早发性腹膜透析相关性腹膜炎的临床特点与治疗转归:一项多中心回顾性研究  

Clinical features and treatment outcomes of early-onset peritoneal dialysis-associated peritonitis:a multi-center retrospective study

作　　者：陈洋洋 杨立明[2] 朱学研[3] 张晓暄 赵巧 庄小花[1] 罗萍[1] 崔文鹏[1] Chen Yangyang;Yang Liming;Zhu Xueyan;Zhang Xiaoxuan;Zhao Qiao;Zhuang Xiaohua;Luo Ping;Cui Wenpeng(Department of Nephrology,the Second Hospital of Jilin University,Changchun 130041,China;Department of Nephrology,Second Part of the 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,长春130041 [2]吉林大学第一医院二部肾病内科,长春130031 [3]吉林市中心医院肾病内科,吉林132011 [4]吉林省一汽总医院肾病内科,长春130011

出　　处：《中华肾脏病杂志》2020年第12期911-917,共7页Chinese Journal of Nephrology

基　　金：吉林省卫生厅项目(2017Q024、2018FP031)。

摘　　要：目的探讨早发性腹膜透析相关性腹膜炎(early-onset peritoneal dialysis-associated peritonitis,EOP)的临床特点和治疗转归。方法回顾性收集2013—2018年间在吉林省4家三甲医院就诊的腹膜透析相关性腹膜炎(PDAP)患者的临床资料,按照首次PDAP发生时透析龄,将研究对象分为EOP组(≤12个月)和迟发性PDAP(LOP)组(>12个月),比较两组患者的临床资料、致病菌、当次PDAP治疗结果及转归。结果共纳入575例患者,其中EOP组314例,女性152例(48.4%),年龄(56.53±15.57)岁;LOP组261例,女性144例(55.2%),年龄(56.61±14.42)岁。相较于LOP组,EOP组致病菌培养阴性的比例更高,链球菌感染的比例更低(均P<0.05),并且具有较高的初始治疗有效率、治愈率和较低的拔管率(均P<0.05)。多因素Logistic回归结果显示,EOP组比LOP组的治愈率高79%(OR=1.79,95%CI 1.13~2.82,P=0.012),拔管率低68%(OR=0.32,95%CI 0.15~0.66,P=0.002);Kaplan-Meier生存曲线显示,EOP组累积多发性PDAP、技术失败、全因死亡、复合终点(技术失败或全因死亡)发生率均高于LOP组(均P≤0.001);校正混杂因素后,多因素Cox比例风险回归分析显示,EOP组发生多发性PDAP、技术失败、全因死亡、复合终点(技术失败或全因死亡)的风险分别是LOP组的2.02倍(HR=2.02,95%CI 1.26~3.24,P=0.004)、2.53倍(HR=2.53,95%CI 1.58~4.05,P<0.001)、2.66倍(HR=2.66,95%CI 1.70~4.16,P<0.001)和2.48倍(HR=2.48,95%CI 1.78~3.43,P<0.001)。结论首次发生PDAP类型为早发者当次治疗效果好,但长期预后差。Objective To explore the clinical characteristics and treatment outcomes of early-onset peritoneal dialysis-associated peritonitis(EOP).Methods Clinical data of patients with peritoneal dialysis-associated peritonitis(PDAP)from 2013 to 2018 in four tertiary hospitals of Jilin province were collected retrospectively.According to whether the dialysis time of the first PDAP was≤12 months or not,the subjects were divided into EOP group(≤12 months)and late-onset PDAP(LOP)group(>12 months),and clinical data,pathogenic bacteria,treatment outcomes of PDAP and prognosis of two groups were compared.Results A total of 575 patients were included,including 314 patients in the EOP group,with age of(56.53±15.57)years and 152 females(48.4%),and 261 patients in the LOP group,with age of(56.61±14.42)years old and 144 females(55.2%).Compared with LOP group,the proportion of pathogenic bacteria culture-negative in EOP group was higher and the proportion of streptococcal infection was lower(both P<0.05).The initial treatment efficiency and cure rate of EOP group were higher than that of LOP group,while the extubation rate was lower than that of LOP group(all P<0.05).Multivariate logistic analysis indicated that the cure rate of EOP was 79%higher than that of LOP(OR=1.79,95%CI 1.13-2.82,P=0.012),and the extubation rate of EOP was 68%lower than that of LOP(OR=0.32,95%CI 0.15-0.66,P=0.002).Kaplan-Meier survival curve showed that the cumulative rates of multiple PDAP,technical failure,all-cause death,and composite end points(technical failure or all-cause death)in EOP group were higher than those in LOP group(P≤0.001).After correcting for confounding factors by multivariate Cox proportional hazard regression,the risk of multiple PDAP,technical failure,all-cause death,and composite endpoint(technical failure or all-cause death)in EOP group was 2.02 times(HR=2.02,95%CI 1.26-3.24,P=0.004),2.53 times(HR=2.53,95%CI 1.58-4.05,P<0.001),2.66 times(HR=2.66,95%CI 1.70-4.16,P<0.001)and 2.48 times(HR=2.48,95%CI 1.78-3.43,P<0.001)of LOP group

关 键 词：腹膜透析 腹膜炎 预后 危险因素 

分 类 号：R572.2[医药卫生—消化系统] R459.5[医药卫生—内科学]