腹膜透析相关性腹膜炎的临床特征与治疗失败的危险因素  

Clinical Characteristics of Peritoneal Dialysis associated Peritonitis and Risk Factors for Treatment Failure

作　　者：余潇 金纪伟[1] 杨静 葛冰磊 YU Xiao;JIN Jiwei;YANG Jing;GE Binglei(Department of Clinical Laboratory,the Affiliated Xuancheng Hospital of Wannan Medical College,Xuancheng 242000,China;Department of Nephrology,the Affiliated Xuancheng Hospital of Wannan Medical College,Xuancheng 242000,China)

机构地区：[1]皖南医学院附属宣城医院检验科,安徽宣城242000 [2]皖南医学院附属宣城医院肾内科,安徽宣城242000

出　　处：《湖州师范学院学报》2023年第10期62-67,共6页Journal of Huzhou University

基　　金：宣城市人民医院院级科研项目(KY202236).

摘　　要：为探讨不同细菌所致腹膜透析相关性腹膜炎的临床特征与治疗失败的危险因素,收集2018年1月至2023年3月皖南医学院附属宣城医院肾内科收治的腹膜透析相关性腹膜炎(PDAP)患者作为研究对象,根据腹透液培养结果将其分为革兰阳性菌组(G^(+)组)和革兰阴性菌组(G^(-)组),比较两组患者发生PDAP的临床资料和治疗结果,并通过Logistic回归分析PDAP治疗失败的危险因素.共纳入64例PDAP患者,其中革兰阳性菌组(G^(+)组)39例,革兰阴性菌组(G^(-)组)25例;G^(-)组的腹透液白细胞计数、血C反应蛋白、血清降钙素原水平均显著高于G^(+)组(Z=2.532、2.931、3.543;P<0.05);G^(-)组的血磷水平较G^(+)组低(F=4.212,P=0.044).Logistic回归分析显示,合并导管出口处感染(OR=2.557,95%CI:1.982~3.487,P=0.001)、血C反应蛋白(OR=1.022,95%CI:1.004~1.041,P=0.016)是PDAP治疗失败的独立危险因素.由此得出结论:血C反应蛋白水平、合并导管出口处感染是PDAP治疗失败的独立危险因素;动态监测C反应蛋白与及时纠正导管出口处感染对临床医生改善PDAP结局具有指导意义.To investigate the clinical characteristics of peritoneal dialysis associated peritonitis(PDAP)resulting from different bacteria and to identify the risk factors associated with treatment failure,we collected PDAP patients admitted to the department of nephrology of our hospital between January 2018 to March 2023.Based on peritoneal dialysis culture results,patients were divided into two groups:The gram positive bacteria(G^(+))group and the gram negative bacteria(G^(-))group.We compared the clinical data and treatment outcomes of the two groups,and utilized logistic regression to identify the risk factors for PDAP treatment failure.Results:A total of 64 patients with PDAP were included:39 in Gram positive bacteria(G^(+))group and 25 in the Gram negative bacteria(G^(-))group.The G^(-)group exhibited higher white blood cell count in peritoneal dialysis fluid,C reactive protein(CRP)and procalcitonin(PCT)levels compared to the G^(+)group(Z=2.532,2.931,3.543,P<0.05).Conversely,the blood phosphorus level was lower in the G^(-)group(F=4.212,P=0.044).Logistic regression analysis revealed that infections at the catheter outlet(OR=2.557,95%CI:1.982~3.487,P=0.001),and the elevated CRP levels(OR=1.022,95%CI:1.004~1.041,P=0.016)were independent risk factors for PDAP treatment failure.Both CRP level and catheter outlet infection are significant independent risk factors for PDAP treatment failure.Monitoring CRP and addressing catheter outlet infections are crucial for clinicians aiming to enhance PDAP outcomes.

关 键 词：腹膜透析相关性腹膜炎 C反应蛋白 导管出口处感染 危险因素 

分 类 号：R446.1[医药卫生—诊断学]