[an error occurred while processing this directive]
临床研究

维持性血液透析患者残余肾功能与症状困扰关系的研究

  • 翁佳敏 ,
  • 黄碧红 ,
  • 张炜晨 ,
  • 陈伟生 ,
  • 施君 ,
  • 陈靖 ,
  • 王梦婧
展开
  • 1. 复旦大学附属华山医院肾内科

收稿日期: 2019-01-16

  修回日期: 2019-05-26

  网络出版日期: 2019-08-15

基金资助

上海市自然科学基金(16ZR1449400);国家自然科学基金(81600577);上海市科委创新行动计划项目(17411950700);市级医院新兴前沿技术联合攻关项目(SHDC12018111)

The association between residual renal function and symptom burden in maintenance hemodialysis patients

  • WENG Jia-Min ,
  • HUANG Bi-Hong ,
  • ZHANG Wei-Chen ,
  • CHEN Wei-Sheng ,
  • SHI Jun ,
  • CHEN Jing ,
  • WANG Meng-Jing
Expand
  • 1Division of Nephrology, Huashan Hospital, Fudan Medical University, Shanghai,200040, China

Received date: 2019-01-16

  Revised date: 2019-05-26

  Online published: 2019-08-15

摘要

【摘要】目的探讨维持性血液透析患者残余肾功能(residual renal function,RRF)变化对症状困扰的影响。方法纳入复旦大学附属华山医院行维持性血液透析患者152 例,根据24h 尿量进行分组:RRF 组(24h 尿量≥200 ml)及无RRF 组(24h 尿量<200ml)。收集透析相关数据,应用“透析症状指数量表”评估症状困扰,用多因素线性回归及Logistic 回归分析RRF 与症状困扰的关系。结果①症状困扰发生率前5 名:难以熟睡、性欲降低、感觉疲惫和缺乏活力、皮肤干燥、瘙痒。症状困扰严重程度前5 名:骨骼关节疼痛、难以入睡、焦虑、悲伤、便秘。②多因素线性回归发现,残余肾功能与症状困扰严重程度总分呈负相关(t=-2.670;P=0.009)。且RRF 组患者的呕吐、腹泻、不宁腿、足部麻木刺痛、感觉疲惫和缺乏活力、焦虑等症状困扰发生率低(OR 值分别为0.071,0.064,0.053,0.123,0.187,0.132;Z 值分别为- 2.200,- 2.130,- 2.260,- 2.540,- 2.920,- 2.410;P 值分别为0.028,0.033,0.024,0.011,0.003,0.016)。结论有残余肾功能的血液透析患者症状困扰严重程度更低。

本文引用格式

翁佳敏 , 黄碧红 , 张炜晨 , 陈伟生 , 施君 , 陈靖 , 王梦婧 . 维持性血液透析患者残余肾功能与症状困扰关系的研究[J]. 中国血液净化, 2019 , 18(08) : 524 -526 . DOI: 10.3969/j.issn.1671-4091.2019.08.003

Abstract

【Abstract】Objective To explore the association between residual renal function (RRF) and symptom burden in maintenance hemodialysis (MHD) patients. Methods A total of 152 MHD patients were enrolled in this study. Patients were divided into two groups according to urine volume. Their dialysis related data were collected. Symptom burden was evaluated by Dialysis Symptom Index. Multvariate liner regression and multivariate logistic regression analyses were used for exploring the association between RRF and symptom burden. Results ①The burdens of top five occurred symptoms were trouble staying asleep, decreased libido, tired, dry skin and itching. The burdens of top five severe symptoms were bone or joint pain, insomnia, anxious, sad and constipation. ②Multivariate linear regression revealed that RRF was negatively correlated with the total score of symptoms (t=-2.670, P=0.009) and patients with RRF had lower prevalence of several symptom burdens, including the burdens of vomiting (OR=0.071, z=- 2.200, P=0.028), diarrhea (OR=0.064, z=-2.130, P=0.033), restless legs (OR=0.053, z=-2.260, P=0.024), foot numbness and tingling (OR=0.123, z=-2.540, P=0.011), tired (OR=0.187, z=-2.920, P=0.003) and anxious (OR=0.132, z=-2.410, P=0.016). Conclusion MHD patients with RRF had less symptom burdens.

参考文献

[1]乔勤, 顾波, 马骏.我国与全球终末期肾脏病的流行现状[J].中国血液净化, 2014, 13(10):729-732
[2]肖月,隋宾艳,赵琨.我国终末期肾病现状及透析技术的应用、费用及支付情况分析[J].中国卫生政策研究, 2011, 04(5):29-33
[3]顾勇.应充分重视和保护透析患者残余肾功能[J].中华肾脏病杂志, 2007, 23(7):411-412
[4]付海霞, 安茂竹, 刘子栋.透析患者保护残余肾功能的重要性及对策[J].中国血液净化, 2006, 5(3):160-162
[5]乐伟波, 俞雨生.残余肾功能在腹膜透析中的地位及其保护策略[J].肾脏病与透析肾移植杂志, 2008, 17(03):281-285
[6]王丽妍, 张东亮, 刁宗礼, 刘文虎.透析患者残余肾功能的保护[J].中国血液净化, 2012, 11(02):95-98
[7]董洪, 于文慧.残余肾功能与血液透析患者生活质量的相关性研究[J].天津医科大学学报, 2010, 16(03):488-491
[8]Weisbord SD, Fried LF, Amold RM, et al.Prevalence,Severity,and Importance of Physical and Emotional Symptoms in Chronic Hemodialysis Patients[J].J Am Soc Nephrol, 2005, 16(8):2478-2494
[9]Badger TA,Segrin C,Meek P.Development and validation of an instrument for rapidly assessing symptoms:the general symptom distress scale[J].J Pain Symptom Manage, 2011, 41(3):535-548
[10]周巍, 胡伟锋, 韩国锋, 等.残余肾功能对腹膜透析患者生活质量的影响[J].中华肾脏病杂志, 2016, 32(5):327-333
[11]池向耿, 蔡琪, 许敏玲, 等.残余肾功能与血液透析相关性低血压的关系[J].中国医师进修杂志, 2017, 40(2):117-120
[12]张文君.对血液透析患者残余肾功能的再认识和保护策略[J].国际泌尿系统杂志, 2010, 30(4):532-537
[13]管延蒙.血液透析患者中残余肾功能的临床应用进展[J].医学综述, 2013, 19(3):483-486
[14]周亦伦.残余肾功能对血液透析患者营养状况及死亡率的影响[J].中国血液净化, 2005, 4(6):298-301
[15]Eryavuz N,Yuksel S,Acarturk G,et al.Comparison Of sleep quality between hemodialysis and peritoneal dialysis patients[J].Int Urol Nephrol, 2008, 40(3):785-791
[16]王饶萍, 唐春苑.维持性血液透析患者症状困扰与睡眠质量的相关性研究[J].中国中西医结合肾病杂志, 2016, 17(8):717-719
[17]李永川,刘亚伟,梅长林.尿毒症瘙痒的发病机制与治疗研究现状[J].中国中西医结合肾病杂志, 2010, 11(1):76-78
[18]Narita I, Iguchi S, Omori K, et al.Uremic Pruritus in chronic Hemodialysis patients[J].J Nephrol, 2008, 21(2):161-165
[19]胡小红,陈揭剑,梅长林.尿毒症瘙痒症发病机制与治疗新进展[J].中华肾脏病杂志, 2013, 29(11):866-869
[20]刘广敏, 陆晓艳, 黄春香, 等.例维持性血液透析患者皮肤瘙痒情况及影响因素分析[J].中国中西医结合肾病杂志, 2017, 18(7):624-625
[21]王彦, 杨秀莉, 王钰君.血液透析患者皮肤瘙痒相关因素分析[J].中国麻风皮肤病杂志, 2012, 28(2):84-87
[22]姜能志, 王艳郁, 孙宏伟.抑郁症伴发自杀的相关因素研究进展[J].精神医学杂志, 2012, 25(6):478-480
[23]Weisbord SD, Fried LF, Mor MK, et al.Renal Provider Recognition of Symptoms in Patients on Maintenance Hemodialysis[J].Clin J Am Soc Nephrol, 2007, 2(5):960-967
[24]门春翠, 芦丽霞, 乔婕, 等.维持性腹膜透析患者便秘情况调查及其影响因素分析[J].中国血液净化, 2017, 16(10):684-687
[25]Ito S, Yoshida M.Protein-bound uremic toxins: new culprits of cardiovascular events in chronic kidney disease patients[J].Toxins (Basel), 2014, 6(2):665-678
[26]Azevedo P, Santos R, Duraes J, et al.Sexual dysfunction in men and women on peritoneal dialysis: Differential link with metabolic factors and quality of life perception[J].Nefrologia, 2014, 34(6):703-709
[27]Saglimbene V, Natale P, Palmer S, et al.The prevalence and correlates of low sexual functioning in women on hemodialysis: A multinational,cross-sectional study[J].PLoS One, 2017, 12(6):e0179511-
[28]孙星慧, 林文洪, 吴卫真, 等.男性尿毒症患者替代治疗状态下性生活状况分析[J].中国误诊学杂志, 2008, 8(18):4317-4318
[29] Santoro D,Satta E,Messina S,et al.Pain in end-stage renal disease:a frequent and neglected clinical problem[J].Clin Néphron, 2013, 79 suppl 1 :S2-11
[30]Naves-Diaz M,Alvarez—Hemandez D,Passlick-Deetjen J,et al.ral active vitamin D is associated with improved survival in hemodialysis patient[J].Kidney Int, 2008, 74(8):1070-1078
[31]Wang AY,Woo J,Sea MM,et al.Hyperphosphatemia In Chinese peritoneal dialysis patients with and without residual kidney function:What are the implications[J].Am J Kidney Dis, 2004, 43(4):712-720
[32]Okada S,Inoue T,Nakamoto H,et al.Residual renal function plays an important role in regulating parathyroid hormone in patients on continuous ambulatory peritoneal dialysis[J].Adv Perit Dial, 2007, 23:150-154
[33]Wang M, You L, Li H, et al.Association of circulating fibroblast growth factor-23 with renal phosphate excretion among hemodialysis patients with residual renal function[J].Clin J Am Soc Nephrol, 2013, 8(1):116-125
[34]Salamon K, Woods J, Paul E, et al.Peritoneal Dialysis patients have higher prevalence of gastrointestinal symptoms than hemodialysis patients[J].J Ren Nutr, 2013, 23(2):114-118
[35]陈瑾, 毛敏, 张涛, 等.腹膜透析和血液透析患者胃肠道症状的调查分析[J].临床肾脏病杂志, 2017, 17(6):340-344
[36]许有华,袁萍,牟富荣.透析患者残余肾功能与使用的关系[J].天津医药, 2001, 29(12):742-743
[37]杨玉洁, 余少斌, 张颖君, 等.血液透析患者便秘情况调查与临床相关性研究[J].中国血液净化, 2015, 14(7):437-440
[38]Mucsi I,Molnar MZ, Ambrus C,et a.Restless legs syndrome,insomnia and quality of life in patients on maintenance dialysis[J].Nephrol Dial Transplant, 2005, 20(3):571-577
[39]杜亭, 甘华, 陈泽君,等.维持性血液透析患者不宁腿综合征的临床特点及相关因素[J].中华肾脏病杂志, 2017, 33(3):198-203
[40]陈宗英, 席秋萍, 林昌伟, 等.单中心维持性血液透析患者不宁腿综合征相关因素及生活质量调查与分析[J].临床肾脏病杂志, 2018, 18(1):43-47
[41]肖成根, 梁馨苓, 李锐钊, 等.维持性血液透析患者不宁腿综合征的横断面研究[J].中华内科杂志, 2013, 52(8):672-674
[42]漆映辉,曲晓璐,唐咏华,等.残余肾功能及血液透析方式对肾衰竭患者血清中β-微球蛋白水平的影响分析[J].中国中西医结合肾病杂志, 2008, 9(12):109-l
[43]Shafi T.Jaar BG,Plantinga LC,et a1Association of residual urine output with mortality,quality of life,and inflammation in incident hemodialysis patients:the choices for Healthy Outcomes in Caring for End-Stage Renal Disease(CHOICE) Study[J].Am J Kidney Dis, 2010, 56(2):348-358
[44]Termorshuizen F,Korevaar JC,Dekker FW,et al.The relative importance of residual renal function compared with peritoneal clearance for patient survival and quality of life:an analysis of the Netherlands Cooperative Study on the Adequacy Of Dialysis (NECOSAD)-2[J].Am J Kidney Dis, 2003, Jun,41(6):1293-1302
文章导航

/

[an error occurred while processing this directive]