探讨腹膜透析相关性腹膜炎不同转归患者的临床特点  

Clinical characteristics of peritoneal dialysis-related peritonitis with different outcomes

作　　者：严月华 杨春慧 纪天蓉[1] 鲍运霞[1] 任野萍[1] 孔凡武[1] YAN Yue-hua;YANG Chun-hui;JI Tian-rong;BAO Yun-xia;REN Ye-ping;KONG Fan-wu(Department of Nephrology,The Second Affiliated Hospital of Harbin Medical University,Harbin 150000,China)

机构地区：[1]哈尔滨医科大学附属第二医院肾内科,哈尔滨150000

出　　处：《中国血液净化》2020年第2期77-80,共4页Chinese Journal of Blood Purification

基　　金：黑龙江省卫生计生委科研课题(No.2017-053);黑龙江省博士后科学基金(LBH-Z18128)。

摘　　要：目的探讨腹膜透析相关性腹膜炎不同转归患者的临床特点,分析转归的影响因素。方法回顾性分析腹膜透析相关性腹膜炎患者的临床资料,对2004年1月~2018年12月于哈尔滨医科大学第二附属医院肾内科就诊的腹膜透析相关性腹膜炎患者的临床资料进行回顾性分析,比较腹膜炎治愈和退出(因腹膜炎转血液透析和死亡)患者的临床特征,记录患者因腹膜炎入院时首次化验结果。结果共纳入腹膜透析相关性腹膜炎180例,2组患者在年龄、性别、肾脏原发病、合并症、吸烟史及低钾血症患病率等方面无显著差异。与治愈组患者相比,退出患者血浆白蛋白浓度更低[(23.48±6.43)g/L比(26.84±7.61)g/L,t=2.953,P=0.004],贫血更为严重,血红蛋白[(87.48±19.34)g/L比(93.27±17.50)g/L,t=2.028,P=0.044],真菌的感染率更高,退出的患者转诊率更高(36.10%比18.50%,χ~2=6.747,P=0.009),退出组患者透析龄[36.00(12.66,50.00)]月高于治愈组患者透析龄[24.00(9.00,42.00)]月,Z=2.368,P=0.018。结论营养状态,贫血,就诊方式,多次发生腹膜炎及透析龄影响腹膜透析相关性腹膜炎患者的预后。及时改善患者的营养状态、纠正贫血有利于改善患者腹膜炎的预后,多因素Logistic回归分析结果显示长透析龄、多次发生腹膜炎、转诊是腹膜炎预后不良的独立预测因子。Objective To analyze the clinical characteristics of peritoneal dialysis(PD)-related peritonitis with different outcomes and to explore the risk factors for PD-related peritonitis.Methods We retrospectively analyzed the clinical data of PD patients with PD-related peritonitis hospitalized from Jan.2004 to Dec.2018 in The Second Affiliated Hospital of Harbin Medical University.They were divided into cure group and exit group(change to hemodialysis or death).Their clinical characteristics were compared between the two groups.Results A total of 180 PD patients with PD-related peritonitis were included in this study.There were no significant differences in age,gender,smoking history,complications and prevalence of hypokalemia between the two groups.Compared to cure group,patients in exit group had lower plasma albumin(23.48±6.43 g/L vs.26.84±7.61 g/L,t=2.953,P=0.004)and hemoglobin(87.48±19.34 g/L vs.93.27±17.50 g/L,t=2.028,P=0.044),higher fungal infection rate,higher referral rate(36.10%vs.18.50%,χ~2=6.747,P=0.009),and longer dialysis age(36.00(12.66,50.000)months vs.24.00(9.00,42.00)months,Z=2.368,P=0.018).Multivariate logistic regression showed that longer dialysis age,referral to other department and relapse of peritonitis were the independent predictors for poor prognosis.Conclusion Nutritional status,anemia,referral to other department,relapse of peritonitis and dialysis age were associated with the prognosis in PD patients with peritonitis.Improvement of nutritional status,treatment of anemia will ameliorate the prognosis of PD patients with peritonitis.

关 键 词：腹膜透析相关性腹膜炎 营养状态 危险因素 转诊 

分 类 号：R459.5[医药卫生—治疗学]