腹膜透析液培养阳性腹膜炎临床特征  

Clinical Characteristics of Peritonitis with Peritoneal Dialysis Fluid Culture Positive

作　　者：罗军[2] 邓劲[1] 康梅[1] Luo Jun;Deng Jin;KangMei(Department of Laboratory Medicine,West China Hospital,Sichuan University,Chengdu,Sichuan 610041;Department of Clinical Laboratory,Mianyang Central Hospital,Mianyang,Sichuan 621000,China)

机构地区：[1]四川大学华西医院实验医学科,四川成都610041 [2]绵阳市中心医院检验科,四川绵阳621000

出　　处：《四川医学》2024年第4期377-382,共6页Sichuan Medical Journal

摘　　要：目的探讨腹膜透析中由不同病原菌引起的腹膜炎的临床特点。方法回顾性分析2018年1月至2022年12月在我院肾病护理单元收治的腹膜透析相关性腹膜炎(PDAP)患者的临床资料。根据检出病原菌的不同,分为革兰阳性(G^(+))菌组、革兰阴性(G^(-))菌组和真菌组,比较3组间病原学分布特点和临床特征。根据患者是否拔管分为两组,分析两组间白介素6(IL-6)、降钙素原(PCT)、白细胞、血小板(PLT)、血红蛋白、白蛋白、C反应蛋白(CRP)等指标,二元Logistic回归分析拔管的影响因素。结果共送检1066例腹透液样本,其中332例检出病原菌,阳性检出率为31.14%(332/1066),病原菌检出337株。G^(+)菌组244株,占比72.40%(244/337);以凝固酶阴性葡萄球菌(57.37%)、链球菌(19.67%)为主。G^(-)菌组64株,占比18.99%(64/337);以大肠埃希菌(26.56%)和铜绿假单胞菌(17.18%)为主。真菌组29株,占比8.61%(29/337);以近平滑念珠菌(41.37%)为主。拔管组与非拔管组在年龄、IL-6、CRP、PLT和病原菌感染类型比较差异有统计学意义,二元回归分析显示真菌感染是腹膜炎拔管的独立危险因素。结论PDAP的主要致病菌以G^(+)菌为主,G^(-)菌感染患者具有更高水平的PCT和IL-6,真菌感染者具有更高水平的PLT数量;感染性腹膜炎尤其是真菌性腹膜炎是患者终止腹膜透析改为血液透析的主要危险因素。Objective To investigate the clinical characteristics of peritonitis caused by different pathogens in peritoneal dialysis.Methods We retrospectively analyzed the clinical data of all patients who had peritoneal dialysis-associated peritonitis(PDAP)in our hospital from January 2018 to December 2022.According to the different pathogenic bacteria detected,they were divided into Gram-positive(G^(+))bacteria,Gram-negative(G^(-))bacteria and fungus groups,and the etiological distribution and clinical characteristics of the three groups were compared.Patients were divided into two groups based on whether they had extubation or not,the level of interleukin-6(IL-6),procalcitonin(PCT),white blood cells,platelets(PLT),hemoglobin,albumin,C-reactive protein(CRP)and other laboratory test results between the two groups were analyzed.The influencing factors of extubation were analyzed by binary Logistic regression.Results A total of 1066 samples of peritoneal dialysis fluid were tested.Among which pathogenic bacteria were detected in 332 cases,the positive detection rate was 31.14%(332/1066),and 337 strains of pathogenic bacteria were detected.There were 244 strains of Gram-positive(G^(+))bacteria,accounting for 72.40%(244/337);mainly coagulase negative Staphylococcus(57.37%)and Streptococcus(19.67%).Gram negative bacterium(G^(-))64 strains,accounting for 18.99%(64/337),mainly Escherichia coli(26.56%)and Pseudomonas aeruginosa(17.18%).In the fungal group,there were 29 strains,accounting for 8.61%(29/337),mainly Candida parapsilosis(41.37%).There were statistically significant in age,IL-6,CRP,PLT and pathogen infection types between the extubation group and the non-extubation group.Binary regression analysis showed that fungal infection was an independent risk factor for peritonitis extubation.Conclusion The main pathogenic bacteria of PDAP were G^(+)bacteria,patients with G bacteria infection have higher levels of PCT and IL-6,while those with fungi infection have higher levels of PLT.Infectious peritonitis,especially fungal per

关 键 词：腹膜透析 腹膜炎 临床特点 

分 类 号：R656.4*1[医药卫生—外科学]