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中华实验和临床感染病杂志(电子版) ›› 2020, Vol. 14 ›› Issue (06) : 467 -472. doi: 10.3877/cma.j.issn.1674-1358.2020.06.005

所属专题: 文献

论著

糖尿病肾病和非糖尿病肾病维持性血液透析并发感染者的病原菌分布、预后及影响因素
蒋玲1, 陆鹏1,(), 侯娟1, 张勇1, 李丽芳2   
  1. 1. 210000 南京市,南京市浦口医院肾内科
    2. 223399 淮安市,淮安市第一人民医院内分泌科
  • 收稿日期:2020-01-27 出版日期:2020-12-25
  • 通信作者: 陆鹏
  • 基金资助:
    江苏省卫生计生委医学科研课题(No. H201667)

Distribution of pathogenic bacteria, prognosis and related influencing factors in patients with diabetic nephropathy and non-diabetic nephropathy during maintenance hemodialysis

Ling Jiang1, Peng Lu1,(), Juan Hou1, Yong Zhang1, Lifang Li2   

  1. 1. Department of Nephrology, Nanjing Pukou Hospital, Nanjing 210000, China
    2. Department of Endocrinology, the First People’s Hospital of Huai’an, Huai’an 223399, China
  • Received:2020-01-27 Published:2020-12-25
  • Corresponding author: Peng Lu
引用本文:

蒋玲, 陆鹏, 侯娟, 张勇, 李丽芳. 糖尿病肾病和非糖尿病肾病维持性血液透析并发感染者的病原菌分布、预后及影响因素[J/OL]. 中华实验和临床感染病杂志(电子版), 2020, 14(06): 467-472.

Ling Jiang, Peng Lu, Juan Hou, Yong Zhang, Lifang Li. Distribution of pathogenic bacteria, prognosis and related influencing factors in patients with diabetic nephropathy and non-diabetic nephropathy during maintenance hemodialysis[J/OL]. Chinese Journal of Experimental and Clinical Infectious Diseases(Electronic Edition), 2020, 14(06): 467-472.

目的

分析糖尿病肾病和非糖尿病肾病维持性血液透析并发感染的病原菌分布及预后,并探讨其相关影响因素。

方法

收集2014年1至2018年12月于南京市浦口医院和淮安市第一人民医院进行维持性血液透析并发感染的248例患者的临床资料行回顾性分析,根据是否合并糖尿病将其分为糖尿病肾病组(125例)和非糖尿病肾病组(123例)。比较两组患者感染部位、病原菌分布及预后;收集患者性别、年龄、透析状况、透析通路、贫血及低蛋白血症、多重耐药菌感染、合并糖尿病、氧化蛋白产物(AOPP)及C反应蛋白(CRP)水平等,通过单因素分析和Logistic多因素回归分析探讨MHD并发感染者预后的影响因素。

结果

糖尿病肾病组和非糖尿病肾病组患者感染部位中呼吸道(χ2 = 2.005、P = 0.157)、泌尿道(χ2 = 0.781、P = 0.277)、消化道(χ2 = 1.152、P = 0.283)、静脉导管(χ2 = 0.089、P = 0.765)及皮肤软组织(χ2 = 0.518、P = 0.472)构成比差异无统计学意义;两组患者所感染病原菌中革兰阴性菌、革兰阳性菌和真菌构成比差异无统计学意义(χ2 = 1.576、P = 0.455),且在革兰阴性菌、革兰阳性菌和真菌中各病原菌构成比差异均无统计学意义(χ2 = 0.747、P = 0.862,χ2 = 0.524、P = 0.469,χ2 = 0.036、P = 0.851);两组患者中预后良好和预后不良病例数差异有统计学意义(χ2 = 1.576、P = 0.455)。单因素分析显示,预后良好和预后不良两组患者贫血(χ2 = 5.250、P = 0.022)及低蛋白血症(χ2 = 5.706、P = 0.017)、多重耐药菌感染(χ2 = 5.706、P = 0.001)、合并糖尿病(χ2 = 2.962、P = 0.085)、AOPP(t = 18.189、P < 0.001)以及CRP水平(t = 14.466、P < 0.001)差异均有统计学意义;将以上指标纳入Logistic多因素回归分析模型中,发现多重耐药菌感染(χ2 = 9.964、P = 0.001)、合并糖尿病(χ2 = 7.845、P = 0.016)和高水平AOPP(χ2 = 6.046、P = 0.028)均为影响维持性血液透析并发感染者预后的独立危险因素。

结论

糖尿病肾病和非糖尿病肾病维持性血液透析并发感染者在感染部位和病原菌分布方面差异均无统计学意义;但非糖尿病肾病患者预后优于糖尿病肾病患者,与多重耐药菌感染、糖尿病患病及AOPP水平相关。

Objective

To investigate the distribution of pathogenic bacteria and prognosis in patients with diabetic nephropathy and non-diabetic nephropathy during maintenance hemodialysis, and to investigate the related influencing factors.

Methods

The clinical data of 248 patients undergoing maintenance hemodialysis complicated with infection in Nanjing Pukou Hospital and the First People’s Hospital of Huai’an from January 2014 to December 2018 were analyzed, retrospectively. They were divided into diabetic nephropathy group (125 cases) and non-diabetic nephropathy group (123 cases) according to whether complicated with diabetes. The infection, pathogen distribution and prognosis of patients in both groups were compared, respectively; and the patient’s gender, age, dialysis, dialysis pathway, anemia and hypoproteinemia, multi-drug resistant bacteria infection, diabetes, oxidized protein product (AOPP) and C-reactive protein (CRP) levels and other factors were also collected, then the prognostic factors were investigated by single factor analysis and Logistic regression analysis.

Results

The patients in diabetic nephropathy group and non-diabetic nephropathy group had no significant difference in the composition of respiratory (χ2 = 2.005, P = 0.157), urinary tract (χ2 = 0.781, P = 0.277), digestive tract (χ2 = 1.152, P = 0.283), venous catheter (χ2 = 0.089, P = 0.765) and skin and soft tissue (χ2 = 0.518, P = 0.472). The composition ratio of bacteria, Gram-positive bacteria and fungi in two group was not significantly different (χ2 = 1.576, P = 0.455), and there was no significant difference in the propotion of Gram-negative bacteria (χ2 = 0.747, P = 0.862), Gram-positive bacteria (χ2 = 0.524, P = 0.469) and fungi (χ2 = 0.036, P = 0.851). The number of cases with good prognosis and poor prognosis between the two groups was significantly different (χ2 = 1.576, P = 0.455). According to univariate analysis, there were significant differences between the two groups with good prognosis and poor prognosis in terms of anemia (χ2 = 5.250, P = 0.022), hypoalbuminemia (χ2 = 5.706, P = 0.017), multi-drug resistant bacteria infection (χ2 = 5.706, P = 0.001), diabetes (χ2 = 2.962, P = 0.085), AOPP (t = 18.189, P < 0.001) and CRP levels (t = 14.466, P < 0.001). The above indexes were enrolled in Logistic multivariate regression analysis model, which showed that multidrug-resistant bacterial infection (χ2 = 9.964, P = 0.001), diabetes (χ2 = 7.845, P = 0.016), and high levels of AOPP (χ2 = 6.046, P = 0.028) were all independent risk factors affecting the prognosis of patients with concurrent MHD infection.

Conclusions

The patients of diabetic nephropathy and non-diabetic nephropathy with maintenance hemodialysis complicated with infection had no significant differences in the infection site and the distribution of pathogenic bacteria, but the latter had a better prognosis than the former, which was related to multi-drug resistant bacteria infection, diabetes prevalence and AOPP level.

表1 两组患者的一般资料(± s
表2 糖尿病肾病组和非糖尿病肾病组患者的感染部位[例(%)]
表3 糖尿病肾病组和非糖尿病肾病组患者病原菌类型
表4 糖尿病肾病组和非糖尿病肾病组患者各类型病原菌构成比
表5 影响MHD并发感染者预后的单因素分析
表6 影响MHD并发感染者预后的多因素分析
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