延迟拔管的腹膜透析相关性腹膜炎的临床表现及影像学特点

Peritoneal Dialysis-associated Peritonitis with Delayed Removal of the Peritoneal Catheter:Clinical Manifestation and Imaging Features

目的:探讨延迟拔管的腹膜透析相关性腹膜炎(PDAP)的临床表现及影像学特点。方法:以50例延迟拔管的PDAP为研究对象(D组),以正常维持性PD(A组,27例)、非难治性PDAP(B组,37例)及难治性PDAP内科保守治疗有效组(C组,15例)为对照,比较四组临床表现、生化指标、影像学资料等。结果:与A组相比,B、C、D组纤维蛋白原及CRP更高,C、D组血小板计数明显升高。与B组比,D组血尿素氮水平更低,D二聚体≥2 mg/L、血小板计数≥350×10^9/L及CRP≥100 mg/L比例更高,差异具有统计学意义。与B、C三组相比,D组继发性甲状旁腺功能亢进及不完全性肠梗阻比例更高。D组29例行腹部影像学检查的患者中不完全性肠梗阻及早期包裹性硬化性腹膜炎(EPS)各8例(27.6%),腹膜增厚6例(20.7%),肠系膜增厚及肠壁增厚各3例、腹腔脓肿及肠管水肿各2例。结论:延迟拔管的PDAP患者感染较重、高凝明显、营养状态差、继发性甲旁亢多见。不完全性肠梗阻及早期EPS为其影像学改变特点。

Objective:To explore the clinical manifestation and imaging features of peritoneal dialysis associated peritonitis(PDAP)with delayed removal of the peritoneal catheter.Methods:50 PDAP patients with delayed removal of the peritoneal catheter were identified as research subjects(Group D),and compared to control groups of 27 cases of normal maintaining peritoneal dialysis patients(Group A),37 cases of non-refractory PDAP(Group B)and 15 cases of refractory PDAP but curative effect by medical treatment(Group C).Comparison was made among the four groups on clinical manifestation,biochemical indicators and imaging results.Results:Compared to Group A,Group B,C and D had higher level of fibrinogen and CRP;Group C and D had significantly elevated level of platelet count.Compared to Group B,Group D had significantly lower level of blood urea nitrogen and significantly higher proportion of patients with D-dimer≥2 mg/L,platelet count≥350×10^9/L and CPR≥100 mg/L.Compared to Group B and C,Group D had higher incidence of secondary hyperparathyroidism and incomplete intestinal obstruction.Out of the 29 patients undertaking regular abdomen scans in Group D,there were 8 patients with incomplete intestinal obstruction(27.6%),8 with early stage EPS(27.6%)and 6 cases of thickened peritoneal(20.7%).Moreover,there were 3 patients with thickened mesentery,3 with thickened intestinal wall,2 with abdominal abscess,and 2 with bowel edema.Conclusion:Higher incidence rate of secondary parathyroidism,more severe infection,more hypercoagulability and poor nutrition are found in patients with delay in removal of the peritoneal catheter.Incomplete intestinal obstruction and early stage EPS are shown as its imaging features.