难治性腹膜透析相关性腹膜炎发生的影响因素与风险评分模型研究  

Analysis of influencing factors and establishment of risk scoring model for refractory peritoneal dialysis-associated peritonitis

作　　者：邢虎[1] 张亚峰 刘大东[2] 尹江宁[3] 吴洪敏[1] 周玥[4] XING Hu;ZHANG Ya-feng;LIU Da-dong;YIN Jiang-ning;WU Hong-min;ZHOU Yue(Affiliated Hospital of Jiangsu University,Zhenjiang,Jiangsu 212000,China)

机构地区：[1]江苏大学附属医院感染管理科,江苏镇江212000 [2]江苏大学附属医院重症监护室,江苏镇江212000 [3]江苏大学附属医院急诊科,江苏镇江212000 [4]南京医科大学附属南京医院(南京市第一医院)血液净化中心,江苏南京210006

出　　处：《中华医院感染学杂志》2019年第20期3175-3179,共5页Chinese Journal of Nosocomiology

基　　金：镇江市科技计划基金资助项目(SH2018054);江苏大学附属医院人才启动基金资助项目(jdfyRC2018012)

摘　　要：目的分析难治性腹膜透析相关性腹膜炎发生的影响因素,构建风险评分模型,为临床治疗和预防提供参考依据。方法收集南京医科大学附属南京医院2010年4月-2019年2月血液净化中心临床诊断为腹膜透析相关性腹膜炎(Peritoneal dialysis associated peritonitis,PDAP)患者129例为研究对象,根据临床病情进展分为难治性PDAP 30例、非难治性PDAP 99例,回顾性收集两组患者临床基线资料,归纳难治性PDAP发生的影响因素,建立风险评分模型。结果129例PDAP患者,发生难治性PDAP 30例,发生率为23.26%。腹膜透析透出液培养分离病原菌30株,革兰阳性菌13例占43.33%,革兰阴性菌10例占33.33%,真菌7例占23.33%。革兰阴性菌感染、存在并发症以及CRP是难治性PDAP发生的影响因素(P<0.05)。构建风险评分模型:革兰阴性菌感染(2分)、存在并发症(2分),CRP值1.34~22.6mg/L、23.6~58.8mg/L、62.4~123.5mg/L、124~358mg/L依次为0、1、2、3分,风险评分模型预测难治性PDAP的ROC曲线下面积为0.778(95%CI:0.696~0.846,P<0.05),最佳截断值为4分,灵敏度、特异度分别为60.00%、91.92%,约登指数为0.519。结论革兰阴性菌感染、存在并发症、CRP值较高是难治性PDAP发生的影响因素,构建的风险评分模型预测难治性PDAP准确度较好,临床应用价值较高。OBJECTIVE To analyze the influencing factors of refractory peritoneal dialysis-associated peritonitis,establish the risk scoring model and provide reference for clinical treatment and prevention.METHODS A total of 129patients with peritoneal dialysis-associated peritonitis(PDAP)were collected from the blood purification center in Nanjing First Hospital from Apr.2010to Feb.2019.According to the progress of the disease,30patients were classified as refractory PDAP and 99patients as non-refractory PDAP.The clinical baseline data of the two groups were retrospectively collected,and the suspected influencing factors of refractory PDAP were statistically analyzed,and a risk scoring model was established.RESULTSIn the 129patients with PDAP,30cases of refractory PDAP occurred,and the incidence rate was 23.26%.30strains of pathogens were cultured from the peritoneal dialysis effusion,including 13strains of Gram-positive bacteria(43.33%),10strains of Gram-negative bacteria(33.33%),and 7strains of fungi(23.33%).Multivariate analysis showed that Gram-negative bacterial infection,complications and CRP levels were independent influencing factors for refractory PDAP(P<0.05).Risk scoring model establishment:Gram-negative bacterial infection(2points),complications(2points),CRP values of 1.34 to 22.6mg/L,23.6to 58.8mg/L,62.4to 123.5mg/L,124to 358mg/L were set as 0,1,2,and 3,respectively.The risk scoring model predicted that the area under the ROC curve of refractory PDAP was 0.778(95%CI:0.696to 0.846,P<0.001),and the optimal cutoff value was 4points.The sensitivity and specificity were 60.00%and 91.92%,respectively,and the Yoden index was 0.519.CONCLUSIONGram-negative bacterial infection,complications,and high CRP values are independent influential factors for refractory PDAP.The constructed risk scoring model predicts refractory PDAP with high accuracy,and has a high value in clinical application.

关 键 词：腹膜透析 难治性腹膜透析相关性腹膜炎 影响因素 风险评分模型 

分 类 号：R656.4.1[医药卫生—外科学]