匹多莫德对腹膜透析腹膜炎患者的疗效
| 作者: |
1夏艳芝,
1曾文
1 华润武钢总医院肾内科，武汉 430000 |
| 通讯: |
曾文
Email: zengwen786@21cn.com |
| DOI: | 10.3978/j.issn.2095-6959.2017.05.005 |
摘要
目的：观察口服匹多莫德对腹膜透析相关性腹膜炎的疗效。方法：选取2014年5月至2016年5月在华润武钢总医院肾内科住院的130名腹膜透析相关性腹膜炎患者，随机分为治疗组与对照组，对照组给予头孢唑啉联合头孢他啶，治疗组在对照组基础上加用匹多莫德片。比较两组一般情况、初治及2周后有效率、换液次数及微炎症、血脂与免疫学指标。结果：治疗组与对照组在年龄、性别、透析龄、原发病、体重、改良定量主观整体评分(Modified Quantitative Subjective Global Assessment，MQSGA)、血尿素氮(blood urea nitrogen，BUN)、血肌酐(serum creatinine，Scr)、内生肌酐清除率(endogenous creatinine clearance rate，Ccr)等方面差异无统计学意义；对照组与治疗组之间菌谱差异无统计学意义；治疗组与对照组初治有效率分别为77.7% vs. 80.0%，差异无统计学意义(χ2=0.18，P=0.66)；2周后的有效率分别为93.3% vs. 82.2%，差异有统计学意义(χ2=4.56，P=0.03)；治疗组与对照组至透出液清亮的换液次数分别为4.60±1.90 vs. 5.30±2.60，差异无统计学意义(t=1.75，P=0.08)；治疗组与对照组至发热消失的换液次数分别为7.00±3.30 vs. 7.70±2.50，差异无统计学意义(t=1.36，P=0.17)；治疗组与对照组至腹痛消失的换液次数分别为7.75±2.5 vs. 11.38±2.70，差异有统计学意义(t=7.95，P<0.001)，治疗组至腹痛消失的次数显著少于对照组；治疗组与对照组至白细胞计数<50/μL的换液次数分别为8.60±3.60 vs. 13.75±4.70，差异有统计学意义(t=7.10，P<0.001)，治疗组白细胞计数<50/μL的次数显著少于对照组；治疗后治疗组和对照组较治疗前超敏C反应蛋白(high-sensitivity C-reactive protein，hs-CRP)、高迁移率族蛋白1(high mobility group box-1 protein，HMGB1)显著降低，治疗组hs-CRP、HMGB-1显著低于对照组，在血脂指标中，治疗组与对照组在治疗前和治疗后2周指标均无显著差异，免疫学指标中治疗组在治疗后免疫球蛋白G与免疫球蛋白A显著上升。结论：匹多莫德能够改善腹膜透析相关性腹膜炎抗生素治疗的有效率，缩短患者的临床症状和体征消失时间，同时改善患者的微炎症状态、免疫学功能。
关键词：
腹膜透析相关性腹膜炎
匹多莫德
免疫辅助治疗
微炎症状态
Effect of pidotimod on peritoneal dialysis patients with peritonitis
CorrespondingAuthor: ZENG Wen Email: zengwen786@21cn.com
DOI: 10.3978/j.issn.2095-6959.2017.05.005
Abstract
Objective: To observe the therapeutic effect of oral pidotimod on peritoneal dialysis related peritonitis. Methods: One hundred and thirty peritoneal related peritonitis patients were enrolled into two groups , the therapy group and the control group, from May 2014 to May 2016. The control group was treated with cefazolin combined with ceftazidime. And the therapy group was treated with cefazolin , ceftazidime and pidotimod. The general information, effective rates of initial and two weeks treatment, number of dialysis fluid change was compared between these two groups. Micro-inflammation condition, blood lipid and Immunology after 3 months of treatment was also measured. Results: There was no significant difference between the two groups in terms of age, sexual, the time of dialysis, primary disease, weight, MQSGA score, BUN, Scr, Ccr and distribution of pathogens. The effective rate of initial treatment was 77.7% in the therapy group and 80.0% in the control group, with no significantly difference (χ2=0.18, P=0.66). The effective rate of 2-week treatment was 93.3% in the therapy group, which was significantly higher than 82.2% in the control group (χ2=4.56, P=0.03). The amount of exchanges until the occurrence of clear dialysates and until the disappearance of fever in the therapy group and the control group was 4.60±1.90 vs. 5.30 ±2.60 (t=1.75, P=0.08), 7.00 ±3.3 vs. 7.70 ±2.50 (t=1.36, P=0.17), respectively. The amount of exchanges until the disappearance of abdominal pain was 7.75 ±2.50 in the therapy group, which was significantly lower than 11.38 ±2.70 in the control group (t=7.95, P<0.001). The amount of exchanges until the leucocyte counts <50/μL was 8.60 ±3.60 in the therapy group, which was significantly lower than 13.75 ±4.7 in the control group (t=7.10, P<0.001). The level of hs-CRP, HMGB-1 in the therapy group was significantly lower than that in the control group after 3 months treatment. There was no significant difference between the two groups before and after treatment for 2 weeks, in the immunological index, IgG and IgA increased significantly in the treatment group after the treatment. Conclusion: Pidotimod can modify the positive rate of antibiotic treatment in peritoneal dialysis related peritonitis, and reduce the disappearance time of patients’ clinical symptoms, also it can modify the micro-inflammation condition of patients.