【摘要】目的本研究通过对腹膜透析患者长期随访队列的生存分析，探讨腹膜炎发生频率对腹膜透析患者长期生存的影响。方法研究对象为2006 年1 月～2014 年4 月新进入腹膜透析治疗的成人(年龄≥18 岁)终末期肾病患者，随访截止时间为2020 年12 月。应用COX 回归模型分析影响生存率的因素。按患者腹膜炎发生频次分为3 组：A 组(＜0.2 次/年)；B 组(0.2～0.5 次/年)；C 组(＞0.5 次/年)。应用Kaplan-Meier生存分析、COX回归模型分析比较3 组患者的生存情况。结果共221例腹膜透析患者入选。经过多因素COX 回归，患者年龄(HR=1.058,95% CI:1.040～1.076, P＜0.001)、Charlson 合并症指数(HR=1.274, 95% CI:1.107～1.466, P= 0.001)、时间平均全段甲状旁腺激素(iPTH) (HR=0.998,95%CI:0.996～0.999,P =0.001)和腹膜炎发生频率(HR=3.301,95% CI:2.098～5.196, P＜0.001)是预测死亡的独立危险因素。腹膜炎发生频率不同的3 组间总体生存率存在差异(χ2=99.473，P＜0.001)，C 组死亡风
险高于A 组(HR=2.022，95% CI:1.184～3.452，P=0.010)；高于B 组(HR=3.450，95% CI:1.723～6.906，P＜0.001)；而A 组、B 组死亡风险无差别(HR =1.013，95% CI:0.621～1.652，P=0.958)。结论腹膜透析治疗中，腹膜炎发生频率可以影响患者生存。但其影响存在阈值，当腹膜炎发生频率超过0.5 次/年时，患者死亡风险增加。
【Abstract】Objective To investigate the effect of peritonitis frequency on survival rate of peritoneal dialysis patients. Methods The subjects were adult patients with end- stage renal disease (aged ≥ 18 years) newly admitted to peritoneal dialysis from January 2006 to April 2014. They were followed up till December 2020. COX regression model was used to analyze the related factors of all-cause death. The patients were divided into three groups according to the frequency of peritonitis: group A (＜0.2 episode/ year), Group B(0.2～0.5 episode/year), and Group C (＞0.5 episode/year). Kaplan-Meier survival analysis and COX regression
model were used to analyze the survival rate of the three groups. Results A total of 221 peritoneal dialysis patients were enrolled. After multivariate COX regression, the patients' age (HR=1.058, 95% CI 1.040～1.076，P＜0.001), Charlson complication index (HR=1.274, 95% CI 1.107～1.466, P = 0.001), time-averaged iPTH (HR=0.998, 95% CI 0.996～0.999, P=0.001) and the frequency of peritonitis (HR=3.301, 95% CI 2.098～5.196,P＜0.001) were independent risk factors for predicting death. The overall survival rate was different among the three groups (χ2=99.473，P＜0.001). The risk of death in group C was higher than that in group A (HR=2.022, 95% CI 1.184～3.452, P=0.010), and group B (HR=3.450, 95% CI 1.723～6.906, P＜0.001). But the risk of death was no difference between group A and group B (HR=1.013, 95% CI 0.621～1.652, P=0.958). Conclusion The frequency of peritonitis can affect the survival of patients with peritoneal dialysis. However, there is a threshold for its impact: when the frequency of peritonitis exceeds 0.5 episode/year, the risk of death increases.
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