目的 探讨治疗前D-二聚体对腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis，PDAP)治疗失败的预测价值。 方法 按照治疗效果把161例确诊为PDAP患者分为治疗成功组及治疗失败组，对2组患者的临床资料进行统计学比较，使用Logistic回归分析PDAP治疗失败的危险因素，运用受试者工作曲线(ROC)分析各危险因素对治疗失败的预测价值。 结果 治疗成功组的血清白蛋白(t=3.359，P=0.002)及首次腹膜炎发生率(χ2=6.155，P=0.013)明显高于治疗失败组，其透析龄(Z =-3.314，P=0.001)、第3天透出液白细胞计数(Z=-3.951，P＜0.001)、hs-CRP(Z=-3.093，P=0.002)、PCT(Z=-2.344，P=0.019)、纤维蛋白原(Z=-2.197，P=0.024)、D-二聚体(Z=-4.152，P＜0.001)低于治疗失败组。单因素Logistic分析显示长透析龄(OR=1.025，95% CI:1.011～1.039，P＜0.001)、高hs-CRP(OR=1.007，95% CI:1.002～1.012，P=0.008)、高PCT(OR=1.018，95% CI:1.002～1.034，P=0.029)、高纤维蛋白原(OR=1.568，95% CI:1.052～2.336，P=0.027)、高D-二聚体(OR=1.523，95% CI:1.165～1.991，P=0.002)、低血清白蛋白(OR=0.0915，95% CI:0.840～0.997，P=0.043)是PDAP治疗失败的危险因素；多因素Logistic分析显示长透析龄(OR=1.024，95% CI:1.008～1.039，P=0.003)、高D-二聚体(OR=1.419，95% CI:1.064～1.893，P=0.017)是PDAP治疗失败的独立危险因素。对比ROC曲线，D-二聚体的曲线下面积最大，为0.801，灵敏度和特异度分别为72.2%和76.2%。 结论 PDAP患者长透析龄、治疗前高水平D-二聚体与治疗失败独立相关，D-二聚体是预测PDAP治疗失败的良好指标。
Objective To investigate the predictive value of plasma D-dimer on the treatment failure of peritoneal dialysis-associated peritonitis (PDAP). Methods The clinical data of 161 patients diagnosed with PDAP were retrospectively analyzed. They were divided into cured group and treatment failure group according to the treatment effect. The clinical data were compared between the two groups. Logistic regression was used to analyze the risk factors for the treatment failure of PDAP. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of the risk factors for the treatment failure. Results Serum albumin (t=3.359, P=0.002) and the first episode of PDAP (χ2=6.155, P=0.013) were significantly higher in the cured group than in the treatment failure group, while dialysis duration (Z=-3.314, P=0.001), leukocyte count in effluent dialysate at the 3rd day (Z=-3.951, P＜0.001), hs-CRP (Z=-3.093, P=0.002), procalcitonin (PCT, Z=-2.344, P=0.019), fibrinogen (Z=-2.197, P=0.024) and D-dimer (Z=-4.152, P＜0.001) were significantly lower in the cured group than in the treatment failure group. Univariate logistic regression showed that longer dialysis duration (OR=1.025, 95% CI:1.011～1.039, P＜0.001), higher hs-CRP (OR=1.007, 95% CI:1.002～1.012, P=0.008), higher PCT (OR=1.018, 95% CI:1.002～1.034, P=0.029), higher fibrinogen (OR=1.568, 95% CI:1.052～2.336, P=0.027), higher D-dimer (OR=1.523, 95% CI:1.165～1.991, P=0.002) and lower serum albumin (OR=0.915, 95% CI:0.840～0.997, P=0.043) were the risk factors for treatment failure of PDAP. Multivariate logistic analysis showed that longer dialysis duration (OR=1.023, 95% CI:1.008～1.039, P=0.003) and higher D-dimer (OR=1.419, 95% CI:1.064～1.893, P=0.017) were the independent risk factors for treatment failure of PDAP. ROC curve showed that D-dimer level to predict the treatment failure of PDAP had the area under the curve of 0.801, the sensitivity of 72.2% and the specificity of 76.2%, better than the levels of hs-CRP, PCT, fibrinogen and serum albumin to predict the treatment failure. Conclusions Longer peritoneal dialysis duration and higher D-dimer before treatment were independently correlated with the treatment failure of PDAP. Plasma D-dimer level was a better indicator to predict treatment failure of PDAP.
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