CAJ | 학술논문

目的探讨长腹膜透析龄患者首次腹膜炎的临床特征.方法回顾性分析2000年至2009年发生首次腹膜透析相关性腹膜炎患者315例,按发生首次腹膜炎时腹膜透析龄分为两组:A组(＜36个月)261例,B组(≥36个月)54例.对两组相关临床资料进行比较.结果入组患者平均年龄(55.7±15.9)岁,男性占61.0％,基础肾脏病主要为慢性肾小球肾炎(54.6％),其次为糖尿病肾病(20.6％).发病时A组中位腹膜透析龄8.4个月；B组中位腹膜透析龄49.4个月.发生腹膜炎时,两组间血红蛋白、血清白蛋白和血钾水平差异无统计学意义,但两组血清白蛋白和血钾水平均低于正常值范围.两组腹膜炎最常见诱因均为换液操作接触污染(48.2％比45.2％).剔除未做透出液细菌培养患者,两组革兰阳性菌分布情况差异无统计学意义,但B组革兰阳性菌对甲氧西林的耐药率显著高于A组(46.2％比19.1％,P=0.035).两组革兰阴性菌分布情况及超广谱耐药菌比例差异无统计学意义.B组真菌感染比例显著高于A组(17.8％比6.4％,P=0.011).B组初始治疗有效率及临床结局显著差于A组(均P＜ 0.05).两组间革兰阴性菌及真菌腹膜炎治疗失败率差异无统计学意义,但B组革兰阳性菌、无菌生长及未作培养腹膜炎治疗失败率显著高于A组(23.1％比1.5％、46.2％比6.7％、22.2％比0％,均P＜ 0.05).Logistic回归分析整体资料显示,真菌感染、发病时较长腹膜透析龄、较低血清白蛋白水平为首次腹膜透析相关性腹膜炎治疗失败的独立影响因素(P=0.000、0.002、0.025).结论长腹膜透析龄患者首次腹膜炎的临床结局较短腹膜透析龄患者差.较高真菌和其他耐药菌感染率以及营养不良是影响其疗效的主要因素.
목적 탐토장복막투석령환자수차복막염적림상특정.방법 회고성분석2000년지2009년발생수차복막투석상관성복막염환자315례,안발생수차복막염시복막투석령분위량조:A조(＜36개월)261례,B조(≥36개월)54례.대량조상관림상자료진행비교.결과 입조환자평균년령(55.7±15.9)세,남성점61.0％,기출신장병주요위만성신소구신염(54.6％),기차위당뇨병신병(20.6％).발병시A조중위복막투석령8.4개월；B조중위복막투석령49.4개월.발생복막염시,량조간혈홍단백、혈청백단백화혈갑수평차이무통계학의의,단량조혈청백단백화혈갑수평균저우정상치범위.량조복막염최상견유인균위환액조작접촉오염(48.2％비45.2％).척제미주투출액세균배양환자,량조혁란양성균분포정황차이무통계학의의,단B조혁란양성균대갑양서림적내약솔현저고우A조(46.2％비19.1％,P=0.035).량조혁란음성균분포정황급초엄보내약균비례차이무통계학의의.B조진균감염비례현저고우A조(17.8％비6.4％,P=0.011).B조초시치료유효솔급림상결국현저차우A조(균P＜ 0.05).량조간혁란음성균급진균복막염치료실패솔차이무통계학의의,단B조혁란양성균、무균생장급미작배양복막염치료실패솔현저고우A조(23.1％비1.5％、46.2％비6.7％、22.2％비0％,균P＜ 0.05).Logistic회귀분석정체자료현시,진균감염、발병시교장복막투석령、교저혈청백단백수평위수차복막투석상관성복막염치료실패적독립영향인소(P=0.000、0.002、0.025).결론 장복막투석령환자수차복막염적림상결국교단복막투석령환자차.교고진균화기타내약균감염솔이급영양불량시영향기료효적주요인소.
Objective To investigate the clinic features in long-term peritoneal dialysis (PD) patients with the first episode of dialysis-related peritonitis and the risk factors. Methods In this retrospective study,315 PD patients who experienced the first episode of peritonitis from January 2000 to December 2009 were recruited.All the patients were divided into two groups according to the duration of PD treatment:group A (＜36 months,n=261) and group B (≥36 months,n =54). Clinical information including demographic character,primary renal disease,biochemical laboratory data,etiology data,treatment methods and clinical outcomes was collected.Results Among 315 patients,61.0％ was male and the mean age was (55.7±15.9) years.Theprimary renal diseases were glomerulonephritis (54.6％),and then diabetic nephropathy (20.6％).The median duration of PD was 8.4 months in group A and 49.4 months in group B.Nosignificant difference was found in serum potassium and serum albumin levels between the two groups,but the levels of both indexes were below normal rmge.The most common cause of peritonitis was connection contamination in both groups (48.2％ vs 45.2％ ).There were no significant differences in the incidence of gram-positive and gram-negate peritonitis between the two groups,but group B had higher drug resistance rote in gram-positive peritonitis than that in group A (46.2％ vs 19.1％,P=0.035).The incidence of fungus infection in group B was significantly higher than that in group A (17.8％ vs 6.4％,P=0.011).Treatment response was lower in group B than that in group A (P=0.000) and the clinical outcome in group B was worse than that in group A (P=0.000).Compared to gram-positive peritonitis,culture-negative peritonitis and peritonitis without culture,the incidences of treatment failure in group B were higher than those in group A (23.1％ vs 1.5％,46.2％ vs 6.7％,22.2％ vs 0％,all P＜0.05).By Logistic regression analysis,fungus infection,longer duration of PD treatment and lower serum albumin level were risk factors for the treatment failure of PD-related peritonitis (P=0.000,0.002,0.025).Conclusions The clinical outcome of the first episode of peritonitis in long-term PD patients is poorer than that in short-term PD patients.Fungus and drug-resistant bacteria infection,as well as malnutrition are the risk factors for the treatment failure of PD-related peritonitis in long-term PD patients.