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持续腹膜透析中的真菌性腹膜炎

Authors
Gary M Cox, MD
Carol A Kauffman, MD
Steve J Schwab, MD
Section Editor
Thomas A Golper, MD
Deputy Editor
Alice M Sheridan, MD
Translators
李贵森, 主任医师，教授

引言

接受维持性透析的患者中真菌感染的发病率显著增加。一项有关美国肾脏病数据系统(United States Renal Data System, USRDS)中1992-1997年间超过300,000例患者的回顾性研究证实，与一般人群相比，透析患者发生真菌感染的年龄调整发病率比为9.8[1]。这些真菌感染绝大多数由假丝酵母菌种(占79%)所致。

终末期肾病(end-stage renal disease, ESRD)患者中的大多数真菌感染与腹膜透析(peritoneal dialysis, PD)技术相关[2]。

在接受PD的患者中，真菌所致腹膜炎较细菌感染会带来更高的并发症发病率和死亡率。已报道的并发症包括硬化性腹膜炎、粘连及由此导致的肠梗阻或狭窄、肠壁侵袭以及脓肿形成[3]。感染的腹膜外扩散并不常见，死亡率通常与基础疾病相关。

接受持续PD的患者中真菌性腹膜炎的概述见此专题。PD中腹膜炎的总体概述参见其他专题。 (参见“持续腹膜透析中腹膜炎的微生物学和治疗”)

微生物学

腹膜腔感染是PD的主要并发症；其通常由葡萄球菌种所致。相较之下，真菌导致2%-13%的这类病例。大多数PD相关真菌感染是由假丝酵母菌种所致，尤其是白色假丝酵母菌(C. albicans)和近平滑假丝酵母菌(C. parapsilosis)。偶尔也观察到各种各样的霉菌和酵母菌，如曲霉菌[4]、镰刀菌、红酵母属、毛霉目及着色霉菌。当发现真菌与细菌感染作为多种微生物性腹膜炎的一部分时，真菌是对治疗反应差的一个预测指标[5]。

        

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Literature review current through: 2017-06 . | This topic last updated: 2017-05-18.
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