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中国循证儿科杂志

中国循证儿科杂志 ›› 2016, Vol. 11 ›› Issue (1): 13-16.

• 论著 • 上一篇    下一篇

儿童慢性腹膜透析相关腹膜炎危险因素的病例对照研究

沈茜 徐虹 方晓燕 翟亦晖 张俊 张欣 缪千帆 龚一女 周清   

  1. 复旦大学附属儿科医院肾脏风湿科 上海，201102
  • 收稿日期:2016-02-23 修回日期:2016-02-23 出版日期:2016-02-05 发布日期:2016-02-05
  • 通讯作者: 徐虹

Risk factors of peritoneal dialysis related peritonitis in children: a case-control study

SHEN Qian, XU Hong, FANG Xiao-yan, ZHAI Yi-hui, ZHANG Jun, ZHANG Xin, MIAO Qian-fan, GONG Yi-nv, ZHOU Qinga   

  1. Department of Nephrology and Rheumatology, Children's Hospital of Fudan University, Shanghai 201102, China
  • Received:2016-02-23 Revised:2016-02-23 Online:2016-02-05 Published:2016-02-05
  • Contact: XU Hong

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摘要：

目的 分析终末期肾病（ESRD）患儿慢性腹膜透析（CPD）相关腹膜炎(简称腹膜炎)发生的危险因素，为儿童腹膜炎防治提供依据。方法 回顾性收集复旦大学附属儿科医院（我院）开展ESRD患儿CPD 以来的全部病历，依据连续随访记录，以是否出现CPD分为腹膜炎组和非腹膜炎组，分析两组人口学指标、CPD指标和透析充分性指标。并行多因素分析探讨发生腹膜炎的危险因素。结果 2001年至2014年在我院接受CPD治疗的109例ESRD患儿进入本文分析，男60例（55%）、女49例。开始腹膜透析的中位年龄9.9岁，中位透析病程13.4月。连续性非卧床腹膜透析（CAPD）15例，自动腹膜透析（APD）94例（86.2％）。43例（39.4%）仍接受CPD治疗，50例（45.9%）成功行肾移植，7例（6.4%）转行血液透析治疗，6例（5.5%）死亡，3例（2.8%）失访。1、2、3和5年的生存率分别为97.1%、93.3%、90.1%和90.1%。33例发生57例次腹膜炎，平均腹膜炎发生率为1次/35.1病人月。单因素分析显示，开始透析时身高SDS（P=0.01）、透析病程（P<0.001）和白蛋白水平（P=0.01）腹膜炎组和非腹膜炎组差异有统计学意义。多因素Logistic回归分析显示，开始透析时身高SDS<-2.0（OR=12.746，95％CI：2.436~66.675，P=0.003）和透析病程>1年（OR=8.162，95%CI：2.514~26.500，P<0.001）是腹膜炎发生的独立危险因素。结论 开始透析时身高SDS<-2.0和透析病程>1年是儿童CPD相关腹膜炎发生的独立危险因素。

Abstract:

Objective To evaluate the risk factors of chronic peritoneal dialysis (CPD) related peritonitis in children.Methods All end-stage renal disease (ESRD) patients who received the CPD in Children's Hospital of Fudan University were collected retrospectively. The patients were grouped as peritonitis group and non-peritonitis group. According to the consecutive follow-up data, demographic factors, dialysis characteristics and main indicators of dialysis adequacy were analyzed.Results A total of 109 children who received the CPD from 2001 to 2014 in our hospital were enrolled in this study. 60 cases (55%) were boys and the other 49 were girls. The median age started CPD was 9.9 years and median duration of dialysis was 13.4 months. 15 cases (13.8%) received continuous ambulatory peritoneal dialysis (CAPD) and the other 94 received automated peritoneal dialysis (APD). At the latest follow-up, 43 cases (39.4%) still received CPD, 50 cases (45.9%) received renal transplantation, 7 cases (6.4%) were transferred to hemodialysis, 6 cases (5.5%) died and the other 3 cases (2.8%) were lost to follow-up. 1-year, 2-year, 3 year and 5-year patient survival rate was 97.1%, 93.3%, 90.1% and 90.1%, respectively. Totally, 33 patients suffered from 57 times of peritonitis. The incidence of peritoneal dialysis related peritonitis was 1 episode per 35.1 patient-month. There were significant differences in height at the start of dialysis (P=0.01), duration of dialysis (P<0.001) and serum albumin level (P=0.01) between peritonitis group and non-peritonitis group. The results of Logistic regression analysis indicated that height SDS<-2.0 at the start of dialysis (OR=12.746, 95%CI: 2.436-66.675, P=0.003) and more than one year duration of dialysis (OR=8.162, 95%CI: 2.514-26.500, P<0.001) were the independent risk factors of peritoneal dialysis related peritonitis.Conclusion Height SDS<-2.0 at the start of dialysis and more than one year duration dialysis were the independent risk factors of peritoneal dialysis related peritonitis in children.