摘要目的:探讨低甲状旁腺素血症（HPTH）和2型糖尿病（T2DM）的交互作用与腹膜透析（PD）患者发生腹膜炎的关系。方法:回顾性纳入2012年1月1日至2018年12月31日在贵州省人民医院腹膜透析中心新置管的PD患者，收集患者的人口学、基线临床及实验室检查结果等资料，随访至2020年12月31日。采用Kaplan-Meier生存曲线及Cox回归分析HPTH和T2DM的交互作用对PD患者腹膜炎发生的影响。结果:共270例PD患者入选本研究，年龄（39.9±13.2）岁，其中男性143例，T2DM患者24例，血全型甲状旁腺激素（iPTH）水平［ M（ Q1， Q3）］为268.1（121.7，447.0）pg/ml。中位随访时间为29.5（范围：4.0~75.0）个月，共有69例（25.6%）患者首次发生腹膜炎。调整混杂因素后，相加交互作用分析显示，T2DM+HPTH组（ n=12）发生腹膜炎的风险为非T2DM+非HPTH组（ n=180）的3.48倍（ HR=3.48，95% CI：1.04~3.87），且大于两因素单独存在（ HR=1.35，95% CI：0.78~2.31和 HR=0.82，95% CI：0.20~3.40）之和。HPTH与T2DM同时存在的交互作用指数为1.95，交互作用归因比为67.6%，相对超额危险度为2.35。HPTH与T2DM联合受试者特征工作曲线下面积为0.626（95% CI：0.550~0.703， P=0.039）。 结论:HPTH与T2DM的正相加交互作用是PD患者发生腹膜炎的危险因素，两者共存可增加腹膜炎发生风险。

abstractsObjective:To investigate the interactive effect of hypoparathyroidism (HPTH) and type 2 diabetes mellitus (T2DM) on peritonitis in patients on peritoneal dialysis (PD).Methods:In this retrospective cohort study, all PD patients who were firstly catheterized in the peritoneal dialysis center of Guizhou Provincial People′s Hospital from January 1, 2012 to December 31, 2018 were included. The characteristics of demographics, baseline clinical and laboratory data were collected, and patients were followed up until December 31, 2020. Kaplan-Meier survival curve and Cox regression analysis were used to explore the associations between the interaction of HPTH+T2DM and peritonitis.Results:A total of 270 PD patients were enrolled in this study, aged (39.9±13.2) years, including 143 males and 24 T2DM patients. These serum levels of intact parathyroid hormone (iPTH) [ M( Q1, Q3)] was 268.1 (121.7, 447.0)pg/ml. After a median follow-up of 29.5 (range from 4.0 to 75.0) months, peritonitis occurred in 69 (25.6%) PD patients for the first time. After controlling for confounding factors, the interaction analysis showed that the risk of peritonitis in T2DM patients with HPTH ( n=12) was 3.48 times that of non-T2DM patients without HPTH ( n=180) ( HR=3.48, 95% CI: 1.04-3.87, P=0.034), which was also greater than the sum of the factors alone ( HR=1.35, 95% CI: 0.78-2.31 and HR=0.82, 95% CI: 0.20-3.40). The synergy index between HPTH and T2DM was 1.95, the attributable proportion of interaction was 67.6%, and the relative excess risk of interaction was 2.35. The receiver operating characteristic (ROC) curve indicated that the area under the curve of combined diagnosis of HPTH and T2DM was 0.626 (95% CI: 0.550-0.703, P=0.039). Conclusion:The positive interaction between HPTH and T2DM is an independent risk factor for peritonitis in PD patients, both of which can significantly increase the risk of peritonitis.