长腹膜透析龄患者首次腹膜炎的临床特征分析  

Clinical features of the first episode of peritonitis in patients with long-term peritoneal dialysis

作　　者：易春燕[1] 阳晓[1] 郭群英[1] 姜宗培[1] 林建雄[1] 蔡金辉[1] 余学清[1] 

机构地区：[1]中山大学附属第一医院肾内科,广州510080

出　　处：《中华肾脏病杂志》2011年第10期715-719,共5页Chinese Journal of Nephrology

摘　　要：目的探讨长腹膜透析龄患者首次腹膜炎的临床特征。方法回顾性分析2000年至2009年发生首次腹膜透析相关性腹膜炎患者315例，按发生首次腹膜炎时腹膜透析龄分为两组：A组（〈36个月）261例，B组（≥36个月）54例。对两组相关临床资料进行比较。结果入组患者平均年龄（55．7±15．9）岁，男性占61．0％，基础肾脏病主要为慢性肾小球肾炎（54．6％），其次为糖尿病肾病（20．6％）。发病时A组中位腹膜透析龄8．4个月；B组中位腹膜透析龄49．4个月。发生腹膜炎时，两组间血红蛋白、血清白蛋白和血钾水平差异无统计学意义，但两组血清白蛋白和血钾水平均低于正常值范围。两组腹膜炎最常见诱因均为换液操作接触污染（48．2％比45．2％）。剔除未做透出液细菌培养患者，两组革兰阳性菌分布情况差异无统计学意义，但B组革兰阳性菌对甲氧西林的耐药率显著高于A组（46．2％比19．1％，P=0．035）。两组革兰阴性菌分布情况及超广谱耐药菌比例差异无统计学意义。B组真菌感染比例显著高于A组（17．8％比6．4％，P=0．011）。B组初始治疗有效率及临床结局显著差于A组（均P〈0．05）。两组间革兰阴性菌及真菌腹膜炎治疗失败率差异无统计学意义，但B组革兰阳性菌、无菌生长及未作培养腹膜炎治疗失败率显著高于A组（23．1％比1．5％、46．2％比6．7％、22．2％比0％，均P〈0．05）。Logistic回归分析整体资料显示，真菌感染、发病时较长腹膜透析龄、较低血清白蛋白水平为首次腹膜透析相关性腹膜炎治疗失败的独立影响因素（P=0．000、0．002、0．025）。结论长腹膜透析龄患者首次腹膜炎的临床结局较短腹膜透析龄患者差。较高真菌和其他耐药菌感染率以及营养不良是影响其疗效的主要因素。Objective To investigate the clinic features in long-term peritoneal dialysis （PD） patients with the first episode of dialysis-related peritonitis and the risk factors. Methods In this retrospective study, 315 PD patients who experienced the first episode of peritonitis from January 2000 to December 2009 were recruited. All the patients were divided into two groups according to the duration of PD treatment： group A （〈36 months, n=261） and group B （≥36 months, n =54）. Clinical information including demographic character, primary renal disease, biochemical laboratory data, etiology data, treatment methods and clinical outcomes was collected. Results Among 315 patients, 61.0% was male and the mean age was （55.7±15.9） years. The primary renal diseases were glomerulonephritis （54.6%）, and then diabetic nephropathy （20.6%）. The median duration of PD was 8.4 months in group A and 49.4 months in group B. No significant difference was found in serum potassium and serum albumin levels between the two groups, but the levels of both indexes were below normal range. The most common cause of peritonitis was connection contamination in both groups （48.2% vs 45.2% ）. There were no significant differences in the incidence of gram-positive and gram-negative peritonitis between the two groups, but group B had higher drug resistance rate in gram-positive peritonitis than that in group A （46.2% vs 19.1%, P=0.035）. The incidence of fungus infection in group B was significantly higher than that in group A （17.8% vs 6.4%, P=0.011）. Treatment response was lower in group B than that in group A （P=0.000） and the clinical outcome in group B was worse than that in group A （P=0.000）. Compared to gram-positive peritonitis, culture-negative peritonitis and peritonitis without culture, the incidences of treatment failure in group B were higher than those in group A （23.1% vs 1.5%, 46.2% vs 6.7%, 22.2% vs 0%, all P〈0.05）. By Logistic regression analysis, fungus infection, longer duration of

关 键 词：腹膜透析 腹膜炎 长透析龄 临床特征 

分 类 号：R459.5[医药卫生—治疗学]