| 高继娟.腹透相关细菌性腹膜炎的病原学分布及影响因素分析[J].浙江中西医结合杂志,2025,35(2): |
| 腹透相关细菌性腹膜炎的病原学分布及影响因素分析 |
| Analysis of the pathogenic distribution and risk factors of bacterial infection peritoneal dialysis associated peritonitis |
| 投稿时间：2024-05-24 修订日期：2024-08-30 |
| DOI： |
| 中文关键词: 腹透相关细菌性腹膜炎 革兰氏阳性菌 革兰氏阴性菌 影响因素 |
| 英文关键词:Abdominal dialysis associated bacterial peritonitis Gram positive bacteria Gram negative bacteria influencing factors |
| 基金项目:]浙江省中医药科技计划项目(2023ZR118) |
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| 中文摘要: |
| 目的 分析细菌感染所致腹透相关性腹膜炎(PDRP)的病原学分布及相关影响因素。方法 选取2021年1月至2023年12月于我院进行腹膜透析的255例患者,对发生细菌感染(n=150)者进行病原菌谱分析。根据革兰氏特征分为革兰氏阳性(G+)菌组(n=100)和革兰氏阴性(G-)菌组(n=50),同期未感染病原菌者设为对照组(n=105)。分别比较细菌组、G+菌组、G-菌组与对照组的临床资料差异,并采用多因素Logistic回归分析不同革兰氏菌感染的危险因素,通过受试者工作曲线评估其预测效能。结果 ?150例细菌性PDRP腹透液样本共检出154株菌,G+菌(66.23%)以表皮葡萄球菌和唾液链球菌为主。G-菌(33.77%)以大肠埃希菌和肺炎克雷伯菌为主。细菌组年龄、透析月龄及血WBC、NEU%、hsCRP、PCT、HCAR等炎性指标均高于对照组,而K,Na、Cl、Ca、TP、ALB水平均低于对照组(均P<0.05)。G+菌组与对照组比较,PCT、HCAR、NEU%明显偏高、TP明显偏低,且均是G+菌PDRP的独立危险因素,OR分别为1.471、2.112、1.090、0.826(P均<0.05),联合检测的预测效能AUC为0.950(0.922~0.979),敏感度为97.0%,特异度为83.0%。G-菌组与对照组比较, WBC、NEU%、hsCRP、PCT明显偏高,且均是G-菌PDRP的独立危险因素,OR分别为0.362、1.314、1.086、1.786(P均<0.05),联合检测的预测效能AUC为0.998(0.995~1.000),敏感度为98.0%,特异度为98.1%。结论? PDRP 细菌性感染中,G+菌PDRP以表皮葡萄球菌、唾液链球菌为主,G-菌PDRP以大肠埃希菌和肺炎克雷伯菌为主。高PCT、HCAR、NEU%及低TP是G+菌性PDRP的独立危险因素；高WBC、NEU%、hsCRP、PCT是G-菌性PDRP的独立危险因素。多指标联合检测在鉴别诊断不同革兰氏菌PDRP感染具有一定价值。 |
| 英文摘要: |
| Objective To analyze the pathogenic distribution and related influencing factors of peritoneal dialysis associated peritonitis (PDRP) caused by bacterial infection. Method A total of 255 patients who underwent peritoneal dialysis in our hospital from January 2021 to December 2023 were selected, and pathogen spectrum analysis was performed on patients with bacterial infection (n=150). According to the characteristics of Gram, the patients were divided into Gram positive (G+) bacterial group (n=100), Gram negative (G-) bacterial group (n=50), and non-infection group (n=105). The clinical data differences between the G+ bacterial group and the non-infection group, the G-bacterial group and the non-infection group were explored respectively. The risk factors were analyzed using multiple logistic regression. The predictive efficacy was evaluated through the subject work curve. Results A total of 154 bacterial strains were detected from dialysis fluid cultures in 156 patients with bacterial PDRP, with G+ bacteria accounting for 66.23%, mainly Staphylococcus epidermidis and Streptococcus salivarius, and with G-bacteria account for 33.77%, mainly Escherichia coli and Klebsiella pneumoniae. Compared with the control group,the bacterial group had significantly longer dialysis months, significantly higher years, inflammatory indicators (NEU%, hsCRP, PCT, and HCAR), and significantly lower levels of K, Na, Cl, Ca, TP, and ALB (all P<0.05). Compared with non-infection group, the levels of PCT, HCAR, and NEU% were increased significantly, while the level of TP was decreased significantly in G+ bacterial PDRP (P<0.05). Multivariate logistic regression analysis showed that PCT, HCAR and NEU% elevation, TP decline were independent risk factors for the occurrence of G+ bacterial PDRP infection (P<0.05). The AUC areas for diagnosing G+ bacterial infections using PCT, HCAR, NEU% and TP, and their combination were 1.471, 2.112, 1.090, and 0.826 (all P<0.05), respectively. The predictive performance AUC of the combined detection was 0.950 (0.922-0.979), with a sensitivity of 97.0% and a specificity of 83.0%. Compared with non-infection group, the levels of WBC, NEU%, hsCRP, and PCT were increased significantly in G- bacterial PDRP (P<0.05). Multivariate logistic regression analysis showed that WBC, NEU%, hsCRP and PCT were independent risk factors for the occurrence of G- bacterial PDRP infection (P<0.05). The AUC areas for diagnosing G- bacterial infections using WBC, NEU%, hsCRP and PCT, and their combination were 0.362, 1.314, 1.086, and 1.786 (all P<0.05), respectively. The predictive performance AUC of the combined detection was 0.998 (0.995~1.00), with a sensitivity of 98.0% and a specificity of 98.1%. Conclusion Bacterial PDRP infections were mainly caused by G+ bacteria such as Staphylococcus epidermidis and Streptococcus salivarius, and then caused by G- bacteria such as Escherichia coli and Klebsiella pneumoniae. High PCT HCAR, NEU%, and low TP were independent risk factors for G+ bacterial PDRP. High WBC, NEU%, hsCRP, and PCT were independent risk factors for G-bacterial PDRP. The combined detection of multiple indicators has certain value in distinguishing and diagnosing PDRP infections caused by different Gram bacteria. |
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