腹膜透析相关性腹膜炎预后的危险因素研究  

Risk factor of prognosis following peritoneal dialysis-related peritonitis

作　　者：晏焕青 王鹤定 朱彤莹[1,3] YAN Huanqing;WANG Heding;ZHU Tongying(a Department of Nephrology,1b.Clinical laboratory,Renhe hospital（Huashan Hospital North,Baoshan Branch,Fudan University）,Shanghai 200431,China;Department of Nephrology,Huashan Hospital,Fudan University,Shanghai 200040,China)

机构地区：[1]上海市宝山区仁和医院(复旦大学附属华山北院宝山分院)肾脏科,上海200431 [2]上海市宝山区仁和医院(复旦大学附属华山北院宝山分院)检验科,上海200431 [3]复旦大学附属华山医院肾内科,上海200040

出　　处：《内科理论与实践》2018年第3期165-169,共5页Journal of Internal Medicine Concepts & Practice

基　　金：宝山卫生青年医学人才培养计划(项目编号:bswsyq-2015-A06)

摘　　要：目的 :探讨腹膜透析相关性腹膜炎患者预后的危险因素。方法 :采用回顾性分析方法 ,收集2007年1月至2016年12月期间发生的腹膜透析相关性腹膜炎患者临床资料,根据患者预后将其分为治愈组、复发组和拔管/死亡组。采用Logistic回归法分析影响患者预后的相关因素。结果:184例腹膜透析患者共发生312例次细菌性腹膜炎,其中革兰阳性菌感染144例次,阴性菌83例次,多种微生物感染19例次,培养阴性66例次。与治愈组相比,革兰阴性菌在复发组和拔管/死亡组比例均较高(P<0.01)。与治愈组和复发组相比,拔管/死亡组血清血红蛋白、白蛋白水平较低(P<0.01),C-反应蛋白(C-reactive protein,CRP)水平较高(P<0.01)。Logistic回归分析结果显示,血清CRP水平的升高是影响腹膜炎患者复发、再发、重现和拔管、死亡的独立危险因素。结论:全身炎症反应状态是影响腹膜炎患者预后的危险因素。Objective To investigate the risk factor predicting the outcome of peritoneal dialysis（PD）-related peritonitis. Methods All the episodes of PD-related bacterial peritonitis during Jan 2007 to Dec 2016 in our center were retrospectively reviewed. Clinical and laboratory parameters at the onset of peritonitis were recorded. Patients with episodes of PD-related peritonitis were divided into three groups according to the outcome： complete cure group, relapse group and peritonitis-related catheter removal/death group. Results There were 184 continuous ambulatory PD（CAPD） patients with312 episodes of bacterial peritonitis, with 144 episodes of Gram-positive bacterial infection, 83 episodes of Gram-negative bacterial infection, 19 episodes of poly-microbial and 66 episodes with culture negative. Compared with complete cure group, Gram negative bacterial infection was more prevalent in relapse group and peritonitis-related catheter removal/death group. Furthermore, patients in peritonitis-related catheter removal/death group showed lower levels of hemoglobin and albumin（P〈0.01） and higher serum C-reactive protein（CRP）（P 〈0.01）. Logistic analysis indicated that increased CRP was an independent predictor both for CAPD patients with relapse of peritonitis and peritonitis-related catheter removal/death.Conclusions Increased CRP was a risk factor predicting relapse of peritonitis and peritonitis-related catheter removal/death in CAPD patients.

关 键 词：腹膜透析 腹膜炎 预后 危险因素 

分 类 号：R656.41[医药卫生—外科学]