早期血液透析患者合并感染的相关影响因素及中医证型探讨

Preliminary Study on the Associated Influencing Factors and Traditional Chinese Medicine Syndrome Types in Early Hemodialysis Patients Complicated with Infection

【目的】了解早期血液透析患者合并感染的临床特征,并探讨其影响因素与中医证型,为临床防治提供依据。【方法】选取2018年11月1日至2019年9月30日在广州中医药大学第一附属医院肾病科血液净化区进行早期血液透析且资料完整的149例患者作为研究对象,根据是否合并感染将其分为感染组54例和非感染组95例。观察感染组与非感染组患者的一般临床资料、导致终末期肾病的病因、合并疾病及不良习惯、共病指数、衰弱指数、相关实验室指标和中医证型分布情况,分析感染组患者的感染部位和肺部感染特征,并采用Logistic回归分析探讨早期血液透析患者感染的影响因素。【结果】(1)149例患者中,有54例(占36.24%)共55例次(占36.91%)合并感染。合并感染的常见部位有肺部感染(43例次,占28.86%)、泌尿生殖系统感染(4例次,占7.27%)、导管感染(2例次,占3.64%)等,其中以合并肺部感染的发生率为最高,且其肺部感染累及的部位主要为双侧及下叶,分别为25例次(占58.14%)和19例次(占44.19%)。(2)经单因素分析,感染组合并糖尿病比例、共病指数、衰弱评分、白细胞计数(WBC)和中性粒细胞百分比(NE)水平均高于非感染组,血清白蛋白(ALB)、淋巴细胞百分比(LYM)、血清铁(Fe)和转铁蛋白(TRF)水平均低于非感染组,差异均有统计学意义(P<0.05或P<0.05)。(3)经Logistic回归分析,共病指数与早期血液透析患者感染相关,差异有统计学意义(P<0.05)。(4)在中医证型分布方面,感染组与非感染组的本虚证表现基本相似(P>0.05),均主要表现为脾肾阳虚证;而在标实证中,感染组的水气证多于非感染组,差异有统计学意义(P<0.01)。【结论】早期血液透析患者易并发感染,与低蛋白血症、淋巴细胞水平、共病指数、衰弱评分、糖尿病史等有关,特别是与共病指数关系密切;中医辨证方面,早期血液透析合并感染患者出现水气证的比例明显高于非感染患者。

Objective To investigate the clinical characteristics of early hemodialysis patients complicated with infection,and to explore their influencing factors and traditional Chinese medicine(TCM)syndrome types,so as to provide basis for the clinical prevention and treatment of early hemodialysis patients complicated with infection.Methods The 149 cases of early hemodialysis patients with complete clinical data admitted in the hemodialysis section of nephropathy department of the First Affiliated Hospital of Guangzhou University of Chinese Medicine from November 1, 2018 to September 30, 2019 were enrolled into the analysis. Of the 149 cases, 54 cases complicated with infection served as the infection group,and the left 95 cases without infection served as the non-infection group. The observation indexes in the two groups included their general clinical data,etiological factors of end-stage renal disease,comorbidities and bad habits,comorbidity index,frailty index, relevant laboratory indexes and traditional Chinese medicine(TCM)syndrome types. And then the infection foci and pulmonary infection characteristics in the patients of infection group were analyzed, and the influencing factors of early hemodialysis patients complicated with infection were explored by Logistic regression analysis. Results(1)Of the 149 patients,54 patients(36.24%)were complicated with infection and the frequency of comorbidity of infection was 55 cases(36.91%). The pulmonary infection had the highest frequency of comorbidity of infection(43 cases,accounting for 28.86%),and then came the urogenital system infection(4 cases,accounting for 7.27%)and catheter infection(2 cases,accounting for 3.64%). The pulmonary infection involved the bilateral lobe of lung and the lower lobe of lung,and the infection frequency was 25 cases(accounting for 58.14%)and 19 cases(accounting for 44.19%)respectively.(2)The results of the single factor analysis showed that the comorbidity of diabetes,comorbidity index,frailty scores,white blood cell(WBC)count and neutrophil(NE)percentage in the infection group were higher than those in the non-infection group,and serum albumin(ALB)level,lymphocyte(LYM)percentage,serum ferritin(Fe)level and transferrin(TRF)saturation in the infection group were lower than those in the non-infection group,the differences being statistically significant between the two groups(P<0.05 or P<0.01).(3)The results of Logistic regression analysis showed that comorbidity index was correlated with the infection in early hemodialysis patients,and the difference was statistically significant(P<0.05).(4)In respect of TCM syndrome types,the manifestations of deficiency syndromes in the origin of the two groups were basically similar(P>0.05),and were characterized by spleen-kidney yang deficiency syndrome. Of the excess syndromes in the superficiality,the percentage of the water-retention syndrome in the infection group was higher than that in the non-infection group(P<0.01). Conclusion Early hemodialysis patients are prone to being complicated with infection, which is closely related to hypoproteinemia, lymphocyte level, comorbidity index, frailty scores,medical history of diabetes and so on, in particular related to the comorbidity index. In respect of the TCM syndrome types,the percentage of water-retention syndrome in the early hemodialysis patients complicated with infection is higher than that in the early hemodialysis patients without infection.