单中心频发腹膜透析相关性腹膜炎的临床分析

Clinical characteristics of frequent peritoneal dialysis related peritonitis

目的:了解频发腹膜透析相关性腹膜炎的临床特征,探讨其发生原因。方法:回顾性分析2009年9月—2015年4月行腹膜透析的患者76例,其中23例1年内发生两次及以上感染性腹膜炎(频发组),53例1年内仅发生1次腹膜炎(偶发组),对两组患者临床和实验室数据进行比较,探讨频发腹膜透析相关性腹膜炎发生的原因。结果:两组患者的性别、年龄、文化程度、糖尿病发生率、血红蛋白、肾功能指标及血电解质水平间比较差异无统计学意义(P>0.05);两组患者置管时及腹膜炎发作时人血白蛋白水平间比较差异均有统计学意义(P<0.05)。频发组革兰阳性球菌感染率较偶发组高(P=0.034),革兰阴性杆菌感染率较偶发组低(P=0.038),其他菌谱相比无明显差异。Logistic回归分析显示频发组患者腹透开始时血白蛋白水平和其感染腹膜炎的频次呈负相关(OR=-1.124,P=0.001)。结论:低蛋白血症可能是频发腹膜透析相关性腹膜炎的易患因素,早期纠正低蛋白血症可能有助于该病的预防和控制。

Objective： To identify the clinical characteristics,and explore the cause of frequent peritoneal dialysis related peritonitis. Methods： A retrospective analysis was conducted in the peritonitis patients undergoing peritoneal dialysis in our hospital. Frequent peritoneal dialysis related peritonitis was defined by two or more onsets in one year,and the patients with only one onset served as the control group. The clinical and laboratory data of the two groups were compared and the cause of peritoneal dialysis related peritonitis analyzed. Results： No significant differences were found between the two groups in age,gender,culture degree,incidence of diabetes mellitus,serum creatinine,calcium,phosphorus,potassium and blood leucocytes（ P〉0. 0 5）. There were significant differences in serum albumin level at the start of peritoneal dialysis therapy and at peritonitis between two groups. The infection rate of gram- positive bacteria in frequent group was higher than the sporadic group（ P =0. 034）,the infection rate of gram- negative bacteria is slightly lower than the sporadic group（ P = 0. 038）,no other significant difference in bacterial spectrum. Logistic regression analysis shows that there was positive correlation between serum albumin level at the start of peritoneal dialysis therapy and peritonitis episodes（ OR =- 1. 124,P = 0. 001）. Conclusion： Hypoalbuminemia may be one liability factor of frequent peritoneal dialysis related peritonitis. Measures to ameliorate hypoalbuminemia early may help prevent and control frequent peritoneal dialysis related peritonitis.