Niu Hong-xin, Tang Xun, Zhou Wei-dong, Wei Lian-bo, Chen Zhi-guo, Long Hai-bo
Center of Integrated Traditional and Western Nephrology, Zhujiang Hospital, Southern Medical University, Guangzhou 510282, China.
Nan Fang Yi Ke Da Xue Xue Bao. 2010 Apr;30(4):855-8.
To identify the clinical characteristics and risk factors of frequent peritoneal dialysis (PD)-related peritonitis.
A retrospective analysis was conducted in the peritonitis patients undergoing continuous ambulatory peritoneal dialysis (CAPD) in our hospital. Frequent PD-related peritonitis was defined by two or more onsets in one year, and the patients with only one onset served as the control group. The clinical and laboratory data of the two groups were compared and the risk factors of PD-related peritonitis analyzed.
Forty-four episodes of peritonitis were recorded in the 16 patients with frequent PD-related peritonitis, as compared to 53 episodes in the 45 control patients. Compared with those in the control group, the patients with frequent peritonitis had significantly higher blood pressure (P<or=0.05) but lower hemoglobulin (P<or=0.05) and plasma albumin (P<or=0.01), with higher rates of edema (P<or=0.01), gram-negative bacteria and fungal infection (P<or=0.05) and PD catheter removal (P<or=0.05). No significant differences were found between the two groups in age, mode of catheter placement surgery, intervals between PD initiation and peritonitis occurrence, inducing factors of peritonitis, incidence of dyspnea, serum creatinin, urea, calcium, mineral phosphorus, blood or dialysate leucocytes (P>0.05). Variables identified to be associated with an increased likelihood of frequent PD-related peritonitis included hemoglobulin<70 g/L (OR=0.135, P<or=0.01) and plasma albumin<30 g/L (OR=0.181, P<or=0.05).
Compared with the patients with only one annual occurrence of peritonitis, the patients with frequent PD-related peritonitis have severer malnutrition and water overload, which are probably correlated to the high rates of PD catheter removal and poor prognosis. Severe anemia and proteinemia are risk factors and also predictive factors of frequent PD-related peritonitis. Measures to ameliorate anemia and proteinemia and effective management of celiac endogenous infection may help prevent and control frequent PD-related peritonitis.
确定频繁发生的腹膜透析（PD）相关腹膜炎的临床特征及危险因素。
对我院行持续性非卧床腹膜透析（CAPD）的腹膜炎患者进行回顾性分析。将一年内发生两次或两次以上发作的患者定义为频繁PD相关腹膜炎，仅发作一次的患者作为对照组。比较两组的临床和实验室数据，并分析PD相关腹膜炎的危险因素。
16例频繁PD相关腹膜炎患者共记录到44次腹膜炎发作，而45例对照患者为53次发作。与对照组相比，频繁腹膜炎患者血压显著更高（P≤0.05），但血红蛋白（P≤0.05）和血浆白蛋白更低（P≤0.01），水肿发生率更高（P≤0.01），革兰阴性菌和真菌感染率更高（P≤0.05），PD导管拔除率更高（P≤0.05）。两组在年龄、导管置入手术方式、PD开始至腹膜炎发生的间隔时间、腹膜炎诱发因素、呼吸困难发生率、血清肌酐、尿素、钙、血磷、血液或透析液白细胞方面无显著差异（P＞0.05）。确定与频繁PD相关腹膜炎可能性增加相关的变量包括血红蛋白＜70 g/L（OR = 0.135，P≤0.01）和血浆白蛋白＜30 g/L（OR = 0.181，P≤0.05）。
与每年仅发生一次腹膜炎的患者相比，频繁PD相关腹膜炎患者营养不良和水负荷过重更严重，这可能与较高的PD导管拔除率及不良预后相关。严重贫血和低蛋白血症是频繁PD相关腹膜炎的危险因素及预测因素。改善贫血和低蛋白血症的措施以及有效控制腹腔内源性感染可能有助于预防和控制频繁PD相关腹膜炎。
