CAJ | 학술논문

目的探讨影响腹膜透析(腹透)相关性细菌性腹膜炎患者预后的相关因素.方法采用回顾性分析的方法.收集上海交通大学医学院附属仁济医院腹膜透析中心2009年1月至2013年12月期间发生的腹透相关性细菌性腹膜炎患者临床资料,包括年龄、性别、腹透龄、残肾功能、局部和全身炎性反应状态、腹透液交换次数、腹膜葡萄糖暴露量等,记录患者腹膜炎发生时相关临床和实验室指标.根据腹膜炎患者预后将其分为治愈组(治疗后完全缓解且无复发、再发或重现)、拔管/死亡组(结局为拔管或死亡)、复发组(含治疗后复发、再发或重现).采用logistic回归法分析影响腹透相关性细菌性腹膜炎患者预后的相关因素. 结果 187例腹透患者腹膜炎发生时的中位腹透龄为27.15(11.15,53.13)个月,共发生347例次细菌性腹膜炎,其中革兰阳性菌感染130例次,阴性菌71例次,多种微生物感染15例次,培养阴性131例次.与治愈组和复发组相比,拔管/死亡组患者革兰阴性菌感染发生率较高;腹透龄较长;血清高敏C反应蛋白(hs?CRP)水平较高(均P﹤0.01).与治愈组相比,拔管/死亡组患者血清白蛋白水平较低(P﹤0.01),复发组患者Kt/V值较低(P﹤0.05).logistic回归分析结果显示,年龄、非革兰阳性菌感染、hs?CRP升高是影响腹膜炎患者拔管/死亡的独立危险因素. 结论年龄、非革兰阳性菌感染、全身炎性反应状态是影响腹透相关细菌性腹膜炎患者拔管或死亡的独立危险因素.
목적 탐토영향복막투석(복투)상관성세균성복막염환자예후적상관인소.방법 채용회고성분석적방법.수집상해교통대학의학원부속인제의원복막투석중심2009년1월지2013년12월기간발생적복투상관성세균성복막염환자림상자료,포괄년령、성별、복투령、잔신공능、국부화전신염성반응상태、복투액교환차수、복막포도당폭로량등,기록환자복막염발생시상관림상화실험실지표.근거복막염환자예후장기분위치유조(치료후완전완해차무복발、재발혹중현)、발관/사망조(결국위발관혹사망)、복발조(함치료후복발、재발혹중현).채용logistic회귀법분석영향복투상관성세균성복막염환자예후적상관인소. 결과 187례복투환자복막염발생시적중위복투령위27.15(11.15,53.13)개월,공발생347례차세균성복막염,기중혁란양성균감염130례차,음성균71례차,다충미생물감염15례차,배양음성131례차.여치유조화복발조상비,발관/사망조환자혁란음성균감염발생솔교고;복투령교장;혈청고민C반응단백(hs?CRP)수평교고(균P﹤0.01).여치유조상비,발관/사망조환자혈청백단백수평교저(P﹤0.01),복발조환자Kt/V치교저(P﹤0.05).logistic회귀분석결과현시,년령、비혁란양성균감염、hs?CRP승고시영향복막염환자발관/사망적독립위험인소. 결론 년령、비혁란양성균감염、전신염성반응상태시영향복투상관세균성복막염환자발관혹사망적독립위험인소.
Objective To investigate the risk factors predicting the outcome of peritoneal dialysis (PD)-related bacterial-complicating peritonitis. Methods In this retrospective study, all the episodes of PD-related bacterial peritonitis presenting during Jan 2009 to Dec 2013 in our center were reviewed. Clinical and laboratory parameters at the onset of peritonitis, including patient demographic information, age, gender, duration of PD, residual renal function, local and systemic inflammation state, daily exchange number, peritoneal glucose exposure and so on, were recorded. Patients episodes were divided into three groups according to the outcome: complete cure (complete resolution of peritonitis without relapse or recurrence or repeat), peritonitis-related catheter removal/death group, and relapse (relapse or recurrence or repeat) group. Results 187 CAPD patients with 27.15(11.15, 53.13) PD duration were enrolled in the study. Total of 347 episodes of bacterial peritonitis in these patients were analyzed, with 130 episodes of gram-positive bacterial infection, 71 episodes of gram-negative bacterial infection, 15 episodes of polymicrobial and 131 episodes of cultured negative. Compared to the complete cure group and the relapse group, gram negative bacterial infection was more prevalent in the peritonitis-related catheter removal/death group. Furthermore, patients in the peritonitis-related catheter removal/death group showed longer PD age (P﹤0.01) and higher serum hs-CRP (P﹤0.01). Compared to the complete cure group, the serum albumin concentration was lower in the peritonitis-related catheter removal/death group (P﹤0.01). Kt/V was significantly lower in the relapse group than that in the complete cure group (P﹤0.05). Logistic analysis indicated age, non gram positive bacterial infection and increased hs-CRP were independent predictors for peritonitis-related catheter removal or death. Conclusions Age, non gram positive bacterial infection and hs-CRP are risk factors predicting peritonitis-related catheter removal or death in CAPD patients.