台湾持续性非卧床腹膜透析患者腹膜炎的预测因素及腹膜炎对临床结局的影响——单中心10年经验
Predictors of peritonitis and the impact of peritonitis on clinical outcomes of continuous ambulatory peritoneal dialysis patients in Taiwan--10 years' experience in a single center.
作者信息
Hsieh Yao-Peng, Chang Chia-Chu, Wen Yao-Ko, Chiu Ping-Fang, Yang Yu
机构信息
Division of Nephrology,1 Department of Internal Medicine, Changhua Christian Hospital, Changhua;
出版信息
Perit Dial Int. 2014 Jan-Feb;34(1):85-94. doi: 10.3747/pdi.2012.00075. Epub 2013 Oct 1.
OBJECTIVE
Peritoneal dialysis (PD) has become more prevalent as a treatment modality for end-stage renal disease, and peritonitis remains one of its most devastating complications. The aim of the present investigation was to examine the frequency and predictors of peritonitis and the impact of peritonitis on clinical outcomes. ♢
METHODS
Our retrospective observational cohort study enrolled 391 patients who had been treated with continuous ambulatory PD (CAPD) for at least 90 days. Relevant demographic, biochemical, and clinical data were collected for an analysis of CAPD-associated peritonitis, technique failure, drop-out from PD, and patient mortality. ♢
RESULTS
The peritonitis rate was 0.196 episodes per patient-year. Older age (>65 years) was the only identified risk factor associated with peritonitis. A multivariate Cox regression model demonstrated that technique failure occurred more often in patients experiencing peritonitis than in those free of peritonitis (p < 0.001). Kaplan-Meier analysis revealed that the group experiencing peritonitis tended to survive longer than the group that was peritonitis-free (p = 0.11). After multivariate adjustment, the survival advantage reached significance (hazard ratio: 0.64; 95% confidence interval: 0.46 to 0.89; p = 0.006). Compared with the peritonitis-free group, the group experiencing peritonitis also had more drop-out from PD (p = 0.03). ♢
CONCLUSIONS
The peritonitis rate was relatively low in the present investigation. Elderly patients were at higher risk of peritonitis episodes. Peritonitis independently predicted technique failure, in agreement with other reports. However, contrary to previous studies, all-cause mortality was better in patients experiencing peritonitis than in those free of peritonitis. The underlying mechanisms of this presumptive "peritonitis paradox" remain to be clarified.
目的
腹膜透析（PD）作为终末期肾病的一种治疗方式已变得更为普遍，而腹膜炎仍然是其最严重的并发症之一。本研究的目的是调查腹膜炎的发生率、预测因素以及腹膜炎对临床结局的影响。♢
方法
我们的回顾性观察队列研究纳入了391例接受持续性非卧床腹膜透析（CAPD）治疗至少90天的患者。收集相关的人口统计学、生化和临床数据，以分析与CAPD相关的腹膜炎、技术失败、退出腹膜透析及患者死亡率。♢
结果
腹膜炎发生率为每位患者每年0.196次发作。年龄较大（>65岁）是唯一确定的与腹膜炎相关的危险因素。多变量Cox回归模型显示，发生腹膜炎的患者比未发生腹膜炎的患者技术失败更为常见（p<0.001）。Kaplan-Meier分析显示，发生腹膜炎的组比未发生腹膜炎的组生存时间更长（p = 0.11）。经过多变量调整后，生存优势具有显著性（风险比：0.64；95%置信区间：0.46至0.89；p = 0.006）。与未发生腹膜炎的组相比，发生腹膜炎的组退出腹膜透析的情况也更多（p = 0.03）。♢
结论
本研究中腹膜炎发生率相对较低。老年患者发生腹膜炎发作的风险较高。与其他报告一致，腹膜炎是技术失败的独立预测因素。然而，与先前的研究相反，发生腹膜炎的患者全因死亡率低于未发生腹膜炎的患者。这种假定的“腹膜炎悖论”的潜在机制仍有待阐明。
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