目的 探讨预后营养指数(prognostic nutritional index,PNI)与腹膜透析相关性腹膜炎(peritoneal dialysis-associated peritonitis，PDAP)患者治疗失败的关系。 方法 选择2016年1月─2024年8月在安徽医科大学第二附属医院肾脏内科住院治疗的PDAP患者205例，根据治疗结果将患者分为治愈组(n=170)和治疗失败组(n=35)，分析2组患者的临床资料。 结果 与治愈组相比，治疗失败组患者透析龄、第3天腹腔引流液白细胞计数、血C反应蛋白(CRP)较高(Z=-3.422、-5.219、-3.044，P=0.001、＜0.001、0.002)，体质量指数(BMI)、PNI较低(Z/t=-2.032、6.707,P=0.042、＜0.001)。单因素Logistic回归分析结果显示入院前自行使用抗生素((OR=4.592，95% CI：2.118～9.957，P＜0.001)、较高的透析龄(OR=1.250，95% CI：1.105～1.414，P＜0.001)、第3天腹腔引流液白细胞计数(OR=1.021， 95% CI：1.007～1.035，P=0.003)、CRP(OR=1.006，95% CI：1.002～1.010，P=0.028)、较低的BMI(OR=0.886，95% CI：0.796～0.987，P＜0.001)、PNI(OR=0.833，95% CI：0.771～0.898，P＜0.001)为PDAP患者治疗失败的为危险因素。多因素Logistic回归分析结果显示较高的透析龄、第3天白细胞计数、较低的PNI为PDAP患者治疗失败的独立危险因素(OR=1.179、1.028、0.853，95% CI：01.018～1.363、0.777～0.937，P=0.027、0.002、0.001)。PNI预测PDAP患者治疗失败受试者工作特征曲线(ROC)曲线下面积(AUC)最大为0.776，当与透析龄联合预测时其AUC最大为0.816。 结论 PNI反应机体的营养免疫状况，与PDAP治疗失败有关，并且可以较好的预测PDAP患者治疗效果，当与透析龄联合时预测能力增强。
Objective To investigate the relationship between prognostic nutritional index (PNI) and treatment failure in patients with peritoneal dialysis-associated peritonitis (PDAP). Methods A total of 205 PDAP patients hospitalized in the Department of Nephrology from January 2016 to August 2024 were enrolled. Based on treatment outcomes, patients were divided into a cured group (n=170) and a treatment failure group (n=35). Clinical data were compared between the two groups. Results Compared with the cured group, the treatment failure group had longer dialysis vintage (Z=-3.422, P=0.001), higher peritoneal effluent white blood cell (WBC) count on day 3 (Z=-5.219, P＜0.001),higher levels of C-reactive protein (CRP) (Z= -3.044, P=0.002) , but lower body mass index (BMI) (Z=-2.032, P=0.042) and PNI (t=6.707, P＜0.001). Univariate logistic regression analysis showed that self-administered antibiotic use before admission (OR =4.592, 95% CI:2.118～9.957, P＜0.001), longer dialysis vintage (OR=1.250, 95% CI:1.105～1.414, P＜0.001), higher day 3 peritoneal effluent WBC count (OR=1.021, 95% CI:1.007～1.035, P=0.003), higher CRP (OR= 1.006, 95% CI:1.002～1.010, P=0.002), lower BMI (OR =0.886, 95% CI:0.796～0.987, P=0.028), and lower PNI (OR=0.833, 95% CI:0.771～0.898, P＜0.001) were risk factors for treatment failure in PDAP patients. Multivariate logistic regression analysis confirmed that longer dialysis vintage (OR=1.179, 95% CI:1.018～1.363, P=0.027), higher day 3 WBC count (OR=1.028, 95% CI:1.010～1.046, P=0.002), and lower PNI (OR=0.853, 95% CI :0.771～0.937, P=0.001) were independent risk factors for treatment failure. Receiver operating characteristic (ROC) curve analysis showed that PNI had the highest predictive value for treatment failure (AUC=0.776), and its predictive performance further improved when combined with dialysis vintage (AUC=0.816). Conclusion PNI reflects the nutritional and immune status of the body and is associated with PDAP treatment failure. It demonstrates good predictive ability for treatment outcomes, and its predictive power increases when combined with dialysis vintage.
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