Gadallah M F, Tamayo A, Sandborn M, Ramdeen G, Moles K
Department of Medicine, University of Florida, Jacksonville, USA.
Adv Perit Dial. 2000;16:233-6.
Some studies have demonstrated the efficacy and safety of intraperitoneal (i.p.) urokinase in the resolution of recurrent or relapsing peritonitis, while others have not. Most studies were small, and they varied in methodology. Furthermore, the role of i.p. urokinase in shortening the duration of peritonitis or in preventing recurrence after initial peritonitis has not been examined. In addition, no previous studies have examined the role of i.p. urokinase in preventing, after first infection, catheter loss due to unresolving (resistant) peritonitis. Over a period of 3 years, we prospectively randomized into two groups all peritoneal dialysis (PD) patients who developed a first episode of peritonitis. Group I (n = 40) received i.p. urokinase on the first day of diagnosis (5000 IU intraluminally in the peritoneal catheter and left for 4 hours before next exchange). Group II (n = 40) received no urokinase. The duration of peritonitis was assessed by daily PD fluid white blood cell (WBC) count. Indications for catheter removal were: persistent peritonitis after four days from initiation of antibiotic therapy, or peritonitis with multiple organisms, suggesting bowel perforation. No statistically significant difference was seen between the two groups in regard to primary cause of end-stage renal disease (ESRD), age, sex, race, weight, type of dialysis [continuous ambulatory peritoneal dialysis (CAPD), automated peritoneal dialysis (APD), continuous cycling peritoneal dialysis (CCPD)], or duration of dialysis prior to first peritonitis. No statistically significant difference was seen between the two groups in the duration of peritonitis or in the severity of symptoms and signs of peritonitis. Neither was any difference seen in the peritonitis recurrence or relapse rate (10% in the urokinase group vs 7.5% in the control group). Nine patients lost their catheters (3 in the urokinase group: 1 Pseudomonas aeruginosa and 2 Candida tropicalis; 6 in the control group: 1 Klebsiella pneumonia, 1 enterococcus, 2 Pseudomonas aeruginosa, and 2 Candida tropicalis). The difference in the rate of catheter loss between the two groups was not statistically significant; it appeared to relate to the type of organism rather than to the response to urokinase. In conclusion, i.p. urokinase plays no significant role in shortening the course of peritonitis or in preventing recurrence or loss of the PD catheter. Loss of PD catheters in patients having their first peritonitis appears to be related primarily to the type of organism causing the infection.
一些研究已证明腹腔内注射尿激酶在治疗复发性或再发性腹膜炎方面的有效性和安全性，而其他研究则未证明。大多数研究规模较小，且方法各异。此外，腹腔内注射尿激酶在缩短腹膜炎病程或预防初次腹膜炎后复发方面的作用尚未得到研究。此外，既往没有研究探讨腹腔内注射尿激酶在首次感染后预防因持续性（耐药）腹膜炎导致导管丢失方面的作用。在3年的时间里，我们将所有发生初次腹膜炎的腹膜透析（PD）患者前瞻性地随机分为两组。第一组（n = 40）在诊断的第一天接受腹腔内注射尿激酶（在腹膜导管内注入5000国际单位，保留4小时后进行下一次换液）。第二组（n = 40）不接受尿激酶治疗。通过每日腹膜透析液白细胞（WBC）计数评估腹膜炎的持续时间。拔除导管的指征为：抗生素治疗开始4天后仍存在持续性腹膜炎，或腹膜炎伴有多种微生物，提示肠穿孔。两组在终末期肾病（ESRD）的主要病因、年龄、性别、种族、体重、透析类型[持续非卧床腹膜透析（CAPD）、自动化腹膜透析（APD）、持续循环腹膜透析（CCPD）]或初次腹膜炎前的透析时间方面，均未观察到统计学上的显著差异。两组在腹膜炎持续时间或腹膜炎症状和体征的严重程度方面，也未观察到统计学上的显著差异。腹膜炎的复发率或再发率在两组之间也没有差异（尿激酶组为10%，对照组为7.5%）。9名患者拔除了导管（尿激酶组3例：1例铜绿假单胞菌和2例热带念珠菌；对照组6例：1例肺炎克雷伯菌、1例肠球菌、2例铜绿假单胞菌和2例热带念珠菌）。两组之间导管丢失率的差异无统计学意义；似乎与微生物类型有关，而非与对尿激酶治疗的反应有关。总之，腹腔内注射尿激酶在缩短腹膜炎病程、预防复发或预防腹膜透析导管丢失方面没有显著作用。初次发生腹膜炎的患者腹膜透析导管丢失似乎主要与引起感染的微生物类型有关。
