Objective To explore the effect of the time of the first occurrence of peritonitis on the prognosis of patients with maintenance peritoneal dialysis (PD), so as to explore the risk factors of peritonitis and find out the methods to prevent this complication.MethodsA retrospective study was conducted on 114 patients with stable peritoneal dialysis-related peritonitis in the Department of Nephrology, the General Hospital of Ningxia Medical University from January 2004 to December 2014.According to the dialysis age at the time of the first peritonitis, the patients were divided into three groups:13 in the short-term group (dialysis age＜3 months), 20in the medium-term group (3 months＜dialysis age＜12 months) and 81 in the long-term group (dialysis age＞12months).The baseline characteristics, bacteriological data and prognosis of the first peritonitis in the three groups were compared.To explore the relationship between the occurrence time of peritonitis and prognosis with all-cause death as the main end point.Results Hemoglobin in short-term group was lower than that in medium-term group (P=0.001), and there was no significant difference in hemoglobin between medium-term group and long-term group (P=0.052).Patients in middle-term group were younger than that in short-term group (P=0.018) and there was no significant difference in age between medium-term group and long-term group (P=0.169).Albumin in long-term group was lower than that in medium-term group (P=0.032).There was no significant difference between the short-term group and the medium-term group (P=0.868).The residual urine volume in the long-term group was lower than that in the short-term group (P=0.045), and there was no significant difference between the short-term group and the medium-term group (P=0.17).The total KT/V in the long-term group was lower than that in the short-term group and the medium-term group (P＜0.05).The survival time in the long-term group was longer than that in the short-term group and the medium-term group (P＞0.05).There was no significant difference in total KT/V and survival time between short-term group and medium-term group (P＞0.05).e GFR in the short-term group was higher than medium-term group and long-term group, and medium-term group was higher than long-term group (P＜0.05).The main pathogenic bacteria of three groups of peritonitis patients were gram-positive coccus, followed by gram-negative bacillus and fungus.No statistical differences were found in pathogenicjavascript:void (0);organisms (P=0.402).After a median follow-up time of 43 (23, 66) months, 83 cases (72.8％) were cured, 30 cases (26.3％) died and 1 case (0.9％) transferred to hemodialysis.Kaplan-Meier survival analysis showed that the overall mortality rate of short-term group was the highest, while that of the long-term group was lowest, the overall mortality rate of short-term group was higher than the long-term group, the overall mortality rate of middle-term group was higher than the long-term group (P＜0.01).The hazard ratio of mortality in short-term group and middle-term group were 6.08-folds and 10.17-folds to the long-term group (P＜0.01).Conclusion The first episode of peritonitis in PD patients is related to the long-term prognosis of the patients.Patients with earlier peritonitis occurrence has a poor prognosis of patient survival.%目的 探讨维持性腹膜透析患者首次发生腹膜炎的时间对患者预后的影响,以期探索腹膜炎发生的危险因素,为预防此并发症寻求方法.方法 回顾性分析宁夏医科大学总医院肾脏内科2004年1月-2014年12月稳定腹膜透析相关性腹膜炎患者114例,根据首次腹膜炎时的透析龄分为3组:短程组13例(透析龄≤3个月)、中程组20例(3个月＜透析龄≤12个月)和长程组81例(透析龄＞12个月).比较3组发生首次腹膜炎时的基线特征、细菌学资料及预后.以全因死亡为主要终点,探讨腹膜炎发生时间与预后的关系.结果 血红蛋白短程组低于中程组(P=0.001);中程组与长程组间血红蛋白差异无统计学意义(P=0.052);患者年龄中程组小于短程组(P=0.018);中程组与长程组间年龄差异无统计学意义(P=0.169);长程组白蛋白低于中程组(P=0.032),短程组和中程组间的差异无统计学意义(P=0.868);长程组的残余尿量低于短程组(P=0.045),短程组和中程组间的差异无统计学意义(P=0.17);总KT/V长程组低于短程组和中程组(P均＜0.05);生存时间长程组长于短程组和中程组(P均＜0.05),短程组和中程组间总KT/V、生存时间差异均无统计学意义(P均＞0.05);eGFR短程组高于中程组和长程组,中程组高于长程组(P均＜0.05);3组腹透相关腹膜炎患者主要的致病菌均为革兰氏阳性球菌,其次为革兰氏阴性杆菌和真菌,3组病原菌感染率差异无统计学意义(P=0.402).随访中位时间43(23,66)个月,治愈83例(72.8％),死亡30例(26.3％),拔管转血透1例(0.9％).Kaplan-Meier生存分析提示短程组全因死亡率最高,长程组全因死亡率最低,短程组全因死亡率高于长程组,中程组全因死亡率高于长程组(P均＜0.01),腹膜炎短程组和中程组的患者其死亡风险较长程组者分别增加6.08倍和10.17倍(P＜0.01).结论 维持性腹膜透析患者首次腹膜炎发生时间与患者的长期预后有关,发生时间越早患者全因死亡率越高.
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