腹膜透析相关性真菌性腹膜炎20例临床分析  

Clinical analysis of peritoneal dialysis-related fungal peritonitis:Report of 20 cases

作　　者：陈林[1,2] 郭群英[1,2] 阳晓[1,2] 姜宗培[1,2] 陈崴[1,2] 毛海萍[1,2] 余学清[1,2] 

机构地区：[1]中山大学附属第一医院肾内科,卫生部和广东省肾脏病重点实验室,广州广东省510080 [2]广州市第一人民医院

出　　处：《中国血液净化》2006年第10期710-713,共4页Chinese Journal of Blood Purification

基　　金：高等学校全国优秀博士学位论文作者专项资金(2003061);广东省科技计划项目(2004B30701001);霍英东教育基金会高等院校青年教师基金(101044)

摘　　要：目的探讨腹膜透析相关性真菌性腹膜炎(FP)的易感因素、诊治和转归。方法回顾分析2000年1月～2005年11月期间中山大学附属第一医院肾内科收治的CAPD相关性真菌性腹膜炎的临床表现、病源菌、治疗、转归,并与同期收治的革兰氏阳性(G^+)球菌、革兰氏阴性(G^-)杆菌腹膜炎进行分组对比。结果腹膜透析相关性腹膜炎205例,其中真菌性腹膜炎20例(9．76%)；真菌性腹膜炎组、G^+球菌组、G^-杆菌组3组间的发病年龄、性别、血白细胞计数、透出液细胞计数、开始透析时间差异无统计学意义(P＞0．05),真菌性腹膜炎组腹部压痛、反跳痛的发生率显著高于其余两组(P＜0．05)；17例(85%)患者1月内有腹腔/全身系统使用抗生素史：真菌性腹膜炎组6例(30%)死亡,其余14例转血液透析,死亡率及腹膜透析退出率显著高于其余两组(P＜0．05)。结论腹腔/全身使用抗生素是腹膜透析相关真菌性腹膜炎发生的高危因素,真菌性腹膜炎临床症状较重,预后不良,确诊后早期拔管可能可以降低死亡率。Objective To investigate risk factors, clinical characteristics, and outcome of peritoneal dialysis （PD） related fungal peritonitis （FP）. Methods Retrospectively reviewed FP episodes for last five years in our hospital. The clinical characteristics, pathogens, treatment modalities, and outcomes were analyzed and compared with those of gram positive and gram negative bacterial peritonitis. Results Two hundred and five PD related peritonitis episodes were reviewed, of them 20 were FP（9.76%）.The age, gender, WBC count in effluent and blood, and mean duration of PD did not show significant difference in FP and bacterial groups （P〉0.05）. However, the occurance of abdominal pain and rebound was obviously higher in FP episodes than in bacterial episodes（P〈0.05）. Eighty-five percent of FP episodes had a history of bacterial peritonitis and/or antibiotic use within i month before FP. As a result, six patients （30%） died, the other 14 transferred to maintenance hemodialysis（HD）, none was able to remain on PD. The mortality and PD technique failure in FP group were significantly higher than that in bacterial groups（P〈0.05）. Conclusion The risk factors for FP identified in this study include the use of antibiotics and occurrence of bacterial peritonitis. FP is associated to severe manifestation, poor prognosis and higher mortality. Early catheter removal may help to decrease the mortality.

关 键 词：腹膜透析 真菌性腹膜炎 

分 类 号：R45[医药卫生—治疗学]