文化程度低是慢性腹膜透析患者腹膜炎发病的主要危险因素：一项 12 年随访的回顾性队列研究。
Lower education level is a major risk factor for peritonitis incidence in chronic peritoneal dialysis patients: a retrospective cohort study with 12-year follow-up.
机构信息
Division of Nephrology,1 Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine;
出版信息
Perit Dial Int. 2013 Sep-Oct;33(5):552-8. doi: 10.3747/pdi.2012.00065. Epub 2013 Apr 1.
BACKGROUND
Peritoneal dialysis (PD)-related peritonitis remains an important complication in PD patients, potentially causing technique failure and influencing patient outcome. To date, no comprehensive study in the Taiwanese PD population has used a time-dependent statistical method to analyze the factors associated with PD-related peritonitis.
METHODS
Our single-center retrospective cohort study, conducted in southern Taiwan between February 1999 and July 2010, used time-dependent statistical methods to analyze the factors associated with PD-related peritonitis.
RESULTS
The study recruited 404 PD patients for analysis, 150 of whom experienced at least 1 episode of peritonitis during the follow-up period. The incidence rate of peritonitis was highest during the first 6 months after PD start. A comparison of patients in the two groups (peritonitis vs null-peritonitis) by univariate analysis showed that the peritonitis group included fewer men (p = 0.048) and more patients of older age (≥65 years, p = 0.049). In addition, patients who had never received compulsory education showed a statistically higher incidence of PD-related peritonitis in the univariate analysis (p = 0.04). A proportional hazards model identified education level (less than elementary school vs any higher education level) as having an independent association with PD-related peritonitis [hazard ratio (HR): 1.45; 95% confidence interval (CI): 1.01 to 2.06; p = 0.045). Comorbidities measured using the Charlson comorbidity index (score >2 vs ≤2) showed borderline statistical significance (HR: 1.44; 95% CI: 1.00 to 2.13; p = 0.053).
CONCLUSIONS
A lower education level is a major risk factor for PD-related peritonitis independent of age, sex, hypoalbuminemia, and comorbidities. Our study emphasizes that a comprehensive PD education program is crucial for PD patients with a lower education level.
背景
腹膜透析（PD）相关腹膜炎仍然是 PD 患者的一个重要并发症，可能导致技术失败并影响患者预后。迄今为止，尚无针对台湾 PD 人群的全面研究使用时依统计方法分析与 PD 相关腹膜炎相关的因素。
方法
我们的单中心回顾性队列研究于 1999 年 2 月至 2010 年 7 月在台湾南部进行，使用时依统计方法分析与 PD 相关腹膜炎相关的因素。
结果
该研究共纳入 404 例 PD 患者进行分析，其中 150 例在随访期间至少经历过一次腹膜炎发作。腹膜炎的发生率在 PD 开始后前 6 个月最高。单因素分析比较两组患者（腹膜炎组与无腹膜炎组）的结果显示，腹膜炎组中男性较少（p = 0.048），年龄较大（≥65 岁，p = 0.049）的患者较多。此外，从未接受过义务教育的患者在单因素分析中腹膜炎的发生率更高（p = 0.04）。比例风险模型确定教育程度（低于小学学历与任何更高学历）与 PD 相关腹膜炎独立相关[风险比（HR）：1.45；95%置信区间（CI）：1.01 至 2.06；p = 0.045]。使用 Charlson 合并症指数（评分>2 与≤2）测量的合并症具有统计学意义（HR：1.44；95%CI：1.00 至 2.13；p = 0.053）。
结论
教育程度较低是 PD 相关腹膜炎的一个主要危险因素，与年龄、性别、低白蛋白血症和合并症无关。我们的研究强调，对于教育程度较低的 PD 患者，全面的 PD 教育计划至关重要。
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