腹膜透析相关性真菌性腹膜炎19例分析

An analysis of 19 cases with peritoneal dialysis-related fungal peritonitis

目的分析腹膜透析相关性真菌性腹膜炎(FP)的临床表现、病原学特点、诊治和预后。方法回顾性分析单个腹膜透析中心248例发生腹膜透析相关性腹膜炎患者的临床资料,其中19例发生FP(FP组),229例发生细菌性腹膜炎(BP组)。与同期未发生腹膜炎的347例腹膜透析患者(对照组)的临床资料进行比较。结果FP组和BP组血钾、血红蛋白和血清白蛋白水平均低于对照组(P<0.05),其中FP组血清白蛋白水平较BP组更低(P<0.05)。FP组狼疮肾炎患者比例高于BP组和对照组(P<0.05)。FP组3个月内抗生素使用史和拔管退出腹膜透析的患者比例均高于BP组(P<0.05)。FP组15例(78.9%)培养结果为念珠菌。通过早期拔管及规范抗真菌治疗,19例患者均未发生真菌感染相关性死亡。结论严重低白蛋白血症、狼疮肾炎和近期应用抗生素史是FP的易感因素,确诊后尽早拔管和后续规范抗真菌治疗可改善预后。

Objective To analyze the clinical manifestations,pathogenic characteristics,treatment and prognosis of peritoneal dialysis-related fungal peritonitis(FP).Methods The clinical data of 248 patients with peritoneal dialysis-related peritonitis in a single peritoneal dialysis center were retrospectively analyzed.Of 248 patients,19 patients developed FP(group FP)and 229 patients developed bacterial peritonitis(group BP).The clinical data of 347 dialysis patients(group C)without peritonitis in the same period were compared.Results The levels of serum potassium,hemoglobin and serum albumin in groups of FP and BP were lower than those in group C(P<0.05).Serum albumin level in group FP was lower than that in group BP(P<0.05).The proportion of the patients with lupus nephritis in group FP was higher than that in groups of BP and C(P<0.05).The percentages of patients with a history of antibiotic use within 3 months and extubation from peritoneal dialysis in the group FP were higher than those in group BP(P<0.05).Fifteen cases(78.9%)were candida in group FP.Through early extubation and standardized antifungal therapy,no fungal infection-related death occurred in 19 patients.Conclusion Severe hypoproteinemia,lupus nephritis and recent history of antibiotic use are the predisposing factors for FP.Early extubation and subsequent standardized antifungal therapy should be taken after diagnosis to improve the prognosis.