单中心腹膜透析相关性腹膜炎特点

doi:10.3969/j.issn.1004-583X.2025.04.007

摘要/Abstract

摘要：

目的探讨单中心腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis, PDAP) 患者的病原菌类型、感染原因、预后情况。方法选取2015年1月-2024年1月于甘肃省人民医院腹膜透析(peritoneal dialysis,PD)门诊长期规律随访的PD患者412例。根据患者是否发生PDAP分为PDAP组(n=91)和对照组(n=321),比较两组一般情况和实验数据,分析发生PDAP的病原菌类型、感染原因、预后情况。结果与对照组比较,PDAP组年龄、PD龄均较大,前白蛋白水平、血浆白蛋白水平、血红蛋白水平均较低,差异均有统计学意义(P<0.05)。PDAP组共发生腹膜炎121例次。PDAP组细菌培养阳性率84.30%;革兰阳性菌占83.33%,是PDAP的主要致病菌,其中以表皮葡萄球菌为主,占41.18%。PDAP组感染原因中原因不明占39.67%,与操作相关占24.79%,不洁饮食占22.31%。腹膜炎治愈率89.26%,拔管转血液透析占10.74%。结论甘肃省人民医院PD中心PDAP除外原因不明大部分与PD操作相关,其次是进食过夜食物。需加强患者操作的规范性和饮食的健康教育。

关键词: 腹膜炎, 腹膜透析, 病原菌

Abstract:

Objective To investigate the types of pathogens, causes of infection and prognosis of peritoneal dialysis associated peritonitis (PDAP) in a single center. Methods A total of 412 PD patients with long-term regular follow-up in the Peritoneal Dialysis Clinic of Gansu Provincial Hospital from January 2015 to January 2024 were selected. According to the occurrence of PDAP, the patients were divided into the PDAP group (n=91) and control group (n=321). The general conditions and experimental data of the two groups were compared, and the types of pathogenic bacteria, causes of infection and prognosis of PDAP were analyzed. Results Compared with the control group, patients in the PDAP group had significantly older age and onset of PD, and lower prealbumin, plasma albumin and hemoglobin (P<0.05). A total of 121 cases of peritonitis occurred in 91 patients in the PDAP group. The positive rate of bacterial culture in PDAP group was 84.30%. Gram-positive bacteria accounted for 83.33%, which was the main pathogenic bacteria of PDAP, among which Staphylococcus epidermidis was the main pathogen, accounting for 41.18%. In the PDAP group, 39.67% of the causes of infection were unknown, 24.79% were related to operation, and 22.31% were unclean diet. The cure rate of peritonitis was 89.26%, and the rate of extubation to hemodialysis was 10.74%. Conclusion Except for unknown reasons, PDAP in the peritoneal dialysis center of Gansu Provincial People 's Hospital was mostly related to PD operation, followed by eating overnight food. It is necessary to strengthen the standardization of patient operation and health education of diet.

Key words: peritonitis, peritoneal dialysis, peritonitis pathogens

中图分类号:

R572.2

齐雪婷, 李国娜, 薛嵘, 张军芳, 贾京京, 黄文辉, 李莹屏. 单中心腹膜透析相关性腹膜炎特点[J]. 临床荟萃, 2025, 40(4): 334-338.

Qi Xueting, Li Guona, Xue Rong, Zhang Junfang, Jia Jingjing, Huang Wenhui, Li Yingping. Characteristics of single-center peritoneal dialysis-associated peritonitis[J]. Clinical Focus, 2025, 40(4): 334-338.

导出引用管理器 EndNote|Ris|BibTeX

链接本文: https://lchc.magtechjournal.com/CN/10.3969/j.issn.1004-583X.2025.04.007

https://lchc.magtechjournal.com/CN/Y2025/V40/I4/334

图/表 4

表1 两组一般资料和实验室数据比较

Tab.1 General data and laboratory data between the two groups

分组	例数	年龄 (岁)	男性 [例(%)]	PD龄 (月)	前白蛋白 (mg/L)	血浆白蛋白 (g/L)	血红蛋白 (g/L)	尿素氮 (mmol/L)	血肌酐 (μmol/L)
PDAP组	91	50.48±10.13	88(96.70)	53.1±11.67	303±113.54	32.45±4.23	100.12±10.34	25.56±8.32	965.56±342.02
对照组	321	48.45±11.23	57(17.75)	45.67±3.34	435±209.34	34.23±3.45	110.67±34.09	23.43±7.89	982.69±401.34
统计值		$t$ =2.342	χ²=0.101	$t$ =3.563	$t$ =23.421	$t$ =3.345	$t$ =-1.445	$t$ =-0.743	$t$ =-2.345
P值		<0.001	0.326	<0.001	<0.001	<0.001	<0.001	0.442	0.521

表1 两组一般资料和实验室数据比较

Tab.1 General data and laboratory data between the two groups

分组	例数	年龄 (岁)	男性 [例(%)]	PD龄 (月)	前白蛋白 (mg/L)	血浆白蛋白 (g/L)	血红蛋白 (g/L)	尿素氮 (mmol/L)	血肌酐 (μmol/L)
PDAP组	91	50.48±10.13	88(96.70)	53.1±11.67	303±113.54	32.45±4.23	100.12±10.34	25.56±8.32	965.56±342.02
对照组	321	48.45±11.23	57(17.75)	45.67±3.34	435±209.34	34.23±3.45	110.67±34.09	23.43±7.89	982.69±401.34
统计值		$t$ =2.342	χ²=0.101	$t$ =3.563	$t$ =23.421	$t$ =3.345	$t$ =-1.445	$t$ =-0.743	$t$ =-2.345
P值		<0.001	0.326	<0.001	<0.001	<0.001	<0.001	0.442	0.521

表2 病原菌情况

Tab.2 Pathogenic bacteria

致病菌	菌株数	占比(%)
革兰阳性菌	85	83.33
表皮葡萄球菌	42	41.18
耐甲氧西林金黄色葡萄球菌	19	18.63
弗劳地枸橼酸杆菌(无色杆菌属)	4	3.92
口腔链球菌	3	2.94
唾液链球菌	3	2.94
粪肠球菌	3	2.94
咽峡炎链球菌	3	2.94
缓征链球菌	3	2.94
草绿色链球菌a-溶血	1	0.98
溶血葡萄球菌	1	0.98
鸟肠球菌	1	0.98
黑尔嗜胨菌	1	0.98
头状葡萄球菌	1	0.98
革兰阴性菌	16	15.69
奈瑟菌属	3	2.94
铜绿假单胞菌	5	4.90
粪肠杆菌	3	2.94
阴沟肠杆菌	1	0.98
无枝菌酸棒杆菌	1	0.98
鲍曼不动杆菌	1	0.98
肺炎克雷伯菌	1	0.98
血液嗜冷杆菌	1	0.98
真菌	1	0.98
光滑假丝酵母菌	1	0.98

表3 PDAP组感染原因

Tab.3 Causes of infection in PDAP group

感染原因	例次	占比(%)
原因不明	48	39.67
过夜饭菜	27	22.31
手卫生差	19	15.70
隧道感染	14	11.57
操作时未戴口罩	9	7.43
食用冰箱水果	1	0.83
未紫外线消毒环境	1	0.83
使用已破损的PD液	1	0.83
呼吸道感染	1	0.83
总计	121

表4 PDAD组的转归情况

Tab.4 Outcomes of PDAD group

预后	例次	占比(%)
治愈	108	89.26
拔管转血透	13	10.74
死亡	0	0

参考文献 20

[1]	Teitelbaum I. Peritoneal dialysis[J]. N Engl J Med, 2021, 385(19): 1786-1795.
[2]	Li PK, Chow KM, Cho Y, et al. ISPD peritonitis guideline recommendations:2022 update on prevention and treatment[J]. Perit Dial Int, 2022, 42(2): 110-153.
[3]	Bello AK, Okpechi IG, Osman MA, et al. Epidemiology of peritoneal dialysis outcomes[J]. Nat Rev Nephrol, 2022, 18(12): 779-793. doi: 10.1038/s41581-022-00623-7 pmid: 36114414
[4]	Yu D, Cai Y, Chen Y, et al. Development and validation of risk prediction models for cardiovascular mortality in Chinese people initialising peritoneal dialysis: A cohort study[J]. Sci Rep, 2018, 8(1): 1966-1972. doi: 10.1038/s41598-018-20160-3 pmid: 29386542
[5]	Liyanage T, Ninomiya T, Jha V, et al. Kidney disease: A systematic review[J]. Lancet, 2015, 385(9981):1975-1982.
[6]	Ruiz-Ortega M, Rayego-Mateos S, Lamas S, et al. Targeting the progression of chronic kidney disease[J]. Nat Rev Nephrol, 2020, 16(5):269-288. doi: 10.1038/s41581-019-0248-y pmid: 32060481
[7]	Perl J, Fuller DS, Bieber BA, et al. Peritoneal dialysis-related infection rates and outcomes: Results from the peritoneal dialysis outcomes and practice patterns study (PDOPPS)[J]. Am J Kidney Dis, 2020, 76 (1):42-53. doi: S0272-6386(19)31105-9 pmid: 31932094
[8]	Cheikh Hassan HI, Murali K, Lonergan M, et al. Association of peritonitis with cardiovascular mortality over time in the peritoneal dialysis population: An Australia and New Zealand dialysis and transplant registry study[J]. Kidney Int Rep, 2022, 7(11):2388-2396. doi: 10.1016/j.ekir.2022.08.008 pmid: 36531876
[9]	Ye H, Zhou Q, Fan L, et al. The impact of peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis patients[J]. BMC Nephrol, 2017, 18(1):186-193. doi: 10.1186/s12882-017-0588-4 pmid: 28583107
[10]	Benabed A, Bechade C, Ficheux M, et al. Effect of assistance on peritonitis risk in diabetic patients treated by peritoneal dialysis: Report from the French Language Peritoneal Dialysis Registry[J]. Nephrol Dial Transplant, 2016, 31(4): 656-662.
[11]	高丹, 余沛, 赵子豪, 等. 影响腹膜透析患者发生腹膜炎的相关因素分析[J]. 中国实用内科杂志, 2021, 41(7): 619-623.
[12]	Jensen GL. Malnutrition and inflammation-“burning down the house”: Inflammation as an adaptive physiologic response versus self-destruction?[J]. JPEN J Parenter Enteral Nutr, 2015, 39(1): 56-62.
[13]	Li PK, Chow KM. Infectious complications in dialysis-epidemiology and outcomes[J]. Nat Rev Nephrol, 2011, 8(2):77-88.
[14]	Szeto CC, Wong TY, Chow KM, et al. The clinical course of culture-negative peritonitis complicating peritoneal dialysis[J]. Am J Kidney Dis, 2003, 42( 3) : 567-574.
[15]	Li PK, SzetoCC, PirainoB, et al. ISPD peritonitis recommendations: 2016 update on prevention and treatment[J]. Perit Dial Int, 2016, 36(5):481-508.
[16]	Fung WW, Li PK. Recent advances in novel diagnostic testing for peritoneal dialysis-related peritonitis[J]. Kidney Res Clin Pract, 2022, 41( 2) : 156-164.
[17]	Xu R, Yang Z, Qu H, et al. Intraperitoneal vancomycin plus either oral moxifloxacin or intraperitoneal ceftazidime for the treatment of peritoneal dialysis-related peritonitis: A randomized controlled pilot study[J]. Am J Kidney Dis, 2017, 70(1):30-37.
[18]	Liao JL, Zhang YH, Xiong ZB, et al. The association of cognitive impairment with peritoneal dialysis-related peritonitis[J]. Perit Dial Int, 2019, 39(3): 229-235.
[19]	Dong J, Li Z, Xu R, et al. Disease severity score could not predict the outcomes in peritoneal dialysisassociated peritonitis[J]. Nephrol Dial Transplant, 2012, 27(6): 2496-2501.
[20]	Parikova A, Hruba P, Krediet R, et al. Long-term peritoneal dialysis treatment provokes activation ofgenes related to adaptive immunity[J]. Physiol Res, 2019, 68(5): 775-783. pmid: 31424258