赵文曼,
李丹丹,
丛静静,
刘桂凌^,
安徽医科大学第二附属医院 肾脏内科, 安徽 合肥 230601

基金项目: 安徽省卫计委适宜技术推广项目（2018-TG04）


详细信息 作者简介: 赵文曼(1994-), 女, 硕士研究生。E-mail: 18325343757@163.com




通讯作者: 刘桂凌, 主任医师。E-mail: guilingliu369@163.com 中图分类号: R318.16


摘要:目的分析频发性腹膜透析相关性腹膜炎（F-PDAP）患者的临床特征并探讨其危险因素。方法回顾性分析2015年1月至2019年9月在安徽医科大学第二附属医院治疗并规律随访的101例腹膜炎患者资料，包括年龄、透析龄、性别、体质量指数（BMI）、文化程度、细菌培养结果、超敏C反应蛋白、血红蛋白、血白蛋白、淋巴细胞计数、血钙、血磷、血钾、总胆固醇、甘油三酯、尿酸、铁蛋白、全段甲状旁腺激素、末次透出液白细胞计数等指标。将1年内仅发生1次腹膜炎者定义为单发性腹膜透析相关性腹膜炎（S-PDAP）组，1年内发生腹膜炎≥2次者定义为频发性腹膜透析相关性腹膜炎（F-PDAP）组，并分析F-PDAP的临床特征及危险因素。结果（1）101例腹膜炎患者中，共发生腹膜炎133例次。其中F-PDAP组29例，发生61例次；S-PDAP组72例，发生腹膜炎72例次。F-PDAP组与S-PDAP组相比，患者透析龄更长、超敏C反应蛋白更高、铁蛋白更高（均P < 0.005）；但其血红蛋白、血白蛋白、淋巴细胞计数较S-PDAP组低（均P < 0.001）。两组间年龄、性别、高血压患病率、糖尿病患病率、糖尿病肾病发生率、BMI、文化程度、腹透液细菌培养结果、校正钙、血磷、血钾、总胆固醇、甘油三酯、尿酸、全段甲状旁腺激素、末次透出液白细胞计数等指标比较差异均无统计学意义。（2）多因素Logistic回归分析显示高透析龄（OR=1.046，95%CI：1.002-1.091，P=0.039）、低血红蛋白（OR=0.909，95%CI：0.838-0.986，P=0.022）、低血白蛋白（OR=0.510，95%CI：0.328-0.793，P=0.003）、低淋巴细胞计数（OR=0.045，95%CI：0.001-0.864，P=0.045）为F-PDAP的危险因素。结论低血红蛋白、低血白蛋白、低淋巴细胞计数及较高的透析龄是频发性腹膜透析相关性腹膜炎危险因素，积极纠正贫血及低蛋白血症可能有助于降低腹膜透析相关性腹膜炎的发生率。
关键词: 频发性腹膜透析相关性腹膜炎/
临床特征/
危险因素


Abstract:ObjectiveBy collecting data from patients with peritoneal dialysis-associated peritonitis (referred to as peritonitis), the clinical characteristics of patients with frequent peritoneal dialysis-associated peritonitis (F-PDAP) were analyzed and their risk factors were discussed.MethodsThe clinical data of 101 patients with peritonitis, who were treated in the Second Affiliated Hospital of Anhui Medical University from January 2015 to September 2019 and regularly followed up, were retrospectively reviewed including age, dialysis age, gender, body mass index (BMI), education level, bacterial culture results, hypersensitive C-reactive protein, hemoglobin, blood albumin, lymphocyte count, blood calcium, blood phosphorus, blood potassium, total cholesterol, triglycerides, uric acid, ferritin, whole parathyroid glands Hormone, leukocyte count of peritoneal fluid for the last time and other indicators. The patients who had peritonitis only once in 1 year were divided into single-peritoneal dialysis-associated peritonitis (S-PDAP) group, and those who had peritonitis≥2 times in 1 year into F-PDAP group. The clinical characteristics and risk factors of F-PDAP were analyzed.Results(1) A total of 101 patients with peritonitis were included, and 133 cases of peritonitis occurred. Among them, 29 patients were in the F-PDAP group with 61 occurrences of peritonitis and 72 patients in the S-PDAP group with 72 occurrences. Compared with the S-PDAP group, the F-PDAP group had a longer dialysis age, higher hypersensitive C-reactive protein and ferritin (all P < 0.005), but lower hemoglobin, albumin and lymphocyte counts (all P < 0.001). Age, gender, prevalence of hypertension, prevalence of diabetes, prevalence of diabetic nephropathy, BMI, education level, bacterial culture results of peritoneal effusion, corrected calcium, blood phosphorus, blood potassium, total cholesterol, triglyceride, Uric acid, total parathyroid hormone, and white blood cell count of the last exudate were similar between the two groups. (2) Multivariate logistic regression analysis revealed that higher dialysis age (OR=1.046, 95% CI: 1.00-1.091, P=0.039), lower hemoglobin (OR=0.909, 95% CI: 0.838-0.986, P=0.022), lower albumin (OR=0.510, 95%CI: 0.328-0.793, P=0.003) and lower lymphocyte count (OR=0.045, 95% CI: 0.001-0.864, P=0.045) were risk factors of F-PDAP.ConclusionsLower hemoglobin, serum albumin, lymphocyte count and higher dialysis age are risk factors for frequent peritoneal dialysis associated peritonitis. Active correction of anemia and hypoproteinemia may help reduce the incidence of peritonitis associated with peritoneal dialysis.
Keywords:frequent peritoneal dialysis associated peritonitis/
clinical characteristics/
risk factors

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