影响腹膜透析患者发生腹膜炎的相关因素分析  

Analysis of related factors influencing the incidence of peritonitis in peritoneal dialysis patients

作　　者：高丹[1] 余沛 赵子豪 刘东伟[1] 刘章锁[1] 路漫漫 卢利倩 孙小惠 GAO Dan;YU Pei;ZHAO Zi-hao;LIU Dong-wei;LIU Zhang-suo;LU Man-man;LU Li-qian;SUN Xiao-hui(Department of Nephrology,the First Affiliated Hospital of Zhengzhou University,Zhengzhou 450052,China)

机构地区：[1]郑州大学第一附属医院肾内科,河南郑州450052

出　　处：《中国实用内科杂志》2021年第7期619-623,共5页Chinese Journal of Practical Internal Medicine

基　　金：河南省高等学校重点科研项目计划(20A320075)。

摘　　要：目的探讨腹膜透析(PD)患者发生腹膜炎的影响因素。方法回顾分析2018年1月1日至2020年8月31日在郑州大学第一附属医院规律复查的PD患者的临床资料,根据是否发生腹膜透析相关性腹膜炎(PDAP)将其分为腹膜炎组和对照组,比较2组患者的临床资料,分析PD患者发生腹膜炎的影响因素,绘制受试者工作特征曲线,评估中性粒细胞与淋巴细胞比值(NLR)、白蛋白等因素对PD患者发生腹膜炎的预测价值;根据腹膜炎组患者的预后情况将其分为治愈组、复发组和退出组,比较3组之间临床指标的差异,分析腹膜炎患者治疗失败的影响因素。结果共纳入患者260例,其中腹膜炎组102例,对照组158例,经多因素logisti分析显示:NLR(OR 1.929,95%CI 1.418~2.625)是腹膜透析患者发生腹膜炎的危险因素,血磷(OR 0.462,95%CI 0.336~0.634)、尿酸(OR 0.658,95%CI 0.487~0.890)、白蛋白(OR 0.674,95%CI 0.497~0.913)是保护因素。ROC曲线显示,NLR水平升高是预测腹膜透析患者发生腹膜炎的重要指标(AUC 0.717,P=0.000)。低白蛋白水平是导致患者治疗失败的危险因素。结论NLR水平是PD患者发生腹膜炎的危险因素,血磷、尿酸、白蛋白是其保护因素,低白蛋白水平是导致患者治疗失败的危险因素,可为临床上防治PDAP提供思路和依据。Objective To investigate the risk factors of peritonitis in patients with peritoneal dialysis.Methods Peritoneal dialysis patients admitted to the Department of Nephrology,The First Affiliated Hospital of Zhengzhou University between January 1,2018 and August 31,2020 and followed up regularly for a long period of time were recruited in this study.Patients were divided into the peritonitis group and the control group.The relationship between clinical features,and laboratory examination was analyzed in the two groups.Analyze the influencing factors of peritonitis in PD patients.Receiver Operating Characteristic curve was drawn to evaluate the predictive value of neutrophil-to-lymphocyte ratio(NLR),albumin and other factors for peritonitis in peritoneal dialysis patients.According to the prognosis of patients in peritonitis group,they were divided into cure group,recurrence group and withdrawal group.The differences in clinical indicators between the three groups were compared,and the factors affecting the treatment failure of peritonitis patients were analyzed.Results A total of 260 patients were included,including 102 in the peritonitis group and 158 in the control group.Multivariate Logistic analysis showed that NLR(OR=1.929,95%CI 1.418-2.625)was a risk factor for peritonitis in PD patients,and serum phosphorus(OR=0.462,95%CI 0.336-0.634),uric acid(OR=0.658,95%CI 0.487-0.890),albumin(OR=0.674,95%CI 0.497-0.913)were protective factors.ROC curve showed that elevated NLR level was an important indicator for predicting peritonitis in PD patients(AUC=0.717,P=0.000).Hypoalbuminemia is a risk factor leading to treatment failure in patients.Conclusion NLR level is a risk factor for peritonitis in PD patients,and serum phosphorus,uric acid and albumin are protective factors.Hypoalbuminemia is a risk factor leading to treatment failure in patients.Improving the nutritional status of PD patients can prevent the occurrence of peritonitis,which can provide a train of thought and basis for clinical prevention and treatment of

关 键 词：腹膜透析 腹膜透析相关性腹膜炎 影响因素 

分 类 号：R459.5[医药卫生—治疗学]