目的 探讨腹膜透析相关性腹膜炎(peritoneal dialysis associated peritonitis，PDAP)痊愈后营养不良-炎症-动脉粥样硬化(malnutrition, inflammation and atherosclerosis，MIA)综合征对腹膜透析(以下简称腹透)患者临床不良预后的影响。 方法 回顾性分析2008年01月01日～2021年12月31日在北京大学第一医院腹透中心发生PDAP并痊愈腹透患者的临床资料。结合患者是否合并心血管疾病、腹膜炎痊愈后3个月内血白蛋白＜35g/L以及C反应蛋白(CRP)＞3mg/L，将患者分为MIA=0(全否)、MIA=1(1项为是)和MIA≥2(≥2项为是)组。以MIA=0为参考组，采用多因素COX比例风险模型及竞争风险模型分析MIA分值是否为腹膜炎患者预后不良(死亡、转血液透析及腹膜炎再发)的预测因素。 结果 研究期间共有483例患者发生716次腹膜炎，其中397例(82.19%)患者首次腹膜炎痊愈后继续维持腹透，剔除数据缺失的96例患者，本研究最终共纳入301例患者，其中MIA=0组患者74例(24.58%)，MIA=1患者112例(37.21%)，MIA≥2组115例(38.21%)。腹膜炎痊愈后MIA分值越高的患者在基线时白蛋白水平越低(F=26.306,P＜0.001)，CRP水平越高(F=8.549,P=0.014)。采用COX比例风险模型分析，发现与腹膜炎痊愈后MIA=0的患者相比，MIA=1分及MIA≥2分的患者死亡风险分别增加了137%(HR=2.369，95% CI:1.127～4.979；P=0.023)和448%(HR =5.480，95% CI:2.590～11.590；P＜0.001)。通过竞争风险模型发现MIA分值对增加患者转血液透析和腹膜炎再发的风险无显著影响。 结论 PDAP痊愈后MIA综合征对患者产生持续影响，存在MIA综合征因素越多死亡风险越高。
Objective To investigate the effect of malnutrition-inflammation-atherosclerosis (MIA) syndrome on the poor prognosis of patients with peritoneal dialysis associated peritonitis (PDAP) after recovery. Methods Clinical data of the patients developed PDAP and then cured in the Peritoneal Dialysis Center of Peking University First Hospital between January 1, 2008 and December 31, 2021 were retrospectively analyzed. These patients were divided into MIA0, MIA1 and MIA ≥2 groups according to whether or not they had cardiovascular disease, serum albumin＜35g/L or C-reactive protein (CRP) >3mg/L within 3 months after recovery from PDAP. With MIA0 group as the reference, multivariate COX proportional risk model and competitive risk model were used to analyze whether MIA score was a predictor of death, transferred to hemodialysis, and recurrent peritonitis. Results During the study period, a total of 716 PDAP episodes occurred in 483 patients, of which 397 (82.19%) patients continued to maintain PD after recovery from the first PDAP. Excluding 96 patients with missing data, 301 patients were finally incorporated in this study, including 74 patients (24.58%) in MIA0 group, 112 patients (37.21%) in MIA1 group, and 115 patients (38.21%) in MIA ≥2 group. The results suggested that the patients with higher MIA score had lower albumin level and higher CRP level at baseline (P＜0.05). COX proportional risk model found that death risks of the patients in MIA1 and MIA ≥2 groups increased by 137% (HR 2.369, 95% CI:1.127~4.979, P=0.023) and 448% (HR 5.480, 95% CI:2.590~11.590, P＜0.001), respectively, as compared with that of the patients in MIA0 group. The competitive risk model showed that MIA score had no significant effects on the risks of transferred to hemodialysis and recurrent peritonitis. Conclusion MIA syndrome has a continuous adverse effect on patients after recovery from PDAP. The more the items of MIA syndrome, the higher the risk of mortality in the PDAP patients after recovery.
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