气候因素对单中心腹膜透析相关腹膜炎的影响

Influence of climatic factors on single-center peritoneal dialysis-associated peritonitis

目的:腹膜透析相关腹膜炎(peritoneal dialysis associated peritonitis,PDAP)是腹膜透析最常见的并发症之一,是导致腹膜透析技术性失败、患者住院率和病死率升高的重要原因。PDAP的防治一直是腹膜透析临床治疗的重要环节。本文探讨中国湖南省气候因素对单中心PDAP发病及预后的影响,可为PDAP的防治提供临床依据。方法:以2009年1月1日至2017年12月31日中南大学湘雅三医院(以下简称我院)肾内科收治的885名腹膜透析患者为研究对象,收集2009年至2017年发生PDAP患者的人口学资料、临床数据和湖南省气候数据。按PDAP发病季节进行病例分组,比较不同季节组患者的一般情况及临床生物化学指标的差异。同时,比较不同季节组PDAP发病率、致病菌占比、临床转归的差异。采用Logistic多因素多元回归分析PDAP在季节发病中的危险因素。采用Pearson相关分析检测PDAP发病率与月平均温度、月平均相对湿度的相关性。结果:2009年至2017年我院腹膜透析中心共发生448例次PDAP,发病率为0.17次/病人年。夏季组的总体PDAP发病率(0.246次/病人年)和革兰氏阴性(Gram negative,G−)菌PDAP发生率(0.048次/病人年)均最高,各季节组之间差异均有统计学意义(均P<0.05)。与春季组(OR=0.321,95%CI:0.144~0.713;P<0.01)、秋季组(OR=0.419,95%CI:0.187~0.937;P<0.05)、冬季组(OR=0.326,95%CI:0.139~0.763;P<0.05)相比,夏季组的肠道功能障碍患者发生PDAP的可能性偏高。与春季组比较,夏季组体重指数(body mass index,BMI)越低的患者更易发生PDAP(OR=1.175,95%CI:0.144~0.713;P<0.01)。总体PDAP(r=0.258,P<0.05)及G−菌PDAP(r=0.278,P<0.05)的发生率与湖南省月平均温度水平均呈显著正相关,但与月平均湿度水平无相关性。PDAP的总体治愈率为83%,治疗转归在各季节组间差异无统计学意义(均P>0.05)。结论:中国湖南省气候因素对我院腹膜透析患者的PDAP发病率有显著影响,夏季是PDAP尤其是G−菌PDAP的发病高峰,肠道功能障碍和低BMI是患者在夏季发生PDAP的危险因素,温度高(而非湿度高)与总体PDAP(尤其是G−菌PDAP)的发病率增高有关。

Objective:Peritoneal dialysis associated peritonitis(PDAP),one of the most common complications of peritoneal dialysis,is generally believed as an important factor causing technique failure and increasing hospital admission and fatality rate in peritoneal dialysis patients.Moreover,the prevention and treatment for PDAP have always been considered as an important link in clinical peritoneal dialysis.Thus,the study is performed to investigate the impact of climate factors on the incidence and prognosis of single-center PDAP in Hunan Province,China,which can provide a clinical basis for the prevention and treatment strategy for PDAP.Methods:A total of 885 patients on peritoneal dialysis,who were admitted to Department of Nephrology,Third Xiangya Hospital,Central South University(hereinafter referred to as our hospital)from January 1,2009 to December 31,2017,were enrolled as the subjects,and the demographic and clinical data for patients with PDAP from 2009 to 2017 as well as climate data of Hunan Province were collected.The patients were divided into different season groups,and the general information and clinical biochemical indicators in different season groups were compared.The incidence,the proportion of pathogenic bacteria and the clinical outcome of PDAP in the different season groups were compared.The risk factors of PDAP in different season groups were analyzed by using a multivariate logistic regression.Pearson’s correlation analysis was used to analyze the correlations of the overall incidence of PDAP with the monthly mean temperature and the monthly mean humidity.Results:There were 448 cases of PDAP that occurred in the peritoneal dialysis center of our hospital from 2009 to 2017(9 years),the incidence was 0.17 time/patient-years.The incidence of overall PDAP(0.246 time/patient-years)and the incidence of Gram-negative(G−)bacterial PDAP(0.048 time/patient-years)in the summer group were the highest compared with the other season groups,with significant difference(all P<0.05).Compared with the spring group(OR=0.321,95%CI 0.144−0.713;P<0.01),the autumn group(OR=0.419,95%CI 0.187,0.937;P<0.05)and the winter group(OR=0.326;95%CI 0.139,0.763;P<0.05),the probability suffered from PDAP in the summer group were higher.The patients with low body mass index(BMI)in the spring group were more likely to suffer from PDAP in the summer group.The overall incidences of PDAP(r=0.258,P<0.05)and G-bacterial PDAP(r=0.278,P<0.05)were significantly positively correlated with the monthly mean temperature in Hunan Province,which was not correlated with the monthly average humidity.The overall cure rate of PDAP was 83%,and there was no difference in the treatment outcomes among the different season groups(all P>0.05).Conclusion:The climate factors in Hunan,China have a significant impact on the incidence of PDAP in peritoneal dialysis patients in our hospital.Summer is the peak of PDAP,especially G−bacterial PDAP.Intestinal dysfunction and low BMI are risk factors for the onset of PDAP in summer.High temperature rather than high humidity is correlated with increased incidence of overall PDAP,especially for G−bacterial PDAP.