腹膜透析相关腹膜炎危险因素分析  

Risk factor analysis of peritoneal dialysis associated peritonitis

作　　者：万程[1] 杨聚荣[1] 张炜炜[1] 杨杰[1] 林利容[1] 蔡明玉[1] 何娅妮[1] 

机构地区：[1]第三军医大学大坪医院野战外科研究所肾脏内科,重庆400042

出　　处：《临床内科杂志》2014年第4期240-242,共3页Journal of Clinical Internal Medicine

摘　　要：目的 研究腹膜透析患者腹膜炎发生危险因素,以此定位高危人群,为临床个体化干预治疗提供指导.方法 收集单中心维持性腹膜透析患者266例,以是否发生腹膜炎分为腹膜炎组和对照组.采用单因素和Logistic回归分析腹膜透析相关腹膜炎发生的操作及非操作危险因素,ROC曲线确定其最佳预测值.结果 腹膜炎组总体文化程度、透析龄显著低于对照组;而体质量指数、腹膜透析操作总误评分显著高于对照组.腹膜炎组在随访时血红蛋白及血浆白蛋白显著低于对照组,时间平均血浆白蛋白亦显著低于对照组.Logistic回归分析显示,随访血浆白蛋白＜28.95g/L、随访前白蛋白＜280.95 mg/L、时间平均血浆白蛋白＜29.78 g,/L、透析龄＜14.50个月,以及腹膜透析操作总误评分≥19.50分为腹膜透析相关腹膜炎发生的危险因素.结论 低白蛋白血症、较短透析龄,以及腹膜透析操作错误为腹膜透析相关腹膜炎发生的危险因素.临床可针对相关高危人群进行个体化干预,从而降低腹膜透析相关腹膜炎发生率,改善患者生活质量和预后.Objective To identify the risk factors for peritoneal dialysis（PD）-associated peritonitis,locating high risk group,providing guidance for individualized intervention.Methods A single centered,retrospective study was carried out to examine 266 PD patients,in which the patients with peritonitis served as peritonitis group,and without served as control group.All of the patients＇ data were collected,and the risk factors for PD-related peritonitis were analyzed with Logistic regression.Receiver operating characteristic curve was used to confirm the optimal predicted value of risk factor.Results The degree of education in peritonitis group was lower than control group,and duration of peritonitis-free time in peritonitis group were significant shorter than that in control group.But the BMI,and the misoperation score of peritonitis group was significant higher than control group.Peritonitis group had a significant lower hemoglobin and serum albumin concentration than those in control group during follow-up visit,and time-averaged serum albumin concentration showed the same trend.Variables identified to be risk factors of peritonitis by the Logistic regression included serum albumin ＜ 28.95 g/L,prealbumin ＜ 280.95 mg/L during follow-up visit,and time-averaged serum albumin ＜ 29.78 g/L,duration of PD ＜ 14.5 months,and score of misoperation ≥ 19.5.Conclusion Hypoalbuminemia,shorter duration after initiate PD,and misoperation are risk factors of PD-related peritonitis.Based on above findings,we can aim at high risk group to give individualized intervention earlier.

关 键 词：腹膜透析 腹膜炎 危险因素 

分 类 号：R459.5[医药卫生—治疗学]