内科理论与实践

内科理论与实践 ›› 2026, Vol. 21 ›› Issue (02): 132-137.doi: 10.16138/j.1673-6087.2026.02.05

• 论著 • 上一篇    下一篇

老年腹膜透析患者合并腹膜炎的预后及临床危险因素分析

张春燕, 章倩莹(), 杨俪, 崔岩, 徐天, 王朝晖, 任红, 黄晓敏()   

  1. 上海交通大学医学院附属瑞金医院肾脏科，上海　200025
  • 收稿日期:2024-12-19 修回日期:2025-06-17 出版日期:2026-04-25 发布日期:2026-06-15
  • 通讯作者: 章倩莹 E-mail: zhangqianying1742@163.com; 黄晓敏 E-mail: mini_xiaomin@163.com
  • 作者简介:作者贡献/Authors’ Contributions张春燕负责研究构思、实验设计、数据收集、论文撰写；章倩莹负责统计分析、图表制作、结果解释；黄晓敏负责研究监督；杨俪、崔岩、徐天、王朝晖、任红负责数据录入、数据验证。

Analysis of prognosis and clinical risk factors in elderly peritoneal dialysis patients with peritonitis

ZHANG Chunyan, ZHANG Qianying(), YANG Li, CUI Yan, XU Tian, WANG Zhaohui, REN Hong, HUANG Xiaomin()   

  1. Department of Nephrology; Ruijin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai 200025, China
  • Received:2024-12-19 Revised:2025-06-17 Online:2026-04-25 Published:2026-06-15

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摘要：

目的：分析老年腹膜透析患者合并腹膜炎的临床危险因素及预后情况。方法：回顾性分析本腹透中心2020年1月至2022年11月期间进行腹膜透析且合并腹膜炎的患者资料。根据发生腹膜炎时的年龄将患者分为老年腹膜炎组（年龄≥65岁）和非老年腹膜炎组（年龄<65岁）2组。收集患者的一般资料、腹膜炎相关资料，比较2组患者发生腹膜炎的临床危险因素及预后情况。结果：共纳入腹膜炎患者62例，老年腹膜炎组26例，中位年龄71（65，88）岁，男性12例（46.2%），糖尿病肾病及合并糖尿病5例（19.2%）；非老年腹膜炎组36例，中位年龄48（26，63）岁，男性23例（63.9%），糖尿病肾病及合并糖尿病5例（13.9%）。老年腹膜炎组较非老年腹膜炎组预后更差（死亡率30.8%比2.8%；技术失败率23.1%比16.7%，P=0.004）。老年腹膜炎组初中及以下学历者更多（72.2%比53.8%，P=0.038）、需要照顾者比例更高（100.0%比83.3%，P=0.035）、更换操作者频率更高（38.5%比11.1%， P=0.011）,首次培训时间更久（4 d比3 d, P<0.01），透析龄更长（70.5个月比29.5个月, P=0.002）。非老年腹膜炎患者营养状况更好：标准化蛋白质分解率（normalized protein catabolic rate，nPCR）（0.90比0.79, P=0.007）及血浆白蛋白(34.78 g/L比30.77 g/L, P<0.01)均更高；老年腹膜炎组血肌酐(872.42 μmol/L比1 053.69 μmol/L, P<0.01)、血尿酸（345.0 μmol/L比372.0 μmol/L, P=0.023）、血钾（3.65 mmol/L比3.95 mmol/L, P=0.012）、血磷（1.54 mmol/L比1.80 mmol/L, P=0.022）、全段甲状旁腺激素（intact parathyroid hormone, iPTH）（227.2 pg/mL比414.0 pg/mL, P=0.037）、25羟维生素D3（17.95 nmol/L比22.57 nmol/L, P=0.007）水平均低于非老年腹膜炎组。结论：老年腹膜炎患者预后较差。与非老年腹膜炎患者相比，老年患者教育程度更低、透析龄更长，营养状况较差、操作能力差且更需要照顾者。

关键词: 腹膜透析, 腹膜炎, 老年, 危险因素

Abstract:

Objective To analyze the clinical risk factors and prognosis of elderly peritoneal dialysis patients with peritonitis. Methods A retrospective analysis was conducted on the data of patients who underwent peritoneal dialysis and developed peritonitis at this peritoneal dialysis center between January 2020 and November 2022. Patients were divided into 2 groups according to their age at peritonitis onset: an elderly peritonitis group (age≥65) and a non-elderly peritonitis group (age<65). General information and peritonitis-related data were collected, and the clinical risk factors and prognosis of peritonitis between the 2 groups were compared. Results A total of 62 patients with peritonitis were enrolled, including 26 in the elderly peritonitis group, where the median age was 71 (range 65-88), 12 patients were male (46.2%), and 5 patients had diabetic nephropathy complicated by diabetes mellitus (19.2%); 36 in the non-elderly peritonitis group, where the median age was 48 (range 26-63), 23 patients were male (63.9%), and 5 patients had diabetic nephropathy complicated by diabetes mellitus (13.9%). The elderly peritonitis group exhibited a worse prognosis than the non-elderly peritonitis group (mortality 30.8% vs. 2.8%; technique failure rates 23.1% vs. 16.7%, P=0.004). The elderly peritonitis group had a higher proportion of patients with education level of middle school or below (72.2% vs. 53.8%, P=0.038), a higher proportion requiring caregivers (100% vs. 83.3%, P=0.035), a higher frequency of operator changes (38.5% vs. 11.1%, P=0.011), longer initial training time (4 d vs. 3 d, P<0.01), and longer dialysis duration (70.5 months vs 29.5 months, P=0.002). The non-elderly peritonitis patients had better nutritional status: both normalized protein catabolic rate (nPCR) (0.90 vs. 0.79, P=0.007) and plasma albumin (34.78 g/L vs. 30.77 g/L, P<0.01) were higher. The elderly peritonitis group had lower levels of blood creatinine (872.42 μmol/L vs. 1053.69μmol/L, P<0.01), blood uric acid (345.0 μmol/L vs. 372.0 μmol/L, P=0.023), blood potassium (3.65 mmol/L vs. 3.95 mmol/L, P=0.012), blood phosphorus (1.54 mmol/L vs. 1.80 mmol/L, P=0.022), intact parathyroid hormone (iPTH) (227.2 pg/mL vs. 414.0 pg/mL, P=0.037), and 25-hydroxyvitamin D3 (17.95 nmol/L vs. 22.57 nmol/L, P=0.007). Conclusions Elderly patients with peritonitis had a poorer prognosis. Compared with younger patients with peritonitis, elderly patients had lower education levels, longer dialysis duration, worse nutritional status, poorer operational ability, and a greater need for caregivers.

Key words: peritoneal dialysis, peritonitis, elderly, risk factors