摘要/Abstract

摘要： 目的 ·探讨腹膜炎对腹膜透析（ peritoneal dialysis，PD，腹透）患者全因死亡及心血管死亡的影响。方法 ·回顾性入选 2003年 1月— 2017年 9月于上海交通大学医学院附属瑞金医院肾脏内科接受 PD治疗的患者 614例。依据接受治疗后是否发生腹膜炎，将患者分为腹膜炎组和非腹膜炎组。根据首次标准腹膜平衡试验的结果，将患者分为低转运组（ L组）、低平均转运组（ LA组）、高平均转运组（HA组）及高转运组（ H组）。研究终点定义为患者全因死亡或心血管死亡。比较腹膜炎组、非腹膜炎组患者的人口统计学资料、基线（开始 PD治疗后 1个月内）临床资料和 PD结局。建立时依比例风险回归模型（ proportional hazards model，Cox模型），分析腹膜炎对患者全因死亡或心血管死亡的影响。结果 ·在腹膜炎组（ 213例）中， 125例（58.7%）患者的病原菌培养为阳性；其中， 69例（32.4%）患者为革兰阳性菌， 46例（21.6%）为革兰阴性菌， 6例（2.8%）为真菌。与非腹膜炎组相比，腹膜炎组患者的透析龄较长（ P0.000）、年龄较大（ P0.001）、低文化程度的比例较高（ P0.000）、合并脑血管病及糖尿病患者的比例较高（ P0.004，P0.036）、血清白蛋白水平较低（ P0.016）。多因素 Cox回归分析显示，在校正年龄、糖尿病、血清白蛋白等因素后，腹膜炎是全因死亡和心血管死亡的独立危险因素（ P0.015，P0.046）。进一步亚组分析显示，与高文化程度患者相比，低文化程度患者发生腹膜炎后的全因死亡风险 [HR：1.99（1.14～ 3.46）vs 1.39（0.74～ 2.62）]及心血管死亡风险 [HR：1.95（0.89～ 4.25）vs 1.14（0.50～ 2.61）] 的增加幅度更大；与 H组 +HA组相比， L组 +LA组患者发生腹膜炎后的全因死亡风险 [HR：2.31（1.30～ 4.11）vs 1.22（0.70～ 2.12）]及心血管死亡风险 [HR：3.24（1.41～ 7.42）vs 0.95（0.45～ 2.02）]的增加幅度更大。结论 ·腹膜炎是 PD患者全因死亡和心血管死亡的独立危险因素。低文化程度或 L组 +LA组患者较高文化程度或 H组 +HA组患者发生腹膜炎后全因死亡及心血管死亡风险增加幅度更大。
关键词: 腹膜炎, 腹膜透析, 死亡
Abstract:
Objective · To investigate the effect of peritonitis on all-camortality and cardiovascular mortality of peritoneal dialysis (PD) patients. Methods · January 2003 to September 2017, 614 patients treated with PD in the Department of Nephrology of Ruijin Hospital, Shanghai Jiao Tong University School of Medicine were retrospectively included. The patients were divided into the peritonitis group and the peritonitis-free group according to whether peritonitis occurred after PD treatment. According to the first standard peritoneal equilibrium test results, the patients were divided into low transport group (L group), low average transport group (LA group), high average transport group (HA group) and high transport group (H group). The study endpoints were defined as all-camortality or cardiovascular mortality. The demographic data, clinical data at baseline (within one month of starting PD treatment) and PD outcomes were compared between the peritonitis group and the peritonitis-free group. The proportional hazards model (Cox model) was established to analyze the effect of peritonitis on all-cadeath or cardiovascular death. Results · In the peritonitis group (213 cases), 125 patients (58.7%) were positive for pathogenic bacteria, in whom 69 patients (32.4%) were Gram-positive bacteria, 46 patients (21.6%) were Gram-negative bacteria, and 6 patients (2.8%) were fungi. Compared with the peritonitis-free group, the patients in the peritonitis group had longer dialysis duration (P0.000), older age (P0.001), higher proportion of lower education level (P0.000), higher proportion of patients with cerebrovascular disease and diabetes mellitus (P0.004, P0.036), and lower serum albumin level (P0.016). Multivariate Cox regression analysis showed that peritonitis was an independent risk factor for all-camortality and cardiovascular mortality (P0.015, P0.046) after age, diabetes mellitus, serum albumin and other factors being adjusted. Subgroup analysis showed that compared with the patients with high educational level, the risk of all-camortality [HR: 1.99 (1.14-3.46) vs 1.39 (0.74-2.62)] and cardiovascular mortality [HR: 1.95 (0.89-4.25) vs 1.14 (0.50-2.61)] were more intensively increased in patients with low educational level after peritonitis. Compared with the H group+HA group, the risk of all-camortality [HR: 2.31 (1.30-4.11) vs 1.22 (0.70-2.12)] and cardiovascular mortality [HR: 3.24 (1.41-7.42) vs 0.95 (0.45-2.02)] were more intensively increased in the L group+LA group after peritonitis. Conclusion · Peritonitis is an independent risk factor for all-camortality and cardiovascular mortality of PD patients. The risk of all-camortality and cardiovascular mortality after peritonitis increases more significantly in those with lower educational level or in L group+LA group than those with higher educational level or in H group+HA group.
Key words: peritonitis, peritoneal dialysis (PD), mortality


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