老年腹膜透析患者首次腹膜炎的临床特征分析

Clinical characteristics of the first episode of peritonitis in elderly patients with peritoneal dialysis

目的分析老年腹膜透析(腹透)患者发生首次腹膜炎的临床特征及预后。方法回顾性分析中山大学附属第一医院腹透中心2006年1月至2018年12月发生首次腹透相关性腹膜炎且年龄65岁以上患者的资料。按首次腹膜炎发生时的腹透龄,将患者分为短腹透龄组(<36个月)和长腹透龄组(≥36个月)。收集患者的社会人口学及首次腹膜炎相关资料,比较两组患者首次腹膜炎的临床特征和预后。结果共纳入患者163例,年龄(71.7±4.9)岁,男性占53.4%,糖尿病肾病占32.5%,中位腹透龄为21.8(5.5,41.3)个月。短腹透龄组和长腹透龄组患者首次腹膜炎最常见诱因均为换液操作的接触污染,所占比例分别为39.8%和46.0%。长腹透龄组患者治疗失败率显著高于短腹透龄组(34.0%比13.3%,χ2=9.437,P=0.002)。真菌感染均予拔管,治疗失败率为100.0%。Logistic回归分析结果显示,长腹透龄(OR=12.544,95%CI 2.168~72.576,P=0.005)及较低的血清白蛋白水平(OR=0.858,95%CI 0.744~0.988,P=0.034)是老年患者首次腹透相关性腹膜炎治疗失败的影响因素。结论真菌感染、长腹透龄及低血清白蛋白水平是老年患者首次腹透相关性腹膜炎治疗失败的影响因素。

Objective To analyze the clinical characteristics and prognosis for the first episode of peritonitis in elderly patients with peritoneal dialysis(PD).Methods PD patients who were aged more than 65 years old and had experienced PD-associated peritonitis(PDAP)for the first time at the PD center of the First Affiliated Hospital of Sun Yat-sen University from January 2006 to December 2018,were retrospectively enrolled into this study.All patients were divided into two groups according to PD duration:short-term PD group(<36 months)and long-term PD group(≥36 months).Demographic data,clinical indicators,treatment and prognosis of the first episode of PDAP were compared between the two groups.Results A total of 163 patients were enrolled.The age was(71.7±4.9)years and the median duration of PD was 21.8(5.5,41.3)months.Among them,male accounted for 53.4%,and diabetic nephropathy accounted for 32.5%.The leading cause of the first episode of PDAP was both contamination by operation in short-term PD group and long-term PD group,accounting for 39.8%and 46.0%,respectively.The treatment failure rate of the first episode of PDAP in long-term PD group was significantly higher than that in short-term PD group(34.0%vs 13.3%,χ2=9.437,P=0.002).All PD patients with fungal peritonitis were extubated,and the treatment failure rate was 100.0%.Logistic regression analysis showed that long-term duration of PD(OR=12.544,95%CI 2.168-72.576,P=0.005)and lower level of serum albumin(OR=0.858,95%CI 0.744-0.988,P=0.034)were independently influencing factors for treatment failure of the first episode of PDAP in elderly patients.Conclusion Fungal infection,long-term duration of PD and lower level of serum albumin are influencing factors for treatment failure of the first episode of PDAP in elderly patients.