长腹膜透析龄患者首次腹膜炎的临床特征及治疗转归：基于4家医院625例患者数据

目的 探讨长腹膜透析龄患者首次发生腹膜透析相关性腹膜炎（PDAP）的临床特点及治疗转归。方法 回顾性收集2013~2019年期间在吉林省4家三甲医院首次发生PDAP的所有患者资料。根据发生首次PDAP时的透析龄是否大于36个月，将研究对象分为长透析龄组（≥36个月）和短透析龄组（<36个月）。比较两组患者首次PDAP的临床资料、治疗结果及转归。结果 本研究共纳入625例PDAP患者，长透析龄组93例，短透析龄组532例。在发生首次PDAP时，长透析龄组患者血红蛋白明显高于短透析龄组，而肾小球滤过率明显低于短透析龄组（P<0.05）；长透析龄组较短透析龄组更易感染革兰阴性菌（P<0.05）。长透析龄组的初始治疗有效率（P=0.009）及完全治愈率（P=0.018）均低于短透析龄组，而拔管率高于短透析龄组（P=0.017）。多因素Logistic回归提示，长透析龄导致首次PDAP拔管及治疗失败的风险分别是短透析龄的3.05倍（95%CI：1.35-6.91，P=0.008）和2.81倍（95%CI：1.45-5.44，P=0.002）。真菌及混合菌感染是长透析龄患者首次PDAP治疗失败的独立危险因素（OR：45.40，95%CI：1.488-1385.5，P=0.029；OR：16.50，95%CI：1.106-246.123，P=0.042）。而两组患者在维持PD、技术失败和全因死亡方面无统计学差异，进一步进行多因素Cox回归发现，长透析龄并不是PDAP患者技术失败（OR：1.36，95%CI：0.84-2.19，P=0.206）或全因死亡（OR：1.51，95%CI：0.97-2.35，P=0.068）的独立危险因素。结论 长透析龄患者首次发生PDAP时易发生革兰阴性菌感染，并且治疗效果较短透析龄患者差，但对于长期转归方面无明显影响。长透析龄是首次PDAP拔管和治疗失败的独立危险因素。真菌及混合菌感染是长透析龄患者首次PDAP治疗失败的独立危险因素。

Clinical characteristics and treatment outcomes of first peritonitis in patients receiving long-term peritoneal dialysis: a multicenter study

Objective To analyze the clinical characteristics and treatment outcomes of the first episode of peritoneal dialysis-associated peritonitis (PDAP) in patients receiving long-term peritoneal dialysis. Methods The clinical data of patients with the first episode of PDAP in 4 general hospitals in Jilin Province from 2013 to 2019 were collected retrospectively. According to the duration of dialysis, the patients were divided into long-term (≥36 months) and short-term (<36 months) dialysis groups for comparison of the clinical data, treatment outcomes and long-term prognostic events. Results A total of 625 patients with PDAP were enrolled, including 93 on long-term and 532 on short-term dialysis. Compared with those on short-term dialysis, the patients on long-term dialysis had significantly higher hemoglobin levels and lower glomerular filtration rates when the first episode of PDAP occurred (P<0.05), were more susceptible to gram-negative bacterial infections (P<0.05), and had significantly lower initial treatment response rate (P=0.009) and complete cure rate (P=0.018) and higher extubation rate (P=0.017). Multivariate logistic regression analysis showed that in patients on long-term dialysis, the risks of extubation and treatment failure for the first episode of PDAP were 3.05 times (OR: 3.05, 95%CI: 1.35-6.91, P=0.008) and 2.81 times (OR: 2.81, 95%CI: 1.45-5.44, P=0.002) those in patients with short-term dialysis, respectively. Fungal infection (OR: 45.40, 95%CI: 1.488-1385.5, P=0.029) and mixed bacterial infection (OR: 16.50, 95%CI: 1.106-246.123, P=0.042) were independent risk factors for treatment failure of the first episode of PDAP in patients on long-term dialysis. Maintenance peritoneal dialysis, technical failure, or all-cause mortality did not differ significantly between the two groups. Multivariate Cox regression analysis suggested that long-term dialysis was not an independent risk factor for technical failure (OR: 1.36, 95%CI: 0.84-2.19, P=0.206) or all-cause mortality (OR: 1.51, 95%CI: 0.97-2.35, P=0.068) in patients with PDAP. Conclusion Compared with those on short-term dialysis, patients on long-term dialysis are prone to gram-negative bacterial infection when the first episode of PDAP occurs with worse treatment outcomes but similar long-term outcomes. Long-term dialysis is an independent risk factor of extubation and treatment failure for the first episode of PDAP, and fungal and mixed bacterial infections are independent risk factors for treatment failure of the first PDAP in patients with long-term dialysis.