【摘要】 目的:调查维持性腹膜透析相关腹膜炎(以下简称：腹膜炎)感染情况，分析影响发生腹膜炎的相关血清学风险指标。方法:回顾性选取2021年3月至2022年7月在本院行腹膜透析治疗的尿毒症患者416例，收集患者临床相关资料，包括一般资料和实验室指标，记录416例患者腹膜炎感染情况及感染病原菌分布，并根据是否存在腹膜炎分为感染组和未感染组，比较两组临床资料差异，分析影响感染的相关因素。采用二元Logistic回归构建实验室指标风险预测模型并利用ROC曲线分析模型价值。结果:416例患者中102例发生腹膜炎，发生率为24.52%,共分离102株病原菌，以革兰阳性菌感染为主，占比62.75%(64/102),其中病原菌以表皮葡萄球菌多见，占比32.81%(21/64),其次为金黄葡萄球菌，占比26.56%(17/64);革兰阴性菌占比34.31%(35/102),其中以大肠埃希菌多见，占比45.71%(16/35)。感染组小学及以下的比例高于未感染组，透析龄长于未感染组，残余肾功能(RRF)低于未感染组(P<0.05)。感染组血红蛋白(Hb)、白蛋白(ALB)水平低于未感染组，血清C-反应蛋白(CRP)、白细胞计数(WBC)、铁蛋白(SF)水平高于未感染组(P<0.05)。Logistic回归分析结果显示，CRP、WBC、SF、ALB是影响尿毒症患者腹膜炎发生的血清学风险因素，根据以上4个指标构建感染预测模型，经ROC曲线分析感染预测型具有较好的预测价值(P<0.05)。结论:尿毒症合并腹膜炎以革兰阳性菌感染为主，患者的低文化程度、长透龄和低RRF可能增加腹膜炎感染的风险；CRP、WBC、SF、ALB是预测腹膜炎发生的血清学风险指标，具有较好的感染预测价值。更多还原

【Abstract】 Objective: To investigate continuous peritoneal dialysis-associated peritonitis(peritonitis), and to analyze the related serological risk indexes. Methods: A total of 416 patients with uremia undergoing peritoneal dialysis in the hospital were retrospectively enrolled between March 2021 and July 2022. The clinical data of patients were collected, including general data and laboratory indexes. The peritonitis infection and distribution of pathogens were recorded. According to presence or absence of peritonitis, they were divided into infection group and non-infection group, and differences in clinical data were compared between the two groups. The influencing factors of infection were analyzed. The risk prediction model based on laboratory indexes was constructed by binary Logistic regression model, and its predictive value was analyzed by ROC curves. Results: Among the 416 patients, there were 102 cases(24.52%) with peritonitis. There were 102 strains of pathogens, mainly on Gram-positive bacteria [62.75%(64/102), including Staphylococcus epidermidis 32.81%(21/64) and Staphylococcus aureus 26.56%(17/64)] and Gram-negative bacteria [34.31%(35/102)], including Escherichia coli [45.71%(16/35)]. The proportion of cases with education level of primary school and below in infection group was higher than that in non-infection group, dialysis age was longer than that in non-infection group, and residual renal function(RRF) was lower than that in non-infection group(P<0.05). The levels of hemoglobin(Hb) and albumin(ALB) in infection group were lower than those in non-infection group, while levels of serum C-reactive protein(CRP), white blood cell count(WBC) and ferritin(SF) were higher than those in non-infection group(P<0.05). The results of Logistic regression analysis showed that CRP, WBC, SF and ALB were risk factors of peritonitis. ROC curve analysis showed that the risk prediction model based on the above 4 indexes was of good predictive value(P<0.05). Conclusion: The main pathogen is Gram-positive bacteria in uremia combined with peritonitis. Low education level, long dialysis age and low RRF may increase the risk of peritonitis infection. CRP, WBC, SF and ALB are serological risk indexes to predict peritonitis, which have good predictive value for infection.更多还原