腹膜透析导管出口周围疖肿的发生情况及影响因素分析

Study on the occurrence and influencing factors of furuncle around the exit of peritoneal dialysis catheter

目的探讨腹膜透析(peritoneal dialysis,PD)导管出口周围疖肿的发生情况及影响因素。方法选择2011年9月─2017年9月北京大学人民医院肾内科规律随访的PD患者,回顾其PD导管出口周围疖肿的发生情况及临床资料,分析其相关影响因素。结果183名PD患者入选研究,男性88例(占48.1%),平均年龄(59.8±13.8)岁,透析龄27(15,51)月。其中23名(12.6%)患者发生36例次出口周围疖肿,发生率0.05次/风险年。14例次(占38.9%)患者疖肿发生部位以PD导管为中心、周围6~9点的位置。并发症方面:4例次(占11.1%)疖肿合并出口和/或隧道感染,无合并腹膜炎。Logistic回归分析结果显示:透析龄(OR=0.969,95%CI:0.941~0.998,P=0.039)、合并糖尿病(OR=3.014,95%CI:1.050~8.651,P=0.040)、血C反应蛋白(OR=1.154,95%CI:1.065~1.251,P<0.001)是PD患者出口周围发生疖肿的独立危险因素。通过Logistic回归分析PD患者出口疖肿频发的相关因素,结果显示合并糖尿病(OR=5.513,95%CI:1.029~29.536,P=0.046)、C反应蛋白(OR=1.103,95%CI:1.016~1.197,P=0.019)是出口周围疖肿频发的独立危险因素。结论PD导管出口周围疖肿形成在PD患者中并不少见,可能发展为出口感染和/或隧道感染。对合并糖尿病、透析龄较短、C反应蛋白水平高的患者应重点关注出口周围疖肿的发生,并给予相应的预防宣教,从而预防出口和/或隧道感染。

Objective To explore the occurrence and influencing factors of furuncle around exit of peritoneal dialysis(PD)catheters.Methods The PD patients who were followed up regularly from September 2011 to September 2017 in the Department of Nephrology,Peking University People’s Hospital were selected.The occurrence of furuncle and related clinical data were reviewed and analyzed.Results A total of 183 PD patients were enrolled in this study,88(48.1%)were male,the average age was 59.8±13.8 years,and the median PD duration was 27(15,51)months.Thirty-six episodes of furuncle around exit of PD catheter occurred in 23(12.6%)patients(0.05 episodes/patient-year).The most common site of furuncle was at 6 to 9 o'clock position around PD catheters(14 episodes,38.9%).In terms of complications,4 episodes of furuncle(11.1%)were complicated with exit-site infection and/or tunnel infection,but without peritonitis.Logistic regression analysis showed that shorter PD duration(OR=0.969,95%CI:0.941~0.998,P=0.039),diabetes mellitus(OR=3.014,95%CI:1.050~8.651,P=0.040)and higher serum C-reactive protein(OR=1.154,95%CI:1.065~1.251,P<0.001)were the independent risk factors for occurrence of furuncle around exit of PD catheters.Binary logistic regression found that diabetes mellitus(OR=5.513,95%CI:1.029~29.536,P=0.046)and C-reactive protein(OR=1.103,95%CI:1.016~1.197,P=0.019)were the independent risk factors for frequent furuncle occurrence around exit of PD catheters.Conclusions Furuncle around exit of PD catheters is not uncommon in PD patients,and may develop into exit-site infection and/or tunnel infection.The patients with diabetes mellitus,shorter PD duration and higher level of C-reactive protein should be paid attention to the presence of furuncle around the exit,and should be given corresponding education to prevent exit-site infection and tunnel infection.