腹膜透析相关性腹膜炎的临床特点、病原菌分布及预后对比

Comparison on the clinical characteristics,the distribution of pathogenic bacteria and prognosis of the patients with peritoneal dialysis related peritonitis

目的 对比单发性与多发性腹膜透析相关性腹膜炎(PDRP)的临床特点、病原菌分布及预后,为透析患者继发感染的预防和治疗提供研究依据。方法 选择2011年6月—2017年12月本院收治的120例PDRP患者作为研究对象,其中,单发性PDRP患者80例,多发性PDRP患者40例。对两类患者的临床特点、病原菌分布及预后情况进行对比和分析。结果 与单发性PDRP患者相比较,多发性PDRP患者的年龄较大、血清血红蛋白水平及白蛋白水平较低、腹膜炎首次发病至透析开始时间较长、合并糖尿病的比例和透析为他人操作的比例较高,差异均有统计学意义(P<0.001,P=0.001,0.003)。单发性PDRP患者检出病原菌75株,其中,革兰阴性菌37株占49.33%,革兰阳性菌30株占40%,真菌8株占10.67%;多发性PDRP患者检出病原菌43株,其中,革兰阴性菌17株占39.53%,革兰阳性菌12株占27.91%,真菌14株占32.56%。两类患者病原菌构成比的差异有统计学意义(P=0.013)。单发性PDRP患者与多发性PDRP患者的预后转归情况的差异无统计学意义(P=0. 917)。结论 相对单发性PDRP患者,多发性PDRP患者存在着营养不良、治疗操作不规范、透析时间长、年龄较大等临床特征,病原菌以革兰阳性菌为主,真菌菌株的检出率也较高,但在接受积极治疗后不会导致患者出现明显的预后恶化。

Objective To compare the clinical characteristics, the distribution of pathogenic bacteria and prognosis between the patients with single and multiple peritoneal dialysis related peritonitis (PDRP), to provide the basis for the prevention and treatment of secondary infections in the patients treated with dialysis.Methods From June 2011 to December 2017,120 cases of patients with PDRP were selected as the research subjects. Among the patients, 80 patients were with single PDRP and 40 patients were with multiple PDRP. The clinical characteristics, the distribution of the pathogenic bacteria and the prognosis between the two kinds of patients were compared and analyzed. Results Compared with the patients with single PDRP, the patients with multiple PDRP had higher age, lower serum hemoglobin level and albumin level, longer time from first onset of the peritonitis to the time of dialysis beginning, higher proportion of complicated diabetes and the operation by others, the differences were statistically significant ( P < 0. 001, P = 0.001,0.003 ). 75 strains of pathogenic bacteria were detected in single PDRP patients, in which ,37 stains were Gram-negative bacteria and accounting for 49.33%, 30 strains were Gram-positive bacteria and accounting for 40%, 8 strains were fungi and accounting for 10.67%.In the patients with multiple PDRP,43 strains of pathogenic bacteria were detected,in which, 17 stains were Gramnegative bacteria and accounting for 39.53%, 12 strains were Gram-positive bacteria and accounting for 27.91%, 14 strains were fungi accounting for 32.56%.The difference of the constituent ratio of pathogenic bacteria between the two kinds of patients was statistically significant ( P = 0.013 ). There was no significant difference of the prognosis between the patients with single and multiple PDRP ( P = 0.917). Conclusions Compared with the patients with single PDRP, the patients with multiple PDRP have clinical characteristics such as malnutrition, irregular treatment, longer dialysis time and older age. The pathogenic bacteria are mainly Gram-positive bacteria, and the detection rate of fungal strains is also high, but it will not lead to obvious prognosis deterioration in patients after receiving active treatment.