腹膜透析相关性腹膜损伤CT影像学特征变化规律及影响因素的研究  

The changes of abdominal CT image and their influence factors in peritoneal dialysis related peritoneal injury

作　　者：杨杰 肖菲 陈佳 侯世会 王毅 张伟国 龚文姜 余艳 蔡明玉 何娅妮 YANG Jie;XIAO Fei;CHEN Jia;HOU Shi-hui;WANG Yi;ZHANG Wei-guo;GONG Wen-jiang;YU Yan;CAI Ming-yu;HE Ya-ni(Department of Nephrology,Daping Hospital,Army Medical University,Chongqing 400042,China;Department of Radiology,Daping Hospital,Army Medical University,Chongqing 400042,China)

机构地区：[1]陆军军医大学大坪医院特色医学中心肾内科,重庆400016 [2]陆军军医大学大坪医院特色医学中心放射科,重庆400016

出　　处：《中国血液净化》2019年第12期809-813,共5页Chinese Journal of Blood Purification

基　　金：重庆市社会民生课题(cstc2018jscx-msybX0013)。

摘　　要：目的明确腹膜透析相关性腹膜损伤CT影像学特征变化规律及影响因素。方法选择陆军军医大学大坪医院特色医学中心肾内科腹膜透析中心规律随访的持续性非卧床腹膜透析的患者173例行全腹部CT扫描,对符合入排标准的109例患者评估腹膜损伤,并分析腹腔CT影像学评价指标与年龄、透析龄、原发病、腹膜转运类型、糖暴露量、腹膜炎次数等临床指标的关系。Logistic回归方法分析腹膜增厚及网膜结构异常的影响因素、腹膜炎次数与腹膜增厚及网膜结构异常发生风险的关系。结果腹部CT扫描109例患者发现壁层腹膜增厚70例(64.22%),网膜结构异常63例(57.8%)。Logistic回归分析显示:腹膜炎发生次数及腹膜炎累积评分是腹膜增厚及网膜结构异常独立危险因素。风险预测模型提示:每发生1次腹膜炎,腹膜增厚发生风险增加4.364倍(OR=4.364,95%CI:1.886~10.098),网膜结构异常发生风险增加5.393倍(OR=5.393,95%CI:2.204~13.197)。结论腹膜透析患者壁层腹膜增厚和网膜结构改变是腹膜进行性损伤影像学主要特征,腹膜炎是导致腹膜进行性损伤的主要危险因素。腹腔CT检查可以全面了解腹膜透析腹膜损伤的特征和程度,有助于早期诊断腹膜损伤。Aim To understand the changes of abdominal CT image and their influence factors in continuous ambulatory peritoneal dialysis(CAPD)patients with peritoneal injury.Methods A total of 173 CAPD patients regularly followed up in our center were subjected to abdominal CT scan.The relationship between the abnormal CT image indices and the clinical indices of age,dialysis age,primary disease,type of peritoneal transport,glucose exposure and number of peritonitis episodes were analyzed in 109 patients who met the criteria of peritoneal injury.Logistic regression was used to evaluate the influence factors for increased thickness of peritoneum and abnormal omental structure as well as the relationship between the number of peritonitis episodes and the increased thickness of peritoneum and abnormal omental structure.Results In the 109 patients with peritoneal injury,70 had increased thickness of parietal peritoneum(64.22%)and 63 showed abnormal omental structure(57.8%)on abdominal CT scan.Multivariate regression analyses revealed that the episode number and the cumulative score of peritonitis were the independent risk factors for increased thickness of peritoneum and abnormal omental structure.The risk prediction model suggested that the risks of peritoneal thickening and abnormal omental structure increased 4.364(OR=4.364,95%CI 1.886~10.098)and 5.393(OR=5.393,95%CI 2.204~13.197)times respectively after every episode of peritonitis.Conclusions The increased thickness of parietal peritoneum and abnormal omentum structure were the main imaging features in CAPD patients with progressive peritoneal injury.The major risk factor for progressive peritoneal injury was peritonitis.Abdominal CT scan is useful to comprehensively investigate the characteristics and extent of peritoneal injury and to diagnose peritoneal injury earlier.

关 键 词：腹膜透析 腹膜损伤 影像学 变化规律 影响因素 

分 类 号：R459.5[医药卫生—治疗学]