【摘要】目的探讨维持性腹膜透析患者基线血尿酸水平与首次腹膜透析相关性腹膜炎(以下简称“腹膜炎”)间的关系。方法选取2012 年1 月～2018 年1 月在安徽医科大学第二附属医院肾脏内科新进入腹膜透析且能长期规律随访的腹膜透析患者130 例，分为首次腹膜炎组和非腹膜炎组，分析两组患者基线血尿酸水平、有关实验室指标间的关系及基线血尿酸水平对首次腹膜炎的预测价值。结果130例患者中首次腹膜炎占37.3%，与非腹膜炎组患者相比，首次腹膜炎组年龄较小(t=1.664，P=0.020)，基线血尿酸、血磷水平较高(t 值分别为-6.367，-3.691；P 值分别为＜0.001，P＜0.001)，血红蛋白(hemoglobin,HGB)较低(t=2.388，P=0.018)。首次腹膜炎与基线血尿酸、血磷呈正相关(r 值分别为0.487，0.310；P 值分别为＜0.001，＜0.001)，与HGB 呈负相关(r=-0.206，P=0.018)。单因素Logistics 回归分析结果显示基线高血尿酸、低HGB 是首次腹膜炎发生的危险因素(OR 值分别为1.013，0.968；95% CI 值分别为1.007～1.018，0.938～1.000；P 值分别为＜0.001, 0.047)。多因素分析显示基线高血尿酸、低血白蛋白、合并有糖尿病是首次腹膜炎发生的危险因素(OR 值分别为1.014，0.909，3.808； 95% CI 值分别为1.008～1.019，0.840～0.985，1.180～12.288；P 值分别为＜0.001,0.020,0.006)。结论维持性腹膜透析患者的基线血尿酸水平与腹膜透析后发生的首次腹膜炎显著相关；腹膜透析治疗的终末期肾病患者，腹膜透析置管前基线血尿酸水平越高，越容易发生腹膜炎。
【Abstract】Objective To investigate the relationship between baseline serum uric acid level and primary peritoneal dialysis-associated peritonitis. Methods Peritoneal dialysis (PD) patients admitted to the Department of Nephrology, The Second Affiliated Hospital of Anhui Medical University for the first time between January 2012 and January 2018 and followed up regularly for a long period of time were recruited in this study. Patients were divided into primary peritonitis group and non- peritonitis group. The relationship between baseline serum uric acid level and other related laboratory indexes was analyzed in the two groups. The
level of baseline serum uric acid for the prediction of primary PD-associated peritonitis was evaluated. Results Primary peritonitis occurred in 37.3% of the 130 PD patients. Patients in primary peritonitis group had younger age (t=1.664, P=0.020), higher levels of baseline serum uric acid (t=-6.367, P<0.001) and phosphorus (t=-3.691, P<0.001) and lower hemoglobin (t=2.388, P=0.018), as compared with those in non-peritonitis group. Primary PD- associated peritonitis was positively correlated with baseline levels of serum uric acid(r=0.487, P<0.001) and serum phosphorus (r=0.310, P<0.001), and negatively correlated with hemoglobin(r=-0.206, P=0.018). Univariate regression analysis showed that higher baseline serum uric acid (OR=1.013,
95% CI=1.007~1.018, P<0.001) and lower HGB (OR=0.968, 95% CI=0.938~1.000, P=0.047) were the risk factors for primary PD-associated peritonitis. Multivariate analysis showed that higher baseline serum uric acid (OR=1.014, 95% CI=1.008~ 1.019, P<0.001) lower albumin (OR=0.909, 95% CI= 0.840~0.985, P=0.020) and diabetes (OR=3.808, 95% CI=1.180~ 12.288, P=0.006) were the risk factors for primary PD-associated peritonitis. Conclusions Baseline serum uric acid level was significantly correlated with primary PD-associated peritonitis in continuous PD patients. For end-stage renal disease patients treated with PD, higher baseline serum uric acid level before PD catheterization will be more likely to complicate with primary PD-associated peritonitis.
[1] Verger C, Ryckelynck J, Duman M, et al. French peritoneal dialysis registry (RDPLF): outline and main results.[J]. Kidney international. Supplement, 2006(70):512-520.
[2] Mehrotra R, Davies O, Devuyst S, et al. The Current State of Peritoneal Dialysis.[J]. Journal of the American Society of Nephrology : JASN, 2016,27(11):3238-3252.
[3] Mujais S, Story K. Peritoneal dialysis in the US: evaluation of outcomes in contemporary cohorts[J]. Kidney Int Suppl, 2006(103):521-526.
[4] Hsieh Y, Chang C, Wang S. Predictors for and impact of high peritonitis rate in Taiwanese continuous ambulatory peritoneal dialysis patients.[J]. International urology and nephrology, 2015(47):183-189.
[5] Liakopoulos V, Nikitidou O, Kalathas T, et al. Peritoneal dialysis-related infections recommendations: 2016 update. What is new?[J]. International urology and nephrology, 2017,49(12):2177-2184.
[6] Ioachimescu A, Brennan D, Hoar B, et al. Serum uric acid is an independent predictor of all-cause mortality in patients at high risk of cardiovascular disease: a preventive cardiology information system (PreCIS) database cohort study.[J]. Arthritis and rheumatism, 2008,58(2):623-630.
[7] 马晓军, 田德英, 许东, 等. 尿酸对树突状细胞成熟及免疫功能的影响[J]. 中国病理生理杂志, 2007,23(1):95-98.
[8] Wai Kei L. Metabolic syndrome and obesity in peritoneal dialysis.[J]. Kidney research and clinical practice, 2016,35(1):10-14.
[9] Roa'A A, Ari P, Justine Yang Y, et al. Characteristic and Outcome of Psoriatic Arthritis Patients with Hyperuricemia.[J]. The Journal of rheumatology, 2018,45(2):213-217.
[10] Zhu J, Li A, Jia E, et al. Monosodium urate crystal deposition associated with the progress of radiographic grade at the sacroiliac joint in axial SpA: a dual-energy CT study.[J]. Arthritis research & therapy, 2017,19(1):83-95.
[11] Martinon F, Burns K, Tschopp J. The inflammasome: a molecular platform triggering activation of inflammatory caspases and processing of proIL-beta.[J]. Molecular cell, 2002,10(2):417-426.
[12] Rock K L, Kataoka H, Lai J. Uric acid as a danger signal in gout and its comorbidities.[J]. Nature reviews. Rheumatology, 2013,9(1):13-23.
[13] Pamela G, Nicolas R, Sabine C, et al. Uric acid is a danger signal activating NALP3 inflammasome in lung injury inflammation and fibrosis.[J]. American journal of respiratory and critical care medicine, 2009,179(10):903-913.
[14] 赵俊, 黄永东, 尤颖. 肺炎患儿血清和唾液生化检验指标水平变化的研究[J]. 右江医学, 2018,46(3):330-333.
[15] Ye H, Zhou Q, Fan L, et al. The impact of peritoneal dialysis-related peritonitis on mortality in peritoneal dialysis patients.[J]. BMC nephrology, 2017,18(1):186-195.
[16] Cho Y, Johnson D W. Peritoneal dialysis-related peritonitis: towards improving evidence, practices, and outcomes.[J]. American journal of kidney diseases : the official journal of the National Kidney Foundation, 2014,64(2):278-289.
[17] Murat D, Mehmet K, Faruk T, et al. Comparison of incidence of peritonitis between peritoneal dialysis solution types.[J]. Nephron. Clinical practice, 2007,106(1):c57-c60.
[18] Prasad N, Gupta A, Sharma R K, et al. Impact of nutritional status on peritonitis in CAPD patients.[J]. Peritoneal dialysis international, 2007,27(1):42-47.
[19] 陈莎, 韩飞, 谢锡绍, 等. 腹膜透析相关性细菌性腹膜炎反复发作的危险因素及预后分析[J]. 中华肾脏病杂志, 2017,33(12):887-894.
[20] Niu H, Tang X, Zhou W, et al. Frequent peritoneal dialysis-related peritonitis: clinical characteristics, risk factors and treatments[J]. Nan fang yi ke da xue xue bao = Journal of Southern Medical University, 2010,30(4):855-858.
[21] 周继红. 全身炎症反应综合征患者血磷水平变化对其预后的影响[J]. 广西医学, 2005,27(1):31-33.
[22] 刘伟, 汤耀卿, 毛恩强, 等. 外科脓毒血症病人血磷水平变化的初步研究[J]. 外科理论与实践, 2003,8(5):400-402.
[23] Zent R, Myers J, Donald D, et al. Continuous ambulatory peritoneal dialysis: an option in the developing world?[J]. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 1994,14(1):48-51.
[24] Oo T, Roberts T, Collins A. A comparison of peritonitis rates from the United States Renal Data System database: CAPD versus continuous cycling peritoneal dialysis patients.[J]. American journal of kidney diseases : the official journal of the National Kidney Foundation, 2005,45(2):372-380.
[25] De V A, Maccario M, Braga M, et al. Peritoneal dialysis in nondiabetic patients older than 70 years: comparison with patients aged 40 to 60 years.[J]. American journal of kidney diseases : the official journal of the National Kidney Foundation, 1998,31(3):479-490.
[26] Chow K M, Szeto C C, Leung C B, et al. Impact of social factors on patients on peritoneal dialysis.[J]. Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association, 2005,20(11):2504-2510.
[27] Chow K M, Szeto C C, Leung C B, et al. A risk analysis of continuous ambulatory peritoneal dialysis-related peritonitis.[J]. Peritoneal dialysis international : journal of the International Society for Peritoneal Dialysis, 2005,25(4):374-379.
