腹膜透析相关性细菌性腹膜炎预后的危险因素分析

Predictors of the outcome following peritoneal dialysis-related bacterial-complicating peritonitis

目的探讨影响腹膜透析（腹透）相关性细菌性腹膜炎患者预后的相关因素。方法采用回顾性分析的方法。收集上海交通大学医学院附属仁济医院腹膜透析中心2009年1月至2013年12月期间发生的腹透相关性细菌性腹膜炎患者临床资料，包括年龄、性别、腹透龄、残肾功能、局部和全身炎性反应状态、腹透液交换次数、腹膜葡萄糖暴露量等，记录患者腹膜炎发生时相关临床和实验室指标。根据腹膜炎患者预后将其分为治愈组（治疗后完全缓解且无复发、再发或重现）、拔管／死亡组（结局为拔管或死亡）、复发组（含治疗后复发、再发或重现）。采用logistic回归法分析影响腹透相关性细菌性腹膜炎患者预后的相关因素。结果187例腹透患者腹膜炎发生时的中位腹透龄为27．15（11．15，53．13）个月，共发生347例次细菌性腹膜炎，其中革兰阳性菌感染130例次，阴性菌7l例次，多种微生物感染15例次，培养阴性131例次。与治愈组和复发组相比，拔管／死亡组患者革兰阴性菌感染发生率较高；腹透龄较长；血清高敏C反应蛋白（hs．CRP）水平较高（均P〈0．01）。与治愈组相比，拔管，死亡组患者血清白蛋白水平较低（P〈0．01），复发组患者Kt／V值较低（P〈0．05）。logistic回归分析结果显示，年龄、非革兰阳性菌感染、hs—CRP升高是影响腹膜炎患者拔管，死亡的独立危险因素。结论年龄、非革兰阳性菌感染、全身炎性反应状态是影响腹透相关细菌性腹膜炎患者拔管或死亡的独立危险因素。

[Abstract ] Objective To investigate the risk factors predicting the outcome of peritoneal dialysis （PD）-related bacterial-complicating peritonitis. Methods In this retrospective study, all the episodes of PD-related bacterial peritonitis presenting during Jan 2009 to Dec 2013 in our center were reviewed. Clinical and laboratory parameters at the onset of peritonitis, including patient demographic information, age, gender, duration of PD, residual renal function, local and systemic inflammation state, daily exchange number, peritoneal glucose exposure and so on, were recorded. Patients episodes were divided into three groups according to the outcome： complete cure （complete resolution of peritonitis without relapse or recurrence or repeat）, peritonitis-related catheter removal/death group, and relapse （relapse or recurrence or repeat） group. Results 187 CAPD patients with 27.15（11.15, 53.13） PD duration were enrolled in the study. Total of 347 episodes of bacterial peritonitis in these patients wereanalyzed, with 130 episodes of gram-positive bacterial infection, 71 episodes of gram-negative bacterial infection, 15 episodes of polymierobial and 131 episodes of cultured negative. Compared to the complete cure group and the relapse group, gram negative bacterial infection was more prevalent in the peritonitis-related catheter removal/death group. Furthermore, patients in the peritonitis-related catheter removal/death group showed longer PD age （P 〈 0.01） and higher serum hs-CRP （P 〈 0.01）. Compared to the complete cure group, the serum albumin concentration was lower in the peritonitis- related catheter removal/death group （P 〈 0.01）. Kt/V was significantly lower in the relapse group than that in the complete cure group （P 〈 0.05）. Logistic analysis indicated age, non gram positive bacterial infection and increased hs-CRP were independent predictors for peritonitis-related catheter removal or death. Conclusions Age, non gram positive bacterial infection and hs- CRP are risk factors predicting peritonitis-related catheter removal or death in CAPD patients.