复发和重现性腹膜透析相关腹膜炎的临床特点及转归  

Clinical characteristics and outcomes of relapse and repeat peritonitis related to peritoneal dialysis

作　　者：段丽萍[1,2,3] 董捷[1,2] 

机构地区：[1]北京大学第一医院肾内科 [2]北京大学肾脏病研究所 卫生部重点实验室 教育部慢性肾脏病防治重点实验室(北京大学),北京100034 [3]河北邯郸市中心医院

出　　处：《中国血液净化》2015年第2期65-69,共5页Chinese Journal of Blood Purification

摘　　要：目的探讨复发和重现性腹膜透析相关性腹膜炎的临床特点及转归。方法于2008年1月~2014年4月期间,前瞻性收集北京大学第一医院273例患者发生腹膜透析相关性腹膜炎432例次,据第2次腹膜炎发作的特点分为复发/重现组,并与对照组患者的基本资料、临床特点、致病菌和转归进行比较和分析。结果复发/重现性腹膜炎的主要致病菌为凝固酶阴性葡萄球菌,为66.7%,较对照组29.5%明显增高（χ2=12.969,P〈0.001）,其中又以表皮葡萄球菌居多。患者近期及远期转归分析中发现,复发/重现组再次发生腹膜炎风险较对照组明显增高,分别为20.8%vs.1.7%（P=0.001）;37.5%vs.15.3%（P=0.008）。在近期及远期转归中死亡率、转血液透析率及维持腹膜透析2组间无明显差异。结论复发和重现性腹膜炎的致病菌主要为凝固酶阴性葡萄球菌,其中表皮葡萄球菌最多,复发和重现组再次发生腹膜炎风险较对照组明显增高,在临床上应引起重视。Objective To investigate the clinical characteristics and outcomes of relapse/repeat peritoni- tis related to peritoneal dialysis. Methods A total of 432 episodes of peritonitis between Jan. 2008 and Apr. 2014 were prospectively analyzed. According to the characteristics of the second-episode peritonitis, the epi- sodes were divided into relapse/repeat group and control group. Baseline clinical characteristics, pathogenic bacteria and outcomes were compared between the two groups. Results Most relapse/repeat peritonitis were caused by coagulase negative staphylococcus species especially by epidermis staphylococcus, accounting for 66.7% episodes in relapse/repeat group but for 29.5% episodes in control group （P〈0.001）. Analyses of the short-term and long-term outcomes showed that the risk for developing subsequent peritonitis was higher in re- lapse/repeat group than in control group （20.8% vs. 1.7 %, P=0.001 for short-term outcome; 37.5% vs. 15.3 %, P=0.008 for long-term outcome）, but the mortality rate, the ratio of patients changed to hemodialysis, and the ratio of patients remaining on peritoneal dialysis were similar between the two groups. Conclusions Coagulase negative staphylococcus especially staphylococcus epidermidis was the most important pathogen in relapse/repeated peritonitis. More attention should be paid to the relapse/repeat peritonitis patients, who were at the high risk for developing subsequent peritonitis.

关 键 词：腹膜透析 腹膜炎 复发 重现 

分 类 号：R459.5[医药卫生—治疗学]