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| 多囊肾病与非多囊肾病患者发生腹膜透析相关腹膜炎的比较 |
| 闫嘉,王玉洁,周琪,李茂婷,赵丽芳,杜俊,王铁云,李娟,汪海燕,赖学莉,郭志勇* |
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(海军军医大学(第二军医大学)长海医院肾内科, 上海 200433
*通信作者) |
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| 摘要: |
| 目的 探讨多囊肾病（PKD）的存在是否增加腹膜透析患者腹膜炎的发生风险。方法 收集2008年1月1日至2018年12月31日在海军军医大学（第二军医大学）长海医院接受持续性不卧床腹膜透析（CAPD）作为肾脏替代疗法患者的临床床资料，进行回顾性分析。根据患者原发病类型分为PKD组和非PKD组，根据患者年龄分为≤ 62岁组和>62岁组。透析时间按照患者CAPD开始到停止的总暴露时间来计算。对收集到的数据进行泊松回归分析，计算腹膜透析相关腹膜炎发生率（次/患者年），然后根据年龄和性别等协变量进行调整后得到95%CI并进行假设检验；对每个分组进行泊松回归分析，计算腹膜透析相关腹膜炎发作时间间隔（月）及95%CI。结果 本研究共纳入249例患者，男132例（53.01%）、女117例（46.99%），年龄（62.31±14.82）岁，PKD患者14例（5.62%）、非PKD患者235例（94.38%）。非PKD患者与PKD患者年龄分别为（62.33±15.07）岁和（62.57±10.01）岁，CAPD中位持续时间（范围）分别为42.50（1.00~137.70）个月和55.35（9.60~131.50）个月。非PKD患者和PKD患者的总体腹膜透析相关腹膜炎发生率相似（分别为0.44和0.35次/患者年），革兰阴性菌腹膜炎发生率相同（均为0.09次/患者年）。泊松回归分析结果表明，性别、年龄、是否PKD对腹膜透析相关腹膜炎发生率均无明显影响。非PKD患者和PKD患者的腹膜透析相关腹膜炎发作时间间隔分别为27.39个月（95%CI 23.90~31.91个月）和33.86个月（95%CI 19.83~116.50个月），非PKD和PKD者革兰阴性菌腹膜炎发作时间间隔分别为134.83个月（95%CI 96.00~226.41个月）和141.17个月（95%CI 81.63~521.74个月）。结论 PKD不会增加腹膜透析患者发生腹膜炎的风险。 |
| 关键词: 多囊肾疾病 腹膜透析 腹膜炎 危险性评估 |
| DOI：10.16781/j.0258-879x.2020.12.1394 |
| 投稿时间：2020-02-13修订日期：2020-04-03 |
| 基金项目:国家自然科学基金（81770763，81800678），上海市科学技术委员会科技创新行动计划（18441905900）. |
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| Comparison of peritoneal dialysis-related peritonitis between patients with polycystic and non-polycystic kidney disease |
| YAN Jia,WANG Yu-jie,ZHOU Qi,LI Mao-ting,ZHAO Li-fang,DU Jun,WANG Tie-yun,LI Juan,WANG Hai-yan,LAI Xue-li,GUO Zhi-yong* |
(Department of Nephrology, Changhai Hospital, Naval Medical University(Second Military Medical University), Shanghai 200433, China
*Corresponding author) |
| Abstract: |
| Objective To investigate whether the presence of polycystic kidney disease (PKD) increases the incidence of peritoneal dialysis-related peritonitis. Methods The clinical data of 249 patients who received continuous ambulatory peritoneal dialysis (CAPD) as renal replacement therapy in Changhai Hospital of Naval Medical University (Second Military Medical University) from Jan. 1, 2008 to Dec. 31, 2018 were collected and analyzed retrospectively. According to the type of primary disease, the patients were divided into PKD and non-PKD groups; they were divided into ≤ 62 and >62 years old groups. Dialysis time was calculated from the beginning to the end of CAPD. Poisson regression was performed to calculate the incidence of peritoneal dialysis-related peritonitis (episode/patient-year). The 95% confidence interval (CI) was obtained and hypothesis test was carried out after adjusting the age, gender and other covariates. Poisson regression analysis was performed for each group to calculate the attack time interval (months) and 95% CI. Results A total of 249 patients were enrolled in this study, including 14 PKD patients (5.62%) and 235 non-PKD patients (94.38%), 132 males (53.01%) and 117 females (46.99%), aged (62.31±14.82) years. The age of non-PKD and PKD patients were (62.33±15.07) and (62.57±10.01) years, respectively. The median duration of CAPD was 42.50 (1.00-137.70) and 55.35 (9.60-131.50) months, respectively. The overall incidence of peritonitis was similar in non-PKD and PKD patients (0.44 and 0.35 episode/patient-year, respectively), and the incidence of gram-negative bacterial peritonitis was same (both 0.09 episode/patient-year). Poisson regression analysis showed that gender, age or PKD had no significant effects on the incidence of peritoneal dialysis-related peritonitis. The time intervals for each episode of peritoneal dialysis-related peritonitis in non-PKD and PKD patients were 27.39 (95% CI 23.90-31.91) and 33.86 (95% CI 19.83-116.50) months, respectively. The time intervals for each episode of gram-negative bacterial peritonitis in non-PKD and PKD patients were 134.83 (95% CI 96.00-226.41) and 141.17 (95% CI 81.63-521.74) months, respectively. Conclusion PKD does not increase the risk of peritonitis in peritoneal dialysis patients. |
| Key words: polycystic kidney diseases peritoneal dialysis peritonitis risk assessment |
