早发性腹膜透析相关性腹膜炎的危险因素研究

Risk Factors for Early-onset Peritoneal Dialysis-associated Peritonitis

目的探讨早发性腹膜透析相关性腹膜炎(PDAP)的危险因素。方法选取2011—2015年在郑州大学第一附属医院肾脏病中心接受腹膜透析置管手术并发生PDAP的患者143例。按首次发生腹膜炎的时间分为早发性腹膜炎组(≤3个月)和迟发性腹膜炎组(>3个月)。收集所有患者的一般资料,包括性别、年龄、BMI、文化水平和高血压、糖尿病、出口感染发生率及腹膜炎发生次数等;测定实验室指标,包括血红蛋白、血肌酐、血钾、血钙、血清蛋白、总胆固醇、三酰甘油、估算肾小球滤过率(e GFR),并进行病原学检查和预后判断。危险因素分析采用多元逐步Logistic回归分析。结果 463例腹膜透析患者中,143例(30.9%)患者共发生201例次腹膜炎,其中31例发生早发性腹膜炎,112例发生迟发性腹膜炎。两组性别、年龄、BMI及出口感染发生率间差异有统计学意义(P<0.05),而文化水平和高血压、糖尿病发生率及腹膜炎发生次数间差异无统计学意义(P>0.05)。两组血红蛋白、血肌酐、血钙、总胆固醇、三酰甘油水平及低钾血症发生率间差异无统计学意义(P>0.05);而血清蛋白水平及e GFR间差异有统计学意义(P<0.05)。两组病原学检查结果间差异无统计学意义(P>0.05)。两组治疗转归间差异亦无统计学意义(P>0.05))。多元逐步Logistic回归分析结果显示,男性〔OR=4.838,95%CI(1.591,14.707),P=0.005〕、高BMI〔OR=6.823,95%CI(1.815,25.648),P=0.004〕、出口感染〔OR=6.234,95%CI(1.638,23.730),P=0.007〕、低蛋白血症〔OR=1.027,95%CI(1.006,1.186),P=0.015〕是早发性腹膜炎的独立危险因素。结论男性、BMI、出口感染和低蛋白血症是腹膜透析患者发生早发性腹膜炎的独立危险因素。

Objective To analyze the risk factors for early-onset peritoneal dialysis-associated peritonitis（PDAP）. Methods We selected 143 patients who underwent peritoneal dialysis（PD） catheter insertion in Nephrology Center,the First Affiliated Hospital of Zhengzhou University from 2011 to 2015 and had PDAP as the subjects and divided them into the early-onset PDAP group（first onset of PDAP within 3 months after PD） and late-onset PDAP group（first onset of PDAP after3 months of PD） based on the first onset time of PDAP. We collected the general data of the patients,including sex,age,BMI,educational attainment, incidence rate of hypertension, diabetes and catheter exit-site infection, and frequency of PDAP. Laboratory indicators,such as serum hemoglobin,creatinine,potassium,calcium and albumin,total cholesterol,and triacylglycerol were measured and etiological examination was performed in the patients. The glomerular filtration rate（GFR） was estimated. And the prognosis was predicted. Risk factors for early-onset PDAP was analyzed with multiple stepwise Logistic regression. Results Of the 463 patients with PD,PDAP occurred in 143（30. 9%） for a total of 201 times. Early-onset PDAP occurred in 31 of the 143 patients,and late-onset PDAP occurred in 112. The differences in terms of sex, age, BMI and incidence rate of catheter exit-site infection between the two groups were statistically significant（P〈0. 05）,while those in educational attainment,incidences of hypertension and diabetes and frequency of PDAP were not（P〈0. 05）. There were no significant differences in the serum hemoglobin,creatinine,calcium,total cholesterol,and triacylglycerol levels and incidence of kaliopenia between the two groups（P〈0. 05）. Notable differences were observed in the serum albumin level and estimated glomerular filtration rate（e GFR） between the two groups（P〈0. 05）. No distinct differences existed in the results of etiological examination between the two groups（P〈0. 05）. The treatment outcome of the early-onset PDAP group did not differ remarkably from that of the late-onset PDAP group（P〈0. 05）. Results of multiple stepwise Logistic regression analysis revealed that male 〔OR = 4. 838,95% CI（1. 591,14. 707）,P = 0. 005 〕,higher BMI 〔OR = 6. 823,95% CI（1. 815,25. 648）,P = 0. 004 〕, catheter exit-site infection 〔OR = 6. 234, 95% CI（1. 638, 23. 730）, P = 0. 007 〕 and hypoalbuminemia 〔OR = 1. 027,95% CI（1. 006,1. 186）,P = 0. 015 〕 were risk factors independently associated with early-onset PDAP. Conclusion Male, higher BMI, catheter exit-site infection and hypoalbuminemia were the risk factors independently associated with early-onset PDAP.