Department of Medicine, Tung Wah Hospital, University of Hong Kong, Hong Kong.
Perit Dial Int. 2010 Mar-Apr;30(2):187-91. doi: 10.3747/pdi.2007.00244. Epub 2010 Feb 1.
The risk of development of enteric peritonitis in Chinese peritoneal dialysis (PD) patients with colonic diverticulosis is not known. There have been no reports on whether colonic diverticulosis may affect peritonitis outcomes. The objectives of this study were to examine whether colonic diverticulosis is a risk factor for the development of enteric peritonitis and to study its influence on the outcome of enteric peritonitis.
All continuous ambulatory PD patients that had barium enema and colonoscopic examinations performed between January 1994 and January 2006 were included. They were divided into 2 groups: patients with diverticulosis and patients without diverticulosis. Their demographic and clinical characteristics, colonic examination findings, and peritonitis data were compared and analyzed.
104 Chinese patients received 110 colonoscopies and 51 barium enema examinations. 25 patients (24.0%) had colonic diverticulosis. Patients with diverticulosis were older (65.4 +/- 14.7 vs 58.4 +/- 14.0 years, p = 0.033). The most common site of involvement of diverticulosis was the ascending colon (56%). 128 episodes of enteric peritonitis were recorded in 49 patients. Compared with patients without enteric peritonitis, more patients in the enteric peritonitis group had diverticulosis (38.8% vs 10.9%, p = 0.001) and diverticulosis most often involved the ascending colon (20.4% vs 7.3%, p = 0.082). Multivariate logistic regression analysis showed that the presence of diverticulosis (hazard ratio 5.17, 95% confidence interval 1.86 - 14.40; p = 0.002) and diverticulosis involving the ascending colon (hazard ratio 6.89, 95% confidence interval 1.43 - 33.32, p = 0.016) were independent risk factors for the development of enteric peritonitis. Enteric peritonitis in patients with diverticulosis had a higher but nonsignificant treatment failure rate (26.9% vs 18.4%, p = 0.282).
In this selected cohort of PD patients with indications of colonic examinations, diverticulosis, especially involving the ascending colon, may be a risk factor for the development of enteric peritonitis. Colonic diverticulosis does not appear to affect the outcome of enteric peritonitis. Further studies are warranted to determine ways to prevent enteric peritonitis in PD patients with diverticulosis.
结肠憩室病患者在接受中国腹膜透析（PD）治疗时发生肠源性腹膜炎的风险尚不清楚。目前尚无关于结肠憩室病是否会影响腹膜炎结局的报道。本研究旨在探讨结肠憩室病是否是肠源性腹膜炎发生的危险因素，并研究其对肠源性腹膜炎结局的影响。
纳入 1994 年 1 月至 2006 年 1 月期间接受钡剂灌肠和结肠镜检查的所有持续性非卧床 PD 患者。将他们分为憩室病组和无憩室病组。比较并分析两组患者的人口统计学和临床特征、结肠检查结果和腹膜炎数据。
104 例中国患者接受了 110 次结肠镜检查和 51 次钡剂灌肠检查。25 例（24.0%）患者存在结肠憩室病。憩室病组患者年龄较大（65.4±14.7 岁 vs 58.4±14.0 岁，p=0.033）。憩室病最常见的受累部位是升结肠（56%）。49 例患者共发生 128 次肠源性腹膜炎。与无肠源性腹膜炎的患者相比，更多的肠源性腹膜炎患者存在憩室病（38.8% vs 10.9%，p=0.001），且憩室病多累及升结肠（20.4% vs 7.3%，p=0.082）。多因素 logistic 回归分析显示，憩室病（风险比 5.17，95%置信区间 1.86-14.40；p=0.002）和累及升结肠的憩室病（风险比 6.89，95%置信区间 1.43-33.32，p=0.016）是肠源性腹膜炎发生的独立危险因素。憩室病患者的肠源性腹膜炎治疗失败率虽较高，但无统计学意义（26.9% vs 18.4%，p=0.282）。
在本项针对有结肠检查指征的 PD 患者的选择队列研究中，憩室病，特别是累及升结肠，可能是肠源性腹膜炎发生的危险因素。结肠憩室病似乎不会影响肠源性腹膜炎的结局。需要进一步研究以确定预防 PD 合并憩室病患者发生肠源性腹膜炎的方法。
