难治性腹膜透析相关性腹膜炎发生的影响因素及拔管风险预测  

Influence of refractory peritoneal dialysis⁃associated peritonitis and the prediction of extubation risk

作　　者：王敏[1] 邢玲玲[1] 张春霞[1] 卢素玉[1] 吴晓磊[1] 许龙云 蒋祖娟 李绍梅[1] 裴华颖[1] WANG Min;XING Lingling;ZHANG Chunxia;LU Suyu;WU Xiaolei;XU Longyun;JIANG Zujuan;LI Shao-mei;PEI Huaying(Department of Nephrology,the Second Hospital of Hebei Medical University,Shijiazhuang 050000,China)

机构地区：[1]河北医科大学第二医院肾内科,石家庄050000

出　　处：《实用医学杂志》2023年第9期1143-1147,共5页The Journal of Practical Medicine

基　　金：河北省卫健委医学科学研究课题计划项目(编号:20210062)。

摘　　要：目的分析难治性腹膜透析相关性腹膜炎(refractory peritoneal dialysis⁃associated peritonitis,rPDAP)发生的影响因素,预测rPDAP患者拔管的风险概率。方法回顾性分析2016年1月至2021年12月在我院规律随访并发生腹膜透析相关性腹膜炎(peritoneal dialysis⁃associated peritonitis,PDAP)的患者164例,按照临床治疗结果分为难治组和非难治组,比较两组患者的临床资料,采用多因素logistic回归分析探究rPDAP发生及预后的影响因素,构建rPDAP拔管风险预测模型,采用ROC曲线分析预测因子的诊断价值。结果两组患者中,难治组66例,非难治组98例。与非难治组相比,难治组患者透析龄较长[(42.5(20,64.5)个月vs.32.5(11.8,50.25)个月],血清白蛋白更低[(31.21±5.88)g/L vs.(32.99±5.20)g/L];金黄色葡萄球菌及真菌感染率更高(13.6%vs.3.1%、6.1%vs.0)。多因素logistic回归分析显示,血清白蛋白水平与rPDAP的发生呈负相关,与患者预后未发现相关性(P<0.05)。长透析龄和多次发生PDAP与rPDAP患者拔管率呈正相关(P<0.05)。以透析龄和多次发生PDAP计算rPDAP拔管风险预测的ROC曲线下面积,其中透析龄的诊断价值最大,透析龄界定值为54.5个月。结论血清白蛋白是rPDAP发生的独立保护因素,长透析龄和多次发生PDAP对rPDAP患者是否存在拔管风险具有诊断价值,透析龄在54.5个月及以上rPDAP患者拔管风险更高。Objective Analyzed the factors of refractory peritoneal dialysis⁃associated peritonitis(rP⁃DAP),To predict the probability of extubation in rPDAP patients.Methods A retrospective analysis was per⁃formed on 164 patients who had regular follow⁃up in our hospital from January 2016 to December 2021 and had peritoneal dialysis⁃associated peritonitis(PDAP).According to the clinical treatment results,the patients were di⁃vided into refractory group and refractory group.The clinical data of the two groups were compared,and the influ⁃encing factors of rPDAP occurrence and prognosis were explored by multivariate Logistic regression analysis.The risk prediction model of rPDAP extubation was established,and the diagnostic value of the predictive factors was analyzed by ROC curve.Results Among the two groups,66 patients were in refractory group and 98 were in re⁃fractory group.Compared with non⁃refractory group,patients in refractory group had longer dialysis age[42.5(20,64.5)months vs.32.5(11.8,50.25)months]and lower serum albumin[(31.21±5.88)g/L vs.(32.99±5.20)g/L].Staphylococcus aureus and fungal infections were high(13.6%vs.3.1%and 6.1%vs.0).Multivariate Logistic regression analysis showed that serum albumin level was negatively correlated with rPDAP development,but no cor⁃relation was found with prognosis of patients(P<0.05).The extubation rate of patients with long dialysis age and multiple PDAP was positively correlated with that of patients with rPDAP(P<0.05).The area under ROC curve for predicting extubation risk of rPDAP was calculated based on dialysis age and multiple occurrence of PDAP.The diagnostic value of dialysis age was the largest,and the defined value of dialysis age was 54.5 months.Conclu⁃sion Serum albumin is an independent protective factor for rPDAP development.Long dialysis age and multiple occurrence of PDAP are of diagnostic value for extubation risk in rPDAP patients,and extubation risk is higher in rPDAP patients with dialysis age of 54.5 months or above.

关 键 词：腹膜透析 腹膜透析相关性腹膜炎 难治 影响因素 风险预测 

分 类 号：R692.5[医药卫生—泌尿科学]