革兰阴性菌致腹膜透析相关性腹膜炎患者预后及危险因素
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摘要
目的探讨革兰阴性菌致腹膜透析相关性腹膜炎患者预后及其危险因素。方法选取2011年1月—2017年12月我院收治的82例革兰阴性菌致腹膜透析相关性腹膜炎作为研究对象,记录患者的临床资料,分析影响预后的相关因素。结果本研究完全治愈51.22%(42/82),复发、再发或重现26.83%(22/82),拔管或死亡21.95%(18/82)。不同预后患者年龄、体质量指数及透析时间比较差异具有统计学意义(P<0.05)。经非条件单因素logistic回归分析显示,透析时间过长、既往有心脏病和糖尿病、体质量指数过低、年龄过大、血红蛋白和白蛋白水平过低及钙磷乘积和C-反应蛋白水平过高的革兰阴性菌致腹膜透析相关性腹膜炎患者拔管或死亡的发生率均显著升高(P<0.05)。经非条件多因素logistic回归分析显示,高龄、既往糖尿病病史、白蛋白和血红蛋白水平过低及C-反应蛋白水平过高是革兰阴性菌致腹膜透析相关性腹膜炎患者拔管或死亡的独立危险因素(P<0.05)。结论高龄、既往糖尿病病史、白蛋白和血红蛋白水平过低及C-反应蛋白水平过高是革兰阴性菌致腹膜透析相关性腹膜炎患者拔管或死亡的独立危险因素,临床应予以重视。
Objective To investigate the prognosis and risk factors of patients with CAPD-related peritonitis caused by gram-negative bacteria. Methods Eighty-two patients with CAPD-related peritonitis caused by gram-negative bacteria admitted to our hospital from January 2011 to December 2017 were selected as study objects. Clinical data of the patients were recorded. The related factors affecting prognosis were analyzed. Results In this study, 51.22%(42/82) was completely cured, the recurrence rate was 26.83%(22/82), and the proportion of extubation or death was 21.95%(18/82). The differences in age, body mass index and duration of dialysis of patients with different prognosis were statistically significant(P<0.05). Univariate unconditional logistic regression analysis showed that incidence of extubation or death was significantly increased in patients with CAPD-related peritonitis caused by gram-negative bacteria who had exceedingly long duration of dialysis, exceedingly low BMI and hemoglobin and albumin levels, and exceedingly high calcium-phosphorus product and CRP level, who was too old and who had heart disease and diabetes(P<0.05). Multivariate unconditional logistic regression analysis showed that advanced age, previous history of diabetes, exceedingly low albumin and hemoglobin levels, and exceedingly high CRP levels were independent risk factors for extubation or death in patients with CAPD-related peritonitis caused by gram-negative bacteria(P<0.05). Conclusion Advanced age, previous history of diabetes, exceedingly low albumin and hemoglobin levels, and exceedingly high CRP levels were independent risk factors for extubation or death in patients with CAPD-related peritonitis caused by gram-negative bacteria, to which clinicians should pay more attention.
Objective To investigate the prognosis and risk factors of patients with CAPD-related peritonitis caused by gram-negative bacteria. Methods Eighty-two patients with CAPD-related peritonitis caused by gram-negative bacteria admitted to our hospital from January 2011 to December 2017 were selected as study objects. Clinical data of the patients were recorded. The related factors affecting prognosis were analyzed. Results In this study, 51.22%(42/82) was completely cured, the recurrence rate was 26.83%(22/82), and the proportion of extubation or death was 21.95%(18/82). The differences in age, body mass index and duration of dialysis of patients with different prognosis were statistically significant(P<0.05). Univariate unconditional logistic regression analysis showed that incidence of extubation or death was significantly increased in patients with CAPD-related peritonitis caused by gram-negative bacteria who had exceedingly long duration of dialysis, exceedingly low BMI and hemoglobin and albumin levels, and exceedingly high calcium-phosphorus product and CRP level, who was too old and who had heart disease and diabetes(P<0.05). Multivariate unconditional logistic regression analysis showed that advanced age, previous history of diabetes, exceedingly low albumin and hemoglobin levels, and exceedingly high CRP levels were independent risk factors for extubation or death in patients with CAPD-related peritonitis caused by gram-negative bacteria(P<0.05). Conclusion Advanced age, previous history of diabetes, exceedingly low albumin and hemoglobin levels, and exceedingly high CRP levels were independent risk factors for extubation or death in patients with CAPD-related peritonitis caused by gram-negative bacteria, to which clinicians should pay more attention.
引文
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[2] 章俊,王悦,梁秀洁,等.复发和再发性腹膜透析相关性腹膜炎的危险因素及致病菌特征[J].广东医学,2016,37(4):602-605.
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[8] 陈莎,韩飞,谢锡绍,等.腹膜透析相关性细菌性腹膜炎反复发作的危险因素及预后分析[J].中华肾脏病杂志,2017,33(12):887-894.
[9] 王艳,任伟,陈薇,等.糖尿病腹膜透析患者发生腹膜炎的临床特征及预后分析[J].中国临床保健杂志,2016,19(6):614-617.
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[11] 刘德玲,张苗,蒋春明,等.革兰阴性菌与革兰阳性菌致腹膜透析相关性腹膜炎的临床特征[J].东南大学学报(医学版),2015,34(3):411-414.
[12] 杨杰,张炜炜,万成,等.91例次腹膜透析相关性腹膜炎的致病菌耐药性分析及其与预后的关系[J].中国血液净化,2013,12(11):590-593.
[13] 赵艳花,金玉婷,王文林.1例腹膜透析相关性腹膜炎的药学监护[J].中国临床药理学与治疗学,2015,20(7):775-777.
[14] 刘华,杨敏,高小夏,等.腹膜透析相关性腹膜炎的致病菌及其耐药性分析[J].江苏医药,2014,40(11):1309-1311.
[15] Pecoits-Filho R,Yabumoto F M,Campos L G,et al.Peritonitis as a risk factor for long-term cardiovascular mortality in peritoneal dialysis patients:The case of a friendly fire[J].Nephrology (Carlton),2018,23(3):253-258.
[16] 唐碧雯,方炜.腹膜透析相关腹膜炎预后的预测因素[J].中国中西医结合肾病杂志,2011,12(6):556-558.
[17] 牛和俊,胡志军,陈小元,等.30例腹膜透析相关性腹膜炎致病菌及耐药性分析[J].安徽医学,2016,37(7):849-852.
[18] 马莹,王颖,王海云,等.腹膜透析相关性腹膜炎患者短期预后不良危险因素的分析[J].中国医学科学院学报,2018,40(1):13-20.
[19] 尚瑜,谭峰.终末期肾病不同透析方式患者血清CRP、IL-6、TNF-α水平及与营养指标的关系[J].中国临床研究,2018,31(6):749-752,756.
[20] 黄静雅,谢雪锋,李小梅,等.腹膜透析患者蛋白质营养指数与生存率关系的回顾性分析[J].中国实用护理杂志,2014,30(22):68-71.
[21] 龙银华,徐德宇,李琳,等.腹膜透析相关性腹膜炎的临床分析[J].江苏医药,2016,42(16):1801-1805.
[22] 尚碧莲,陈涌泉.粪类圆线虫病并发腹膜炎一例临床分析[J].临床误诊误治,2016,29(5):5-6.
[23] 王静,吕晶,李文冬,等.腹膜透析相关性腹膜炎病原菌及其危险因素[J].中国感染控制杂志,2016,15(10):739-743.
[24] Feng S,Wang Y,Qiu B,et al.Impact of early-onset peritonitis on mortality and technique survival in peritoneal dialysis patients[J].Springerplus,2016,5(1):1676.
[25] 方芳.糖尿病患者腹膜透析腹膜炎危险因素分析及护理[J].安徽卫生职业技术学院学报,2016,15(6):83-84,86.
[2] 章俊,王悦,梁秀洁,等.复发和再发性腹膜透析相关性腹膜炎的危险因素及致病菌特征[J].广东医学,2016,37(4):602-605.
[3] 朱彦秋,陈瑾,尹丽娟,等.腹膜透析相关性腹膜炎患者病原菌耐药性及预后分析[J].临床肾脏病杂志,2018,18(2):92-96.
[4] 吴振球,孙晶晶,李庆士,等.腹膜透析并发感染性腹膜炎患者病原菌分布及危险因素分析[J].中国临床医生杂志,2016,44(8):58-60.
[5] 张道法,苏淑娟.腹膜透析相关性腹膜炎易感因素分析[J].临床和实验医学杂志,2018,17(9):999-1002.
[6] 赵丽娟,孙世仁,杨君,等.腹膜透析相关性腹膜炎的致病菌及其易感因素分析[J].中华肾病研究电子杂志,2016,5(3):118-122.
[7] 许戎,胡宁,阿荣其其格,等.肠源性与非肠源性腹膜透析相关性腹膜炎的临床特点及预后[J].中国血液净化,2012,11(11):621-625.
[8] 陈莎,韩飞,谢锡绍,等.腹膜透析相关性细菌性腹膜炎反复发作的危险因素及预后分析[J].中华肾脏病杂志,2017,33(12):887-894.
[9] 王艳,任伟,陈薇,等.糖尿病腹膜透析患者发生腹膜炎的临床特征及预后分析[J].中国临床保健杂志,2016,19(6):614-617.
[10] Li P K,Szeto C C,Piraino B,et al.Peritoneal dialysis-related infections recommendations:2010 update[J].Perit Dial Int,2010,30(4):393-423.
[11] 刘德玲,张苗,蒋春明,等.革兰阴性菌与革兰阳性菌致腹膜透析相关性腹膜炎的临床特征[J].东南大学学报(医学版),2015,34(3):411-414.
[12] 杨杰,张炜炜,万成,等.91例次腹膜透析相关性腹膜炎的致病菌耐药性分析及其与预后的关系[J].中国血液净化,2013,12(11):590-593.
[13] 赵艳花,金玉婷,王文林.1例腹膜透析相关性腹膜炎的药学监护[J].中国临床药理学与治疗学,2015,20(7):775-777.
[14] 刘华,杨敏,高小夏,等.腹膜透析相关性腹膜炎的致病菌及其耐药性分析[J].江苏医药,2014,40(11):1309-1311.
[15] Pecoits-Filho R,Yabumoto F M,Campos L G,et al.Peritonitis as a risk factor for long-term cardiovascular mortality in peritoneal dialysis patients:The case of a friendly fire[J].Nephrology (Carlton),2018,23(3):253-258.
[16] 唐碧雯,方炜.腹膜透析相关腹膜炎预后的预测因素[J].中国中西医结合肾病杂志,2011,12(6):556-558.
[17] 牛和俊,胡志军,陈小元,等.30例腹膜透析相关性腹膜炎致病菌及耐药性分析[J].安徽医学,2016,37(7):849-852.
[18] 马莹,王颖,王海云,等.腹膜透析相关性腹膜炎患者短期预后不良危险因素的分析[J].中国医学科学院学报,2018,40(1):13-20.
[19] 尚瑜,谭峰.终末期肾病不同透析方式患者血清CRP、IL-6、TNF-α水平及与营养指标的关系[J].中国临床研究,2018,31(6):749-752,756.
[20] 黄静雅,谢雪锋,李小梅,等.腹膜透析患者蛋白质营养指数与生存率关系的回顾性分析[J].中国实用护理杂志,2014,30(22):68-71.
[21] 龙银华,徐德宇,李琳,等.腹膜透析相关性腹膜炎的临床分析[J].江苏医药,2016,42(16):1801-1805.
[22] 尚碧莲,陈涌泉.粪类圆线虫病并发腹膜炎一例临床分析[J].临床误诊误治,2016,29(5):5-6.
[23] 王静,吕晶,李文冬,等.腹膜透析相关性腹膜炎病原菌及其危险因素[J].中国感染控制杂志,2016,15(10):739-743.
[24] Feng S,Wang Y,Qiu B,et al.Impact of early-onset peritonitis on mortality and technique survival in peritoneal dialysis patients[J].Springerplus,2016,5(1):1676.
[25] 方芳.糖尿病患者腹膜透析腹膜炎危险因素分析及护理[J].安徽卫生职业技术学院学报,2016,15(6):83-84,86.