单中心腹膜透析相关腹膜炎反复发作的临床特点及危险因素

Frequent peritoneal dialysis-related peritonitis in a single center:clinical characteristics and risk factors

目的探讨腹膜透析相关性腹膜炎反复发作的临床特点以及危险因素。方法本研究为回顾性研究,收集中国科学技术大学附属第一医院腹膜透析中心2015年4月至2019年4月发生腹膜透析相关性腹膜炎的所有病人的临床资料,记录其临床特征以及实验室检查资料,根据腹膜炎发生的频次分为单发组(1年内仅发生1次)以及多发组(1年内发生腹膜炎≥2次),比较两组腹膜炎发生时的临床资料以及实验室数据,采用logistic回归分析方法分析多发组反复发生感染的危险因素。结果共有83例病人纳入本研究中,其中单发组57例,发生腹膜炎57例次,多发组26例,共发生腹膜炎67例次,多发组与单发组相比,病人更多的合并糖尿病(9/17)比(5/52)、腹膜透析龄延长[12(6.0,36.0)]比[36(16.5,72.0)]月、白蛋白水平下降[33.30(30.85,36.00)]比[21.85(17.95,26.00)]g/L(均P<0.05),而两组性别、年龄、腹膜炎发生季节、文化程度、拔管率、感染细菌类型、感染时首次透析液的白细胞计数、血红蛋白、C反应蛋白(CRP)、肌酐、血钠、血钙、血磷、钙磷乘积以及全段甲状旁腺激素(PTH)、25-OH维生素D均差异无统计学意义。logistic回归分析显示高血糖、低白蛋白血症以及透析时间的延长是腹膜炎多次发作的独立危险因素。结论高血糖、低白蛋白血症以及透析龄的延长是腹膜炎多次发作的独立危险因素,可作为预测腹膜炎反复发作的因素之一。

Objective To investigate the clinical characteristics and risk factors of frequent peritoneal dialysis(PD)related perito-nitis.MethodsThis study was a retrospective study.Clinical data of all patients with peritoneal dialysis-related peritonitis fromApril 2015 to April 2019 were collected from the First Affiliated Hospital of the University of Science and Technology of China,and their clinical characteristics and laboratory tests were recorded.Patients were divided into two groups according to the frequen-cy of peritonitis,single episode group(only once in 1 year)and multiple episodes group(peritoneitis occurred≥2 times in 1 year).Clinical and laboratory data of the two groups were compared using Logistic regression to analyze the risk factors for frequent PD-related peritonitis.ResultsA total of 83 patients were included in this study,including 57 cases in the single group with 57 epi-sodes of peritonitis,26 cases in the multiple group wigh 67 episods of peritonitis in total.Compared with the single group,the multi-ple group has more patients with diabetes(9/17)vs(.5/52),longer dialysis duration[12(6.0,36.0)]vs[.36(16.5,72.0)]month)and lower serum albumin level[33.30(30.85,36.00)]vs.21.85(17.95,26.00)]g/L(both P<0.05).There were no statistically sig-nificant differences between the two groups in gender,age,season,education,extubation rate,bacterial species,leukocyte count ofperitoneal fluid for the first time,hemoglobin,C-reaction protein,blood creatinine,sodium,calcium,potassium,calcium and phos-phate product,intact parathyroid hormone,25(OH)D3.Logistic regression analysis showed that hyperglycemia,hypoalbuminemiaand prolonged dialysis time were independent risk factors for multiple episodes of peritonitis.ConclusionHyperglycemia,hypoal-buminemia and prolongation of dialysis age are independent risk factors for multiple episodes of peritonitis and can be used as oneof the factors for predicting frequent PD-related peritonitis.