[1]毛雨河,肖丹,邓声京,等.腹膜透析患者发生腹膜透析相关性腹膜炎影响因素分析及病原菌分布特点[J].新乡医学院学报,2024,(3):257-261.[doi:10.7683/xxyxyxb.2024.03.011]
　MAO Yuhe,XIAO Dan,DENG Shengjing,et al.Influencing factors of peritoneal dialysis associated peritonitis and distribution characteristics of pathogenic bacteria[J].Journal of Xinxiang Medical University,2024,(3):257-261.[doi:10.7683/xxyxyxb.2024.03.011]
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腹膜透析患者发生腹膜透析相关性腹膜炎影响因素分析及病原菌分布特点
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《新乡医学院学报》[ISSN:1004-7239/CN:41-1186/R]

卷:
期数:
2024年3
页码:
257-261
栏目:
临床研究
出版日期:
2024-03-05

文章信息/Info

Title:
Influencing factors of peritoneal dialysis associated peritonitis and distribution characteristics of pathogenic bacteria
作者:
毛雨河; 肖丹; 邓声京; 薛少清
（梅州市人民医院肾内科，广东　梅州　514000）
Author(s):
MAO Yuhe; XIAO Dan; DENG Shengjing; XUE Shaoqing
(Department of Nephrology,Meizhou People′s Hospital,Meizhou 514000,Guangdong Province,China)
关键词:
腹膜透析相关性腹膜炎; 病原菌; 影响因素
Keywords:
peritoneal dialysis associated peritonitis; pathogenic bacteria; influencing factors
分类号:
R459.5
DOI:
10.7683/xxyxyxb.2024.03.011
文献标志码:
A
摘要:
目的　分析腹膜透析患者发生腹膜透析相关性腹膜炎（PDAP）的影响因素及病原菌分布特点。
方法　回顾性分析2012年1月至2022年10月于梅州市人民医院行腹膜透析（PD）治疗并规律复查的257例患者的病历资料，根据是否发生PDAP将患者分为PDAP组（n=102）和非PDAP组（n=155）。用无菌注射器抽取透出液5~10 mL，采用血培养法进行病原菌鉴定。收集患者的性别、年龄、原发疾病、文化程度、是否合并高血压、是否合并糖尿病、是否合并心血管疾病、豢养宠物或家禽、体质量指数（BMI）及透析龄等一般资料。于确诊次日清晨抽取空腹肘静脉血，检测血红蛋白（Hb）、白蛋白（ALB）、血钾、血磷、血钙水平，并记录肾小球滤过率估算值（eGFR）及尿素清除指数（UCI）。采用多因素logistic回归分析影响PD患者发生PDAP的危险因素。
结果　102例PDAP患者共发生PDAP 217例次，病原菌培养阳性124例次，培养阳性率为57.14%；共分离出127株病原菌，其中革兰阳性菌84株（66.14%），革兰阴性菌39株（30.71%），真菌4株（3.15%）。培养出的84株革兰阳性菌中，表皮葡萄球菌25株（29.76%），金黄色葡萄球菌17株（20.24%），溶血葡萄球菌12株（14.29%），沃氏葡萄球菌8株（9.52%），唾液链球菌10株（11.90%），血链球菌5株（5.95%），其他7株（8.33%）；39株革兰阴性菌中，大肠埃希菌20株（51.28%），铜绿假单胞菌6株（15.38%），鲍曼不动杆菌6株（15.38%），肺炎克雷伯菌5株（12.82%），阴沟肠杆菌2株（5.13%）；4株真菌中，近平滑假丝酵母菌3株（75.00%），光滑念珠菌1株（25.00%）。PDAP组与非PDAP组患者的性别、年龄、原发疾病、文化程度、BMI及合并高血压、糖尿病、心血管疾病占比比较差异无统计学意义（P>0.05）。PDAP组豢养宠物或家禽患者占比高于非PDAP组，透析龄长于非PDAP组（P<0.05）。PDAP组与非PDAP组患者的血磷、血钙、eGFR、UCI比较差异无统计学意义（P>0.05）。PDAP组患者的Hb、ALB、血钾水平显著低于非PDAP组（P<0.05）。Logistic回归分析显示，豢养宠物或家禽、透析龄长是PD患者发生PDAP的危险因素（P<0.05）；高Hb、ALB水平是PD患者发生PDAP的保护因素（P<0.05）；血钾与PD患者发生PDAP无相关性（P>0.05）。
结论　革兰阳性菌为PDAP的主要致病菌，其中以表皮葡萄球菌为主；豢养宠物或家禽、透析龄长是PD患者发生PDAP的危险因素，高Hb、ALB水平是PD患者发生PDAP的保护因素。
Abstract:
Objective　To analyze the influencing factors of peritoneal dialysis associated peritonitis (PDAP) and the distribution characteristics of pathogenic bacteria.
Methods　The clinical data of 257 patients who underwent peritoneal dialysis (PD) and regular follow-up in Meizhou People′s Hospital from January 2012 to October 2022 were retrospectively analyzed.According to the occurrence of PDAP,the patients were divided into the PDAP group (n=102) and the non-PDAP group (n=155).The exhaled liquid （5-10 mL） was extracted with a sterile syringe,and the pathogen was identified by blood culture method.General data such as gender,age,primary disease,education level,whether complicated with hypertension/diabetes/cardiovascular diseases,whether keeping pets or poultry,body mass index (BMI) and dialysis duration were collected.Fasting elbow venous blood was drawn in the morning of the next day after diagnosis,the levels of hemoglobin (Hb),albumin (ALB),serum potassium,serum phosphorus,and serum calcium were detected.The estimated glomerular filtration rate (eGFR) and urea clearance index (UCI) were recorded.Multivariate logistic regression was used to analyze the risk factors of PDAP in PD patients.
Results　There were 217 cases of PDAP in 102 patients with PDAP,and 124 cases (57.14%) were positive for pathogen culture.A total of 127 pathogenic bacteria were isolated,including 84 Gram-positive strains (66.14%),39 Gram-negative strains (30.71%) and 4 Fungi strains (3.15%).Among the 84 strains of Gram-positive bacteria,there were 25 strains of staphylococcus epidermidis (29.76%),17 strains of staphylococcus aureus (20.24%),12 strains of staphylococcus haemolyticus (14.29%),8 strains of staphylococcus warneri (9.52%),10 strains of streptococcus salivarius (11.90%),5 strains of streptococcus sanguis (5.95%),and 7 other strains (8.33%).Among the 39 strains of Gram-negative bacteria,there were 20 strains of escherichia coli (51.28%),6 strains of pseudomonas aeruginosa (15.38%),6 strains of acinetobacter baumannii (15.38%),5 strains of klebsiella pneumoniae (12.82%),and 2 strains of enterobacter cloacae (5.13%).Among the 4 strains of Fungi,there were 3 strains of near-smooth candida (75.00%) and 1 strain of candida glabrata (25.00%).There was no significant difference in gender,age,primary disease,education level,BMI,and the proportion of comorbidities with hypertension,diabetes and cardiovascular diseases between the PDAP and non-PDAP groups (P>0.05).The proportion of patients keeping pets or poultry in the PDAP group was higher than that in the non-PDAP group,and the dialysis duration was longer than that in the non-PDAP group (P<0.05).There was no significant difference in serum phosphorus,serum calcium,eGFR and UCI between the PDAP and non-PDAP groups (P>0.05).The levels of Hb,ALB and serum potassium in the PDAP group were significantly lower than those in the non-PDAP group (P<0.05).Logistic regression analysis showed that keeping pets or poultry and long dialysis duration were risk factors for PDAP in PD patients (P<0.05).High Hb and ALB levels were protective factors for PDAP in PD patients (P<0.05).There was no correlation between serum potassium and PDAP in PD patients (P>0.05).
Conclusion　Gram-positive bacteria are the main pathogenic bacteria of PDAP,among which staphylococcus epidermidis is the predominant one.Keeping pets or poultry and long dialysis duration are risk factors for PDAP,while high Hb and ALB levels are protective factors for PDAP in PD patients.

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更新日期/Last Update: 2024-03-05