频发腹膜透析相关性腹膜炎的临床特征及危险因素的探讨

Frequent peritoneal dialysis-related peritonitis:clinical characteristics and risk factors

目的探讨频发腹膜透析相关性腹膜炎的临床特征及危险因素。方法回顾性分析2007年1月至2014年12月安徽医科大学附属省立医院腹膜透析置管后行持续性非卧床腹膜透析的尿毒症患者,选择1年内发生腹膜炎≥2次者定义为频发组,1年内仅发生1次腹膜炎者定义为单发组,比较2组临床及实验数据差异,并分析频发腹膜透析相关性腹膜炎的危险因素。结果频发组13例,发生感染性腹膜炎30例次,单发组57例,发生感染性腹膜炎57例次。频发组与单发组相比,患者血压和体质量指数明显升高(P<0.05),未及时治疗者[7例(53.85%)比13例(22.81%)]及抗感染疗程不足者[5例(38.46%)比8例(14.04%)]增多(P<0.05),无效拔管率[5例(38.46%)比7例(12.28%)]增加(P<0.05),血红蛋白、血白蛋白显著降低(P<0.05),全段甲状旁腺素水平升高(P<0.05)。病原学检查分析频发组革兰阴性菌感染率(33.33%)及真菌感染率(10.00%)均较高,但以革兰阴性菌增加的趋势最明显(P=0.035)。2组间置管时年龄、性别、透析时间、文化程度、腹膜炎诱因、病死率、残余肾功能、外周血白细胞、血钙、血磷、C反应蛋白、血总胆固醇、三酰甘油、首次腹透液白细胞数比较差异均无统计学意义。Logistic回归分析显示高体质量指数、严重高血压、低血红蛋白、低血白蛋白为频发腹膜透析相关性腹膜炎的危险因素。结论营养不良、体质量指数过高、严重高血压为腹膜透析者频发腹膜炎的危险因素,积极纠正低蛋白血症、控制血压、保持标准体质量指数,积极按时规范治疗腹腔内源性感染有助于该病的预防和控制。

Objective To identify the clinical characteristics and factors of frequent peritoneal dialysis （PD）-related peritonitis. Methods A retrospective study was conducted on patients undergoing continuous ambulatory peritoneal dialysis following PD catheterization from January 2007 to December 2014 in Anhui Province Hospital. The frequent PD-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 risk factors of frequent PD-related peritonitis were analyzed. Results There were 13 cases with infectious peritonitis of 30 cases/times in frequent group, and 57 cases with infectious peritonitis of 57 cases/times in the control group. As compared with those in the control group, the patients with frequent peritonitis had higher significantly blood pressure （P = 0. 042） and body mass index （BMI） （P = 0. 009）, but lower hemoglobin （P = 0. 007） and plasma albumin （P = 0. 003）, with higher intact parathyroid hormone （P〈0. 05）, gramnegative bacteria （33. 33%） and fungal infection rates （10. 00%）, of which the increasing trend of gram-negative bacteria was more obvious （P = 0. 035）. Moreover, the patients without timely treatment [7 cases （53. 85%） vs. 13 cases （22. 81%）, P〈0. 05] and adequate anti-infection course [5 cases （38.46%） vs. 8 cases （14. 04%）, P〈0. 05] increased. No differences were found between the two group in age, gender, dialysis age, education, inducing factors of peritonitis, mortality, residual renal function, peripheral blood leukocytes, calcium, phosphorus, C-reactive protein, total cholesterol, triglycerides, leukocyte count of peritoneal fluid for the first time. Logistic regression analysis identified an increased likelihood of frequent PD-related peritonitis with high BMI, severe hypertension, low hemoglobin and low serum albumin. Conclusions Malnutrition, high BMI, and severe hypertension are risk factors of frequent PD-related peritonitis. Measures to improve anemia and hypoproteinemia, control blood pressure and maintain standard weight, and positive and regular treatment of peritoneal endogenous infection may contribute to the prevention and control of the frequent PD-related peritonitis.