长腹膜透析龄患者首次腹膜炎的临床特征及治疗转归:基于4家医院625例患者数据  

Clinical characteristics and treatment outcomes of first peritonitis in patients receiving long-term peritoneal dialysis:a multicenter study

作　　者：赵晶 杨立明[2] 朱学研[3] 张晓暄 李忻阳 刘师辰 庄小花[1] 周文华[1] 罗萍[1] 崔文鹏[1] ZHAO Jing;YANG Liming;ZHU Xueyan;ZHANG Xiaoxuan;LI Xinyang;LIU Shichen;ZHUANG Xiaohua;ZHOU Wenhua;LUO Ping;CUI Wenpeng(Department of Nephrology,Second Hospital of Jilin University,Changchun 130041,China;Department of Nephrology,Second Division of First Hospital of Jilin University,Changchun 130031,China;Department of Nephrology,Jilin Central Hospital,Jilin 132011,China;Department of Nephrology,Jilin FAW General Hospital,Changchun 130011,China)

机构地区：[1]吉林大学第二医院肾病内科,吉林长春130041 [2]吉林大学第一医院二部肾病内科,吉林长春130031 [3]吉林市中心医院肾病内科,吉林吉林132011 [4]吉林省一汽总医院肾病内科,吉林长春130011

出　　处：《南方医科大学学报》2020年第12期1740-1746,共7页Journal of Southern Medical University

基　　金：吉林省卫生厅课题(2018FP031)。

摘　　要：目的探讨长腹膜透析龄患者首次发生腹膜透析相关性腹膜炎(PDAP)的临床特点及治疗转归。方法回顾性收集2013~2019年期间在吉林省4家三甲医院首次发生PDAP的所有患者资料。根据发生首次PDAP时的透析龄是否大于36个月,将研究对象分为长透析龄组(≥36个月)和短透析龄组(<36个月)。比较两组患者首次PDAP的临床资料、治疗结果及转归。结果本研究共纳入625例PDAP患者,长透析龄组93例,短透析龄组532例。在发生首次PDAP时,长透析龄组患者血红蛋白明显高于短透析龄组,而肾小球滤过率明显低于短透析龄组(P<0.05);长透析龄组较短透析龄组更易感染革兰阴性菌(P<0.05)。长透析龄组的初始治疗有效率(P=0.009)及完全治愈率(P=0.018)均低于短透析龄组,而拔管率高于短透析龄组(P=0.017)。多因素Logistic回归提示,长透析龄导致首次PDAP拔管及治疗失败的风险分别是短透析龄的3.05倍(95%CI:1.35-6.91,P=0.008)和2.81倍(95%CI:1.45-5.44,P=0.002)。真菌及混合菌感染是长透析龄患者首次PDAP治疗失败的独立危险因素(OR:45.40,95%CI:1.488-1385.5,P=0.029;OR:16.50,95%CI:1.106-246.123,P=0.042)。而两组患者在维持PD、技术失败和全因死亡方面无统计学差异,进一步进行多因素Cox回归发现,长透析龄并不是PDAP患者技术失败(OR:1.36,95%CI:0.84-2.19,P=0.206)或全因死亡(OR:1.51,95%CI:0.97-2.35,P=0.068)的独立危险因素。结论长透析龄患者首次发生PDAP时易发生革兰阴性菌感染,并且治疗效果较短透析龄患者差,但对于长期转归方面无明显影响。长透析龄是首次PDAP拔管和治疗失败的独立危险因素。真菌及混合菌感染是长透析龄患者首次PDAP治疗失败的独立危险因素。Objective To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis(PDAP)in patients receiving long-term peritoneal dialysis.Methods The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively.According to the duration of dialysis,the patients were divided into long-term(≥36 months)and short-term(<36 months)dialysis groups for comparison of the clinical data,treatment outcomes and long-term prognostic events.Results A total of 625 patients with PDAP were enrolled,including 93 on long-term and 532 on short-term dialysis.Compared with those on short-term dialysis,the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred(P<0.05),were more susceptible to gram-negative bacterial infections(P<0.05),and had significantly lower initial treatment response rate(P=0.009)and complete cure rate(P=0.018)and higher extubation rate(P=0.017).Multivariate logistic regression analysis showed that in patients on long-term dialysis,the risks of extubation and treatment failure for the first episode of PDAP were 3.05 times(OR:3.05,95%CI:1.35-6.91,P=0.008)and 2.81 times(OR:2.81,95%CI:1.45-5.44,P=0.002)those in patients with short-term dialysis,respectively.Fungal infection(OR:45.40,95%CI:1.488-1385.5,P=0.029)and mixed bacterial infection(OR:16.50,95%CI:1.106-246.123,P=0.042)were independent risk factors for treatment failure of the first episode of PDAP in patients on long-term dialysis.Maintenance peritoneal dialysis,technical failure,or all-cause mortality did not differ significantly between the two groups.Multivariate Cox regression analysis suggested that long-term dialysis was not an independent risk factor for technical failure(OR:1.36,95%CI:0.84-2.19,P=0.206)or all-cause mortality(OR:1.51,95%CI:0.97-2.35,P=0.068)in patients with PDAP.Conclusion Compared with those on sh

关 键 词：长透析龄 腹膜透析 腹膜炎 

分 类 号：R692.5[医药卫生—泌尿科学] R572.2[医药卫生—外科学]