胃肠道疾病与腹膜透析相关性腹膜炎的相关性

Correlation between gastrointestinal diseases and peritoneal dialysis-associated peritonitis

目的调查腹膜透析(腹透)患者胃肠道症状和胃肠道疾病的发生率,探讨其与腹透相关性腹膜炎的相关关系。方法前瞻性纳入2016年3月1日至2017年12月31日在中山大学附属第一医院腹透中心随访的腹透患者为研究对象,追踪随访至患者退出腹透或研究终止日期2019年12月31日。收集患者胃肠道症状、胃肠道疾病及腹膜炎发生情况,用胃肠道症状评定量表评估患者胃肠道症状严重程度,比较胃肠道疾病组与无胃肠道疾病组患者人口学及临床资料的差异。采用Poisson回归模型筛选腹透患者发生腹透相关性腹膜炎的影响因素。结果共471例腹透患者入选本研究,其中387例(82.2%)患者出现至少1种胃肠道症状,142例(30.2%)患者患有胃肠道疾病。患者总体腹膜炎发生率为0.094次/患者年,革兰阳性菌腹膜炎发生率为0.034次/患者年,革兰阴性菌腹膜炎发生率为0.027次/患者年。多因素Poisson回归分析结果显示,胃肠道疾病是总体腹膜炎及革兰阴性菌腹膜炎发生的独立影响因素(分别OR=1.852,95%CI 1.252~6.369,P=0.002;OR=3.324,95%CI 1.616~6.836,P=0.001);腹泻症状得分较高是革兰阴性菌腹膜炎发生的独立影响因素(OR=2.832,95%CI 1.616~4.963,P<0.001)。结论腹透患者胃肠道疾病的发生率较高,胃肠道疾病是总体腹膜炎及革兰阴性菌腹膜炎发生的独立影响因素,腹泻症状是革兰阴性菌腹膜炎发生的独立影响因素。

Objective To investigate the incidence of gastrointestinal symptoms and diseases in peritoneal dialysis(PD)patients,and explore their associations with PD-associated peritonitis.Methods PD patients who were followed up in PD center of the First Affiliated Hospital of Sun Yat-sen University from March 1,2016 to December 31,2017 were prospectively enrolled and followed up until withdrew from PD or until December 31,2019.Gastrointestinal symptoms,gastrointestinal diseases and peritonitis episodes were collected during the study period.The severity of gastrointestinal symptoms was assessed by the Gastrointestinal Symptoms Rating Scale.The demographic and clinical data were compared between patients with and without gastrointestinal diseases.The influencing factors of peritonitis were analyzed by Poisson regression model.Results A total of 471 PD patients were included.Among them,387(82.2%)patients had at least one gastrointestinal symptom,and 142(30.2%)patients had gastrointestinal diseases.The incidence of peritonitis was 0.094 episodes per patient year,0.034 episodes per patient year for gram-positive bacteria peritonitis and 0.027 episodes per patient year for gram-negative bacteria peritonitis.The multi-factor Poisson regression model showed that gastrointestinal disease was an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis(OR=1.852,95%CI 1.252-6.369,P=0.002;OR=3.324,95%CI 1.616-6.836,P=0.001,respectively),and higher score of diarrheal symptoms was an independent influencing factor for the occurrence of gram-negative bacterial peritonitis(OR=2.832,95%CI 1.616-4.963,P<0.001).Conclusions The incidence of gastrointestinal diseases in PD patients is 30.2%.Gastrointestinal disease is an independent influencing factor for the occurrence of total peritonitis and gram-negative bacteria peritonitis,and diarrhea symptom is an independent influencing factor for the occurrence of gram-negative bacteria peritonitis.