首次腹膜透析相关性腹膜炎的临床特点和危险因素分析

Analysis of Clinical Features and Risk Factors of First-Time Peritoneal Dialysis Associated Peritonitis

目的分析首次腹膜透析相关性腹膜炎(PDAP)的临床特点和危险因素,为首次PDAP的防治提供依据。方法回顾性分析2015年1月1日至2021年1月1日于我院腹膜透析中心随访的患者资料。将上述时间内首次发生腹膜炎的患者定义为腹膜炎组,从未发生过腹膜炎患者定义为非腹膜炎组,比较两组患者临床和实验室指标,多因素分析首次PDAP的危险因素。结果两组患者的原发病、年龄、体质量、婚姻状况、置管方式、腹透方案比较,差异无统计学意义(P>0.05)。腹膜炎组女性患者比例、高中以下文化程度的人员比例高于非腹膜炎组,差异有统计学意义(P<0.05)。两组患者紧急起始透析方式选择、透析月龄比较,差异有统计学意义(P<0.05)。腹膜炎组治疗失败患者更多,差异有统计学意义(P<0.05)。两组患者外周血白细胞、血小板、血浆白蛋白、胆固醇、尿素氮、血肌酐、估算肾小球滤过率、血钙、血磷、全段甲状旁腺激素比较,差异无统计学意义(P>0.05)。腹膜炎组患者血红蛋白、前白蛋白、甘油三脂低于非腹膜炎组(P<0.05)。多因素二元Logistic回归显示,女性、紧急起始血液透析、透析龄≥36个月、血红蛋白偏低为首次PDAP的独立危险因素(P<0.05)。结论紧急起始血液透析、透析月龄≥36个月等为首次PDAP的危险因素,积极建立此类高危人群档案,强化管理,对腹膜炎的防治具有重要意义。

Objective To analyze the clinical characteristics and risk factors of first-time peritoneal dialysis associated peritonitis(PDAP)and provide evidence for the prevention and treatment of first-time PDAP.Methods The data of patients who were followed up in the Peritoneal Dialysis Center of Chengdu Second People′s Hospital from 1^(st) of January,2015 to 1^(st) of January,2021 were retrospectively analyzed.Patients who had peritonitis for the first time in the period above were defined as the peritonitis group,and patients who never had peritonitis as the non-peritonitis group.The differences in clinical and laboratory indicators between the two groups were compared,and the risk factors for the first-time PDAP were analyzed by multiple factors.Results There was no significant difference in the primary disease,age,weight,marital status,catheterization method,and abdominal dialysis protocol between the two groups of patients(P>0.05).The proportion of female patients and the proportion of people with education below high school in the peritonitis group was higher than that in the non-peritonitis group,and the differences were statistically significant(P<0.05).There were statistically significant differences in the choice of emergency starting dialysis mode and the age of dialysis between the two groups of patients(P<0.05).There were more patients in the peritonitis group with treatment failure than in the non-peritonitis group,and the difference was statistically significant(P<0.05).There was no significant difference between the two groups of patients in peripheral blood white blood cells,platelets,plasma albumin,cholesterol,urea nitrogen,blood creatinine,estimated glomerular filtration rate,blood calcium,blood phosphorus,and total parathyroid hormone(P>0.05).The hemoglobin,prealbumin and triglycerides of patients in the peritonitis group were lower than those in the non-peritonitis group(P<0.05).Multivariate binary logistic regression showed that female,emergency hemodialysis,dialysis age of 36 months and above,and low hemoglobin were independent risk factors for first-time PDAP(P<0.05).Conclusion Emergency hemodialysis and dialysis age≥36 months are risk factors for the first-time PDAP.Establishment of the archives of high-risk groups with these risk factors and strengthening management are of great significance to the prevention and treatment of peritonitis.