摘要
目的探讨肠源性腹膜透析相关性腹膜炎(PDAP)治疗失败的危险因素。方法回顾性收集2013年至2019年吉林省4家三甲医院PDAP患者临床资料,按照PDAP的致病菌类型,将研究对象分为肠源性PDAP组(284例)和非肠源性PDAP组(519例)。采用广义估计方程(GEE)比较两组患者的临床资料、初始疗效、当次PDAP治疗结果以及肠源性PDAP治疗失败的危险因素。结果本研究共纳入803例次PDAP,其中肠源性PDAP组为284例次,大肠埃希菌最多,为100例次(35.21%)。与非肠源性PDAP组相比,肠源性PDAP组的女性占比较高(55.99%和47.21%,P=0.043),且原发病为糖尿病肾病的比例较高(16.96%和11.27%,P=0.029)。两组患者在年龄、血红蛋白、血清白蛋白水平等方面均未见明显差异(均P>0.05)。与非肠源性PDAP组相比,肠源性PDAP组初始疗效和当次治疗结果均较差(均P<0.001)。多因素GEE分析显示,长透析龄、生活在农村、低血清白蛋白,以及肺炎克雷伯杆菌、铜绿假单胞菌、真菌及混合菌感染均为肠源性PDAP治疗失败的独立危险因素(P<0.05)。结论肠源性PDAP的治疗效果比非肠源性PDAP差。长透析龄、农村生活、低血清白蛋白水平及肺炎克雷伯杆菌、铜绿假单胞菌、真菌及混合菌感染是肠源性PDAP治疗失败的独立危险因素。
Objective To investigate the risk factors for treatment failure of enterogenous peritoneal dialysis-associated peritonitis(PDAP).Methods Retrospective collection of clinical data on PDAP patients from four hospitals in Jilin Province from 2013 to 2019.According to the type of pathogenic bacteria from PDAP,the study subjects were divided into the enterogenous PDAP group(284 cases)and the non-enterogenous PDAP group(519 cases).The generalized estimation equation(GEE)was used to compare the two groups in clinical data,initial therapeutic effect,and current therapeutic effect of PDAP,as well as risk factors for treatment failure of enterogenous PDAP.Results This study included a total of 803 cases of PDAP,including 284 cases in the enterogenous PDAP group,with E.coli being of the highest number of 100 cases and accounting for 35.21%of the enterogenous PDAP group.Compared with the non-enterogenous PDAP group,the enterogenous PDAP group showed higher proportion of female patients(55.99%versus 47.21%,P=0.043),and higher proportion of diabetic nephropathy as primary disease(16.96%versus 11.27%,P=0.029).There was no significant difference between the two groups in age,hemoglobin level,and serum albumin level(all P>0.05).Compared with the non-enterogenous PDAP group,the enterogenous PDAP group showed worse initial therapeutic effect and current therapeutic effect of PDAP(both P<0.001).Multivariate GEE analysis showed that long dialysis age,living in rural areas,low serum albumin,Klebsiella pneumoniae,Pseudomonas aeruginosa,fungi,and mixed bacteria were independent risk factors for the treatment failure of enterogenous PDAP(P<0.05).Conclusion The therapeutic effect of the enterogenous PDAP was worse than that of the non-enterogenous PDAP.The independent risk factors for treatment failure of the enterogenous PDAP included long dialysis age,living in rural areas,low serum albumin levels,and related types of enterogenous microorganisms.
作者
于梦园
杨立明
朱学研
张晓暄
刘声茂
谢舜昀
倪册
庄小花
崔文鹏
Mengyuan Yu;Liming Yang;Xueyan Zhu;Xiaoxuan Zhang;Shengmao Liu;Shunyun Xie;Ce Ni;Xiaohua Zhuang;Wenpeng Cui(Department of Nephrology,Second Hospital of Jilin University,Changchun 130041;Department of Nephrology,Second Division of First Hospital of Jilin University,Changchun 130031;Department of Nephrology,Jilin Central Hospital,Changchun 132011;Department of Nephrology,Jilin FAW General Hospital,Changchun 130011,Jilin Province,China)
出处
《中华肾病研究电子杂志》
2023年第3期127-133,共7页
Chinese Journal of Kidney Disease Investigation（Electronic Edition）
基金
吉林省卫生厅项目(2018FP031)。
关键词
腹膜透析
腹膜透析相关性腹膜炎
肠源菌
危险因素
Peritoneal dialysis
Peritoneal dialysis-associated peritonitis
Enterogenous microorganisms
Risk factors
