糖尿病腹膜透析患者发生腹膜炎的临床特征及预后分析

摘要

目的：比较糖尿病患者腹膜透析相关性腹膜炎与非糖尿病患者腹膜透析相关性腹膜炎的临床特征、病原学特点及预后。方法回顾性分析行腹膜透析置管并行持续性不卧床腹膜透析（CAPD）治疗的患者临床资料，根据发生第1次腹膜透析相关性腹膜炎时患者是否合并糖尿病分为非糖尿病组和糖尿病组。结果非糖尿病患者108例，其中33例至少发生过1次腹膜炎，占30．8％；糖尿病患者共30例，14例至少发生过1次腹膜炎，占46．7％，两组比较差异有统计学意义（P ＜0．01）。糖尿病组患者置管时平均年龄高于非糖尿病组，分别为（63．21±11．75）岁和（48．36±15．37）岁，差异有统计学意义（P ＜0．05）。糖尿病组患者超敏 C 反应蛋白（hs-CRP）高于非糖尿病组，差异有统计学意义（P ＜0．05）。糖尿病组血浆白蛋白（ALB）、血浆前白蛋白（PAB）、血红蛋白（HGB）、血钾（K ＋）低于非糖尿病组，差异有统计学意义（P ＜0．05）。糖尿病组革兰阴性杆菌及真菌所占比例较非糖尿病组增高，且糖尿病组拔管率及死亡率增加，但差异无统计学意义（P ＞0．05）。结论糖尿病腹膜透析患者较非糖尿病腹膜透析患者更容易发生腹膜炎，且常合并更为严重的营养不良、贫血、全身炎症等表现；两组致病菌仍以革兰阳性球菌为主，但糖尿病组患者透析液培养革兰阴性杆菌及真菌比例增高，拔管及死亡率相对增加，预后不良。%Objective To compare the clinical characteristics,pathogenic characteristics and prognosis of peritoneal dialysis-related peritonitis between diabetic patients and non-diabetic patients.Methods A retrospective analysis was con-duceted in the peritonitis patients undergoing continuous ambulatory peritoneal dialysis(CAPD)in our hospital from October 2015 to October 2009.The patients were divided into diabetic group and non-diabetic group,according to the diabetes or not at the first occurrence of peritoneal dialysis related peritonitis.Results There were 108 cases of non-diabetic patients,of which 33 patients (30.8%)hadat least one peritonitis;There were 30 patients with diabetes,of which 14 patients(46.7%)had at least one peritonitis,the difference was statistically significant (P <0.01).The age of peritoneal dialysis catheter in patients with diabetes mellitus (63.21 ±11.75)was statistically greater than that in the non diabetes group (48.36 ±15.37)(P <0.05).The level of high sensitive C reactive protein (hs CRP)in patients with diabetes was statistically higher than that in non-diabetic group (P <0.05).The levels of serum ALB,PAB,K and HGB in the diabetes group were statistically lower than that in the non-diabetes group (P <0.05).The proportion of gram negative bacilli and epiphyte in the diabetic group was higher than that in the non-diabetic group,and the extubation rate and mortality rate were increased,there was no sta-tistical significance (P >0.05 ).Conclusion Diabetic patients with peritoneal dialysis are more likely to suffer from per-itonitis with the higher adverse reaction of malnutrition,anemia,systemic inflammation and other conditions,which may be probably correlated to the high rates of PD catheter removal and poor prognosis.