialysis related peritonitis was 1 episode per 35. 1 patient-month. There were significant differences in height at the start of dialysis（ P = 0. 01）,duration of dialysis（ P〈0. 001） and serum albumin level（ P = 0. 01） between peritonitis group and non-peritonitis group. The results of Logistic regression analysis indicated that height SDS- 2. 0 at the start of dialysis（ OR = 12. 746,95% CI： 2. 436- 66. 675,P = 0. 003） and more than one year duration of dialysis（ OR = 8. 162,95% CI： 2. 514- 26. 500,P〈0. 001） were the independent risk factors of peritoneal dialysis related peritonitis.Conclusion Height SDS - 2. 0 at the start of dialysis and more than one year duration dialysis were the independent risk factors of peritoneal dialysis related peritonitis in children.