多中心复发、再发及重现性腹膜透析相关性腹膜炎的临床特点与治疗转归

Clinical characteristics and treatment outcomes of relapsing,recurrent and repeat peritoneal dialysis-associated peritonitis:a multicenter study

目的探讨不同类型腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis,PDAP)的临床特点与治疗转归。方法回顾2013年至2019年间在吉林大学第二医院、吉林大学第一医院二部、吉林市中心医院和吉林省一汽总医院4家医院收治的PDAP患者的临床资料,按照PDAP类型分为复发组、再发组、重现组及对照组,比较4组患者的基线资料、病原菌培养结果及治疗转归。结果本研究共纳入542例PDAP患者,复发组43例,再发组32例,重现组27例,对照组440例,随访中位时间为30.5(16.0,50.0)个月。重现组革兰阳性菌的比率高于对照组(70.37%比42.95%,P=0.030);再发组真菌的比率高于对照组(21.88%比3.86%,P=0.006)。与对照组相比,复发组治愈率较低(67.44%比83.64%,P=0.048),复发组再次复发率较高(23.26%比2.27%,P=0.002),再发组拔管率较高(28.13%比8.18%,P=0.012)。多因素Logistic回归分析结果显示,再发是PDAP患者拔管的独立危险因素(OR=5.137,95%CI 2.105~12.539,P<0.001)。复发组和再发组的技术失败率均高于对照组(41.86%比17.05%,P=0.002;46.88%比17.05%,P=0.002)。多因素Cox回归分析结果显示,复发和再发既是技术失败的独立危险因素(HR=2.587,95%CI 1.525~4.389,P<0.001;HR=3.571,95%CI 2.022~6.306,P<0.001),也是复合终点的独立危险因素(HR=1.565,95%CI 1.045~2.344,P=0.030;HR=2.004,95%CI 1.269~3.164,P=0.003)。结论与普通PDAP相比,复发、再发性PDAP的治疗效果及预后较差。

Objective To explore the clinical characteristics and treatment outcomes of different types of peritoneal dialysis-associated peritonitis(PDAP).Methods The clinical data of PDAP patients admitted to the Second Hospital of Jilin University,Second Part of the First Hospital of Jilin University,Jilin Central Hospital and Jilin First Automobile Work General Hospital in Jilin province from 2013 to 2019 were reviewed.According to the type of PDAP,the patients were divided into relapsing group,recurrent group,repeat group and control group,and the baseline data,pathogens culture and treatment outcomes among the four groups were compared.Results A total of 542 patients with PDAP were enrolled in the study,including 43 cases in relapsing group,32 cases in recurrent group,27 cases in repeat group and 440 cases in control group.The median follow-up time was 30.5(16.0,50.0)months.The rate of Gram-positive bacteria in repeat group was higher than that of control group(70.37%vs 42.95%,P=0.030);the rate of fungi in recurrence group was higher than that of control group(21.88%vs 3.86%,P=0.006).Compared with control group,relapsing group had a lower cure rate(67.44%vs 83.64%,P=0.048)and a higher relapse rate(23.26%vs 2.27%,P=0.002),and recurrent group had a higher catheter removal rate(28.13%vs 8.18%,P=0.012).Multivariate logistic regression showed that recurrence was an independent risk factor for catheter removal(OR=5.137,95%CI 2.105-12.539,P<0.001).The technical failure rates in relapsing group and recurrent group were both higher than those in control group(41.86%vs 17.05%,P=0.002;46.88%vs 17.05%,P=0.002).Multivariate Cox regression showed that relapse and recurrence were both independent risk factors for technical failure(HR=2.587,95%CI 1.525-4.389,P<0.001;HR=3.571,95%CI 2.022-6.306,P<0.001),and also were independent risk factors for composite endpoint(HR=1.565,95%CI 1.045-2.344,P=0.030;HR=2.004,95%CI 1.269-3.164,P=0.003).Conclusion Compared with common PDAP,the therapeutic effects and prognosis of relapsing and recurrent PDAP are worse.