老年腹膜透析患者合并腹膜炎的预后及临床危险因素分析OA
Analysis of prognosis and clinical risk factors in elderly peritoneal dialysis patients with peritonitis
目的:分析老年腹膜透析患者合并腹膜炎的临床危险因素及预后情况.方法:回顾性分析本腹透中心2020年 1月至 2022年 11月期间进行腹膜透析且合并腹膜炎的患者资料.根据发生腹膜炎时的年龄将患者分为老年腹膜炎组(年龄≥65岁)和非老年腹膜炎组(年龄<65岁)2组.收集患者的一般资料、腹膜炎相关资料,比较2组患者发生腹膜炎的临床危险因素及预后情况.结果:共纳入腹膜炎患者 62例,老年腹膜炎组 26例,中位年龄71(65,88)岁,男性 12例(46.2%),糖尿病肾病及合并糖尿病 5例(19.2%);非老年腹膜炎组 36例,中位年龄 48(26,63)岁,男性 23例(63.9%),糖尿病肾病及合并糖尿病 5例(13.9%).老年腹膜炎组较非老年腹膜炎组预后更差(死亡率 30.8%比 2.8%;技术失败率 23.1%比 16.7%,P=0.004).老年腹膜炎组初中及以下学历者更多(72.2%比53.8%,P=0.038)、需要照顾者比例更高(100.0%比 83.3%,P=0.035)、更换操作者频率更高(38.5%比 11.1%,P=0.011),首次培训时间更久(4 d比 3 d,P<0.01),透析龄更长(70.5个月比 29.5个月,P=0.002).非老年腹膜炎患者营养状况更好:标准化蛋白质分解率(normalized protein catabolic rate,nPCR)(0.90比 0.79,P=0.007)及血浆白蛋白(34.78 g/L比 30.77 g/L,P<0.01)均更高;老年腹膜炎组血肌酐(872.42 μmol/L比 1 053.69 μmol/L,P<0.01)、血尿酸(345.0 μmol/L比 372.0 μmol/L,P=0.023)、血钾(3.65 mmol/L比 3.95 mmol/L,P=0.012)、血磷(1.54 mmol/L比1.80 mmol/L,P=0.022)、全段甲状旁腺激素(intact parathyroid hormone,iPTH)(227.2 pg/mL比 414.0 pg/mL,P=0.037)、25羟维生素 D3(17.95 nmol/L比 22.57 nmol/L,P=0.007)水平均低于非老年腹膜炎组.结论:老年腹膜炎患者预后较差.与非老年腹膜炎患者相比,老年患者教育程度更低、透析龄更长,营养状况较差、操作能力差且更需要照顾者.
Objective To analyze the clinical risk factors and prognosis of elderly peritoneal dialysis patients with peritonitis.Methods A retrospective analysis was conducted on the data of patients who underwent peritoneal dialysis and developed peritonitis at this peritoneal dialysis center between January 2020 and November 2022.Patients were divided into 2 groups according to their age at peritonitis onset:an elderly peritonitis group(age≥65)and a non-elderly peritonitis group(age<65).General information and peritonitis-related data were collected,and the clinical risk factors and prognosis of peritonitis between the 2 groups were compared.Results A total of 62 patients with peritonitis were enrolled,including 26 in the elderly peritonitis group,where the median age was 71(range 65-88),12 patients were male(46.2%),and 5 patients had diabetic nephropathy complicated by diabetes mellitus(19.2%);36 in the non-elderly peritonitis group,where the median age was 48(range 26-63),23 patients were male(63.9%),and 5 patients had diabetic nephropathy complicated by diabetes mellitus(13.9%).The elderly peritonitis group exhibited a worse prognosis than the non-elderly peritonitis group(mortality 30.8%vs.2.8%;technique failure rates 23.1%vs.16.7%,P=0.004).The elderly peritonitis group had a higher proportion of patients with education level of middle school or below(72.2%vs.53.8%,P=0.038),a higher proportion requiring caregivers(100%vs.83.3%,P=0.035),a higher frequency of operator changes(38.5%vs.11.1%,P=0.011),longer initial training time(4 d vs.3 d,P<0.01),and longer dialysis duration(70.5 months vs 29.5 months,P=0.002).The non-elderly peritonitis patients had better nutritional status:both normalized protein catabolic rate(nPCR)(0.90 vs.0.79,P=0.007)and plasma albumin(34.78 g/L vs.30.77 g/L,P<0.01)were higher.The elderly peritonitis group had lower levels of blood creatinine(872.42 μmol/L vs.1053.69μmol/L,P<0.01),blood uric acid(345.0 μmol/L vs.372.0 μmol/L,P=0.023),blood potassium(3.65 mmol/L vs.3.95 mmol/L,P=0.012),blood phosphorus(1.54 mmol/L vs.1.80 mmol/L,P=0.022),intact parathyroid hormone(iPTH)(227.2 pg/mL vs.414.0 pg/mL,P=0.037),and 25-hydroxyvitamin D3(17.95 nmol/L vs.22.57 nmol/L,P=0.007).Conclusions Elderly patients with peritonitis had a poorer prognosis.Compared with younger patients with peritonitis,elderly patients had lower education levels,longer dialysis duration,worse nutritional status,poorer operational ability,and a greater need for caregivers.
张春燕;章倩莹;杨俪;崔岩;徐天;王朝晖;任红;黄晓敏
上海交通大学医学院附属瑞金医院肾脏科,上海 200025上海交通大学医学院附属瑞金医院肾脏科,上海 200025上海交通大学医学院附属瑞金医院肾脏科,上海 200025上海交通大学医学院附属瑞金医院肾脏科,上海 200025上海交通大学医学院附属瑞金医院肾脏科,上海 200025上海交通大学医学院附属瑞金医院肾脏科,上海 200025上海交通大学医学院附属瑞金医院肾脏科,上海 200025上海交通大学医学院附属瑞金医院肾脏科,上海 200025
医药卫生
腹膜透析腹膜炎老年危险因素
peritoneal dialysisperitonitiselderlyrisk factors
《内科理论与实践》 2026 (2)
132-137,6
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