摘要
目的 探讨腹膜透析中由不同病原菌引起的腹膜炎的临床特点.方法 回顾性分析 2018 年 1 月至 2022年12 月在我院肾病护理单元收治的腹膜透析相关性腹膜炎(PDAP)患者的临床资料.根据检出病原菌的不同,分为革兰阳性(G +)菌组、革兰阴性(G-)菌组和真菌组,比较3 组间病原学分布特点和临床特征.根据患者是否拔管分为两组,分析两组间白介素6(IL-6)、降钙素原(PCT)、白细胞、血小板(PLT)、血红蛋白、白蛋白、C反应蛋白(CRP)等指标,二元Logistic回归分析拔管的影响因素.结果 共送检 1066 例腹透液样本,其中 332 例检出病原菌,阳性检出率为 31.14%(332/1066),病原菌检出337 株.G +菌组 244 株,占比 72.40%(244/337);以凝固酶阴性葡萄球菌(57.37%)、链球菌(19.67%)为主.G-菌组64 株,占比18.99%(64/337);以大肠埃希菌(26.56%)和铜绿假单胞菌(17.18%)为主.真菌组29 株,占比8.61%(29/337);以近平滑念珠菌(41.37%)为主.拔管组与非拔管组在年龄、IL-6、CRP、PLT和病原菌感染类型比较差异有统计学意义,二元回归分析显示真菌感染是腹膜炎拔管的独立危险因素.结论 PDAP的主要致病菌以G+菌为主,G-菌感染患者具有更高水平的PCT和IL-6,真菌感染者具有更高水平的PLT数量;感染性腹膜炎尤其是真菌性腹膜炎是患者终止腹膜透析改为血液透析的主要危险因素.
Abstract
Objective To investigate the clinical characteristics of peritonitis caused by different pathogens in peritoneal dialysis.Methods We retrospectively analyzed the clinical data of all patients who had peritoneal dialysis-associated peritonitis(PDAP)in our hospital from January 2018 to December 2022.According to the different pathogenic bacteria detected,they were divided into Gram-positive(G +)bacteria,Gram-negative(G-)bacteria and fungus groups,and the etiological distribution and clinical characteristics of the three groups were compared.Patients were divided into two groups based on whether they had extuba-tion or not,the level of interleukin-6(IL-6),procalcitonin(PCT),white blood cells,platelets(PLT),hemoglobin,albumin,C-reactive protein(CRP)and other laboratory test results between the two groups were analyzed.The influencing factors of extuba-tion were analyzed by binary Logistic regression.Results A total of 1066 samples of peritoneal dialysis fluid were tested.Among which pathogenic bacteria were detected in 332 cases,the positive detection rate was 31.14％(332/1066),and 337 strains of pathogenic bacteria were detected.There were 244 strains of Gram-positive(G +)bacteria,accounting for 72.40％(244/337);mainly coagulase negative Staphylococcus(57.37％)and Streptococcus(19.67％).Gram negative bacterium(G-)64 strains,ac-counting for 18.99％(64/337),mainly Escherichia coli(26.56％)and Pseudomonas aeruginosa(17.18％).In the fungal group,there were 29 strains,accounting for 8.61％(29/337),mainly Candida parapsilosis(41.37％).There were statistically signifi-cant in age,IL-6,CRP,PLT and pathogen infection types between the extubation group and the non-extubation group.Binary re-gression analysis showed that fungal infection was an independent risk factor for peritonitis extubation.Conclusion The main pathogenic bacteria of PDAP were G+ bacteria,patients with G-bacteria infection have higher levels of PCT and IL-6,while those with fungi infection have higher levels of PLT.Infectious peritonitis,especially fungal peritonitis,is the main risk factor for pa-tients to stop peritoneal dialysis and change to hemodialysis.
维普
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