Tielens E, Nubé M J, de Vet J A, van Limbeek J, Hofman X, Steffens A, van Geelen J A
Dept of Nephrology, Medical Center Alkmaar, The Netherlands.
Nephrol Dial Transplant. 1993;8(11):1237-43.
In recent years an impressive decrease in the incidence of CAPD-related peritonitis was observed in our centre, from 1.4 in the mid-eighties to 0.4 per patient year in 1991. In order to analyse which factors were most responsible for this decline, the present study was performed. From the start of our CAPD programme in 1982 until September 1991, 100 patients were enrolled. For each patient, time elapsed from catheter insertion until first peritonitis episode was recorded. Outcome was measured as the peritonitis-free interval in days. The following variables have been evaluated: age, gender, type of catheter, type of system, presence of diabetes mellitus, leakage, break-in period, presence of an exit-site infection, and performing surgeon. Data were analysed first by Kaplan-Meier product-limit estimate of survival (peritonitis-free interval). Thereafter Cox proportional hazard analysis was applied to the data, providing a conditional probability of peritonitis at each moment during follow-up, given a certain combination of risk factors. Our results show that the system, in conjunction with the type of catheter, was a decisive factor in the decline of the peritonitis rate in our centre. Patients on the twin-bag system (twin-bag group) showed a significant increase in the peritonitis-free interval in comparison with patients using other systems (non-twin bag group). Among the other variables analysed, only diabetes mellitus appeared to be relatively important. Episodes of culture negative peritonitis were more frequently observed in the twin-bag group, compared to the non-twin bag group. In absolute numbers Staph. non-aureus was the micro-organism most effectively reduced.
近年来，我们中心观察到与持续性非卧床腹膜透析（CAPD）相关的腹膜炎发病率显著下降，从八十年代中期的1.4例降至1991年的每患者年0.4例。为了分析哪些因素对这种下降最为关键，我们开展了本研究。从1982年我们的CAPD项目启动至1991年9月，共纳入100例患者。记录每位患者从导管插入至首次发生腹膜炎的时间。以无腹膜炎间隔天数衡量结果。评估了以下变量：年龄、性别、导管类型、系统类型、糖尿病的存在、渗漏、磨合期、出口处感染的存在以及主刀医生。数据首先通过Kaplan-Meier生存乘积限估计法（无腹膜炎间隔）进行分析。此后，对数据应用Cox比例风险分析，在给定特定风险因素组合的情况下，提供随访期间每个时刻发生腹膜炎的条件概率。我们的结果表明，系统结合导管类型是我们中心腹膜炎发生率下降的决定性因素。与使用其他系统的患者（非双袋组）相比，使用双袋系统的患者（双袋组）无腹膜炎间隔显著增加。在分析的其他变量中，只有糖尿病似乎相对重要。与非双袋组相比，双袋组中培养阴性腹膜炎的发作更为常见。从绝对数量来看，非金黄色葡萄球菌是最有效减少的微生物。
