维持性腹膜透析患者并发真菌性腹膜炎的易感因素和结局分析  

The analysis of risk factors and outcomes of peritoneal dialysis-related fungal peritonitis

作　　者：李艺 郭佳 王竟爽 印苏培 赵景宏 黄云剑 LI Yi;GUO Jia;WANG Jingshuang;YIN Shupei;ZHAO Jinghong;HUANG Yunjian(Department of Nephrology,The Second Affiliated Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院肾内科,重庆400037

出　　处：《中国真菌学杂志》2021年第1期29-34,共6页Chinese Journal of Mycology

摘　　要：目的分析腹膜透析相关性真菌性腹膜炎(FP)发生率、致病菌、治疗情况和预后。方法回顾性分析2010年1月至2019年10月陆军军医大学第二附属医院腹膜透析中心发生的18例FP,选择与同期收治非真菌性腹膜炎113例比较,记录所有FP患者的临床资料,治疗方法和转归,分析FP发生的易感因素和结局。结果腹膜透析相关性腹膜炎共389例次,FP 18例次,占4.6%。其中白念珠菌6例(33.3%)、近平滑念珠菌5例(27.8%)、无名念珠菌3例(16.7%)、光滑念珠菌2例(11.1%)、热带念珠菌1例(5.6%)和克柔念珠菌(5.6%)1例。与非真菌性腹膜炎相比较,FP组腹透时间更长(P<0.001)、既往抗生素使用率高(P<0.001)、血浆白蛋白(ALB)更低(P<0.001)、C反应蛋白(CRP)更高(P<0.001)、甲状旁腺激素(PTH)和血磷(P)水平更高(P<0.001)。Logistic回归分析结果显示腹透时间越长、1个月内使用抗生素、低ALB和高CRP是发生FP的危险因素(P<0.05)。18例次FP中,14例患者拔管转血透(77.8%),4例患者死亡(22.2%),FP组腹膜透析技术失败率和死亡率明显高于BP组。结论腹透时间越长、既往使用抗生素、低ALB和高CRP是FP的易感因素。FP是腹膜透析的严重并发症,是导致技术失败的主要原因,确诊后早期拔管可降低死亡率。Objective To evaluate the incidence,pathogenic fungi,treatment and prognosis of peritoneal dialysis-associated fungal peritonitis(FP).Methods The clinical data of 18 cases of FP in the peritoneal dialysis center of the Second Affiliated Hospital of the Army Medical University from January 2010 to October 2019 were retrospective analyzed.The clinical data,treatment methods and outcomes of all FP patients were recorded and compared with those of 113 cases of no fungal peritonitis.Results Three hundred and eighty nine cases of peritoneal dialysis-related peritonitis were reviewed,FP accouted for 4.6%.There were 6 cases(33.3%)of Candida albicans,5 cases(27.8%)of Candida parapsilosis,3 cases(16.7%)of Candida famata,2 cases(11.1%)of Candida smooth,1 case of Candida tropical(5.6%)and 1 case of Candida krusei(5.6%).Compared to no fungal peritonitis group,The FP group showed the longer duration of peritoneal dialysis(P<0.001),higher rate of previous antibiotic use(P<0.001),lower serum albumin(P<0.001),higher c-reactive protein(P<0.001),higher intact parathyroid hormone(P<0.001)and higher phosphorus(P<0.001).Logistic regression analysis showed that the longer duration of peritoneal dialysis,antibiotic use within 1 month,hypoalbuminemia and high c-reactive protein were risk factors for FP(P<0.05).Among the 18 FP patients,14 patients(77.8%)were removed the catheter to maintenance hemodialysis and 4 patients(22.2%)died.The technique failure rate of peritoneal dialysis and mortality in FP group was significantly higher than that in no fungal peritonitis group.Conclusion Long term peritoneal dialysis,previous use of antibiotics,hypoalbuminemia and high c-reactive protein were high risk factors for FP.FP was a serious complication of peritoneal dialysis and a major cause of technical failure.Early catheter removal after diagnosis could reduce the mortality of FP.

关 键 词：腹膜透析 真菌性腹膜炎 抗真菌治疗 易感因素 

分 类 号：R459.5[医药卫生—治疗学] R519.3[医药卫生—临床医学]