季节变化与腹膜透析患者发生腹膜透析相关性腹膜炎的关系

Effects of seasonal changes on peritoneal dialysis associated peritonitis in peritoneal dialysis patients

目的探讨季节变化对腹膜透析（PD）患者发生腹膜透析相关性腹膜炎（PDAP）的影响，为PDAP的临床防治提供依据。方法回顾性分析2007年1月1日至2015年12月31日在北京大学人民医院肾内科接受维持性PD患者的临床资料。按PDAP发病季节分组，记录不同季节PDAP的发生情况、实验室检查、病原微生物检查、临床转归及预后等情况。采用单因素方差分析和卡方检验比较不同季节PDAP发生率、致病菌和临床转归的差异。采用Pearson相关分析腹膜炎发生率与月平均温度、平均湿度的相关性。结果（1）9年间共有119例PD患者在居家治疗期间发生190例次腹膜炎，夏季PDAP发生率最高，为0．21次／风险年，春季（0．16次／风险年）、秋季（0．16次／风险年）次之，但按发病季节分组的各组间腹膜炎发生率的差异无统计学意义。PDAP发生率与月平均温度和平均湿度呈正相关（平均温度r=0．828，P〈0．01；平均湿度r=0．657，P〈0．05）。（2）夏季金黄色葡萄球菌、凝固酶阴性葡萄球菌（CoNS）、革兰阴性菌以及其他致病菌所致的腹膜炎发生率均高于其他季节，但各季节间的差异无统计学意义。CoNS腹膜炎发生率与月平均温度和湿度呈正相关（平均温度r=0．704，P〈0．05；平均湿度r=0．607，P〈0．05）。（3）按发病季节分组的各组患者的一般情况、临床表现、腹膜炎诱因、发生腹膜炎前实验室检查的差异均无统计学意义。夏、秋两季操作相关是发生PDAP最主要的诱因。（4）PDAP总治愈率为90％。秋季和冬季治愈率最高，夏季治愈率最低，但组间差异无统计学意义。治疗无效的PDAP中有52．6％发生在夏季。结论PDAP的发生与季节有一定相关性。在平均温度和湿度较高的月份PDAP发生率，尤其是CoNS腹膜炎的发生率显著升高。夏季PDAP的预后较差，且住院治疗比例较高，治愈率较低。

Objectives To investigate the effects of seasonal changes on peritoneal dialysis associated peritonitis （PDAP） in patients on peritoneal dialysis （PD）, and to provide evidence for clinical prevention and treatment of PDAP. Methods All episodes of PD-related peritonitis during clinic follow-up in maintenance PD patients from Jan 1^st, 2007 to Dec 31^st, 2015 in Peking University People＇s Hospital were reviewed. The incidence of peritonitis, laboratory indexes, pathogens and clinical outcomes in different seasons were recorded and analyzed. One-way ANOVA and chi square test were ernployed to compare the incidence of PDAP and related data in different seasons, and Pearson correlation was used to analyze correlations between PDAP rate and monthly mean temperature and mean humidity. Results During nine years, a total of 119 PD patients occurred 190 times of peritonitis during home PD. The PDAP rate in summer was the highest, 0.21 episodes/year, followed by spring （0.16 episodes/year） and autumn （0.16 episodes/risk year）, but there was no significant difference among peritonitis rates in four seasons. There were significant positive correlation between monthly mean temperature, monthly mean humidity and the peritonitis rate （mean temperature： r=0.828, P 〈 0.01; mean humidity r=0.657, P 〈 0.05）. （2） As for bacteria, in Summer the PDAP rate caused by Staphylococcus aureus and Coaguiase negative staphylococcus （CONS）, and Gram-negative bacteria was higher than that in other seasons, but there was no statistical difference. There were significant positive correlation between monthly mean temperature, mean humidity and the rate of CoNS peritonitis （mean temperature： r=0.704, P 〈 0.05; mean humidity： r=0.607, P 〈 0.05）. （3） There were no statistical difference among results of PD related peritonitis in different seasons about general situation, clinical manifestation, causes of peritonitis and laboratory index before peritonitis episodes. PD procedure- related problems were the main cause of peritonitis in summer and autumn. （4） The cure rate of all peritonitis was 90%. The highest cure rate was in autumn and winter, while the lowest cure rate was in summer, but no statistical difference. Among the peritonitis episodes with treatment failure, 52.6% occurred in summer. Conclusions There is some correlation between the rate of PDAP and seasons. Higher temperature and higher humidity were significantly correlated with higher peritonitis rate, especially the rate of CoNS peritonitis. The prognosis of PDAP in summer was relatively poor, with higher proportion of hospitalization and lower cure rate.