目的 调查中青年维持性血液透析(maintenance hemodialysis,MHD)患者社会回归现状，并探讨其进入透析前后社会功能退化程度的影响因素。 方法 对2023年6月于山西医科大学第二医院接受MHD的中青年患者，采用横断面及回顾性调查方法收集资料，采集生活质量简表(the kidney disease quality of life questionnaire,short-form version 1.3，KDQOL-SFtm 1.3)、社会功能缺陷筛选量表(social disability screening schedule,SDSS)，以透析前后SDSS评分差值的中位数为界将患者分为社会功能退化不明显组和退化明显组。采用单因素分析、二元Logistic回归分析探讨中青年MHD患者社会功能退化的影响因素。 结果 本研究共纳入MHD患者112例，其中社会回归3级42例(37.50%)、4级70例(62.50%)；社会回归4级患者生活质量评分高于3级患者(t=-2.554，P =0.012)，而仅在肾病影响(t=2.185，P =0.031)、工作状态(t=3.203，P=0.002)、社交质量(t=2.117，P =0.037)、情感职能(t=2.700，P=0.008)、社会功能(t =2.349，P =0.021)方面有统计学差异。短透析龄(OR =3.031，95% CI:1.192～7.706，P =0.020)、有疲乏症状(OR =7.574，95% CI:1.829～31.367，P =0.005)、合并焦虑和(或)抑郁(OR=3.765，95% CI:1.120～12.658，P =0.032)、较高的社会影响量表得分(OR =1.303，95% CI:1.104～1.537，P =0.002)是中青年MHD患者社会功能退化的独立危险因素。 结论 中青年MHD患者社会回归及生活质量水平较高；透析龄短、伴有疲乏、有焦虑和/或抑郁状态、病耻感得分高的MHD患者社会功能减退更明显。应高度重视中青年MHD患者的心理和情绪问题。
Objective This study aims to investigate the current status of social rehabilitation and the quality of life, and to explore the factors influencing the degree of social function degradation after dialysis in young and middle-aged maintenance hemodialysis (MHD) patients. Methods The young and middle-aged MHD patients treated in the Second Hospital of Shanxi Medical University were taken as the study subjects. Cross-sectional and retrospective survey methods were used to collect patients' data. The Kidney Disease Quality of Life Scale (KDQOL-SFTM 1.3) and Social Disability Screening Schedule (SDSS) were used for evaluation of the patients. Patients were divided into the group with insignificant social function degradation and the group with significant social function degradation based on the median value of SDSS score difference before and after MHD. Univariate analysis and binary logistic regression analysis were used to investigate the influencing factors for social function deterioration in young and middle-aged MHD patients. Results ①In the 112 MHD cases included in this study, 42 cases (37.50%) were at the social rehabilitation level 3 and 70 cases (62.50%) at the social rehabilitation level 4. The quality of life score was higher in the patients at the social rehabilitation level 4 than those at the social rehabilitation level 3 (t= -2.554, P=0.012), but statistical differences were only in the domains of impact of kidney disease (t=2.185, P=0.031), work status (t=3.203, P=0.002), social quality (t=2.117, P=0.037), emotional function (t=2.700, P=0.008) and social function (t=2.349, P=0.021). ②Shorter dialysis age (OR=3.031, 95% CI：1.192～7.706, P=0.020), fatigue symptom (OR=7.574, 95% CI：1.829～31.367, P=0.005), comorbid anxiety and (or) depression problems (OR=3.765, 95% CI：1.120～12.658, P=0.032), and higher morbidity stigma score (OR=1.303, 95% CI：1.104～1.537, P=0.002) were the independent risk factors for social function deterioration in young and middle-aged MHD patients. Conclusions ① Higher levels of social rehabilitation and quality of life were found in young and middle-aged MHD patients; ②Patients with shorter dialysis age, comorbid symptoms of fatigue, anxiety and (or) depression, and high morbid stigma score were prone to have significant social dysfunction. The psychological and emotional problems should be emphasized clinically in young and middle-aged MHD patients.
[1] Huang B, Lai B, Xu L,et al. Low employment and low willingness of being reemployed in Chinese working-age maintained hemodialysis patients[J].Ren Fail,2017. 39(1):607-612.DOI:10.1080/0886022X.2017.1361834
[2] Shumbusho G,Hategeka C,Vidler M,et al. Health related quality of life of patients undergoing in-centre hemodialysis in Rwanda: a cross sectional study[J]. BMC Nephrol, 2022.23(1):345.DOI:10.1186/s12882-022-02958-6
[3] Alshogran OY,Khalil AA,Oweis AO,et al. Association of brain-derived neurotrophic factor and interleukin-6 serum levels with depressive and anxiety symptoms in hemodialysis patients. Gen Hosp Psychiatry, 2018.53:25-31.DOI:10.1016/j.genhosppsych.2018.04.003
[4] 邹杨,温玉,刘诚,等.维持性血液透析患者焦虑、抑郁情况及与生活质量的关系[J].中国血液净化,2018.17(11):743-747.DOI:10.3969/j.issn.1671-4091.2018.11.006
[5] 陶巍巍,汪涛,王兰,等.腹膜透析患者社会回归分级探讨[J].中国康复医学杂志,2006. 21(9):823-824.
[6] Chow SK,Tam BM. Is the kidney disease quality of life-36 (KDQOL-36) a valid instrument for Chinese dialysis patients? [J].BMC Nephrol,2014.15:199.DOI:10.1186/1471-2369-15-199
[7] Hays R D，Kallich J D，Mapes D L，et al. Kidney disease quality of life short form ( KDQOL-SFTM) ，version 1.3: A manual for use and scoring［M］. Santa Monic:RAND，1995:7994．
[8] 李玲玲,刘玲玲,陈曦,等."80后"维持性血液透析病人心理健康水平与社会功能缺陷状况的相关性研究[J].全科护理,2021.9(4):543-546.DOI:10.12104/j.issn.1674-4748.2021.04.035.
[9] 管晓萌,孙涛,杨华,等.社会影响量表中文版应用于尿失禁患者羞耻感的信效度测量[J]. 护理学杂志,2011.26(7):63-65.DOI:10.3870/hlxzz.2011.07.063.
[10] 虞飞儿,林晶晶,姜玲燕,等.述情障碍对维持性血液透析患者病耻感的影响[J].护理与康复,2019.18(11):24-26.DOI:10.3969/j.issn.1671-9875.2019.11.005.
[11] 景颖颖,唐丽春,汪瑶,等.维持性血液透析患者自我效能、应对方式与生活质量的相关性研究[J].中国护理管理,2015(z1):61-64.
[12] 应金萍,应雅泳,蔡根莲,等.维持性血液透析患者社会回归现状及其影响因素研究[J]. 护理与康复,2021.20(4):25-29.DOI:10.3969/j.issn.1671-9875.2021.04.006.
[13] El-Habashi AF,El-Agroudy AE,Jaradat A,et al. Quality of life and its determinants among hemodialysis patients: A single-center study[J]. Saudi J Kidney Dis Transpl,2020.31(2):460-472.DOI:10.4103/1319-2442.284022
[14] 罗静,张颖君,陈林,等.中青年维持性血液透析患者心理弹性与领悟社会支持及生活质量的相关性研究[J].中国血液净化,2020.19(5):350-352.?DOI:10.3969/j.issn.1671-4091.2020.05.017.
[15] 王祥花,崔莉,崔岩,等.血液透析患者社会回归及生活质量调查[J].中国组织工程研究与临床康复,2011.15(44):8317-8320.DOI:10.3969/j.issn.1673-8225.2011.44.037.
[16] 唐毅,周强,张莉娜,等.某精神特色综合性医院维持性血液透析患者焦虑、抑郁与生活质量的相关性[J].贵州医科大学学报,2022.47(1):90-95.DOI:10.19367/j.cnki.2096-8388.2022.01.015.
[17] Daniel SC,Azuero A,Gutierrez OM,et al. Examining the relationship between nutrition, quality of life, and depression in hemodialysis patients[J]. Qual Life Res, 2021.30(3): 759-768.DOI:10.1007/s11136-020-02684-2
[18] 陈红,徐茸花. 维持性血液透析患者的生活质量及与自我效能感、自我管理行为的相关性分析[J].临床医学研究与实践,2022.7(32):148-150.DOI:10.19347/j.cnki.2096-1413.202232041.
[19] Al Salmi I,Kamble P,Lazarus ER, et al. Kidney Disease-Specific Quality of Life among Patients on Hemodialysis[J].Int J Nephrol, 2021. 2021:8876559.doi:10.1155/2021/8876559
[20] 张留平,李梦婷,谢庆磊,等.老年血液透析患者的社会支持和生活质量及相关性分析[J].中国老年学杂志,2016.36(23):5989-5991.DOI:10.3969/j.issn.1005-9202.2016.23.094.
[21] 郑秋怡,叶玉球,李泽泉,等. 维持性血液透析患者社会功能的影响因素分析[J].新医学,2019.50(7):495-499.?DOI:10.3969/j.issn.0253-9802.2019.07.004.
[22] 程丹,岳树锦. 血液透析病人社会功能评价的文献计量学分析[J]. 循证护理,2017.3(6):683-686.DOI:10.3969/j.issn.2095-8668.2017.06.036.
[23] D'Onofrio G,Simeoni M,Rizza P,et al. Quality of life, clinical outcome, personality and coping in chronic hemodialysis patients[J]. Ren Fail, 2017. 39(1):45-53.DOI:10.1080/0886022X.2016.1244077
[24] 杨昌新. 维持性血液透析患者的生活质量及影响因素研究[J].中国医药指南,2019.17(19):88-89.
[25] 王青尔,孙慧敏,周婷婷,等. 腹膜透析患者社会功能及影响因素研究[J].中华护理杂志,2016.51(6):707-711.DOI:10.3761/j.issn.0254-1769.2016.06.015.
[26] 王亚楠,姜亚芳. 维持性血液透析病人抑郁发生现状及影响因素分析[J]. 蚌埠医学院学报,2020.45(7):977-981.DOI:10.13898/j.cnki.issn.1000-2020.07.036.
[27] Bai YL, Lai LY,Lee BO,et al. The impact of depression on fatigue in patients with haemodialysis: a correlational study[J]. J Clin Nurs, 2015.24(13-14): 2014-22.DOI:10.1111/jocn.12804
[28] Farragher JF,Polatajko HJ, Jassal SV. The Relationship Between Fatigue and Depression in Adults With End-Stage Renal Disease on Chronic In-Hospital Hemodialysis: A Scoping Review[J]. J Pain Symptom Manage, 2017. 53(4): 783-803.DOI:10.1016/j.jpainsymman.2016.10.365
[29] Wang SY,Zang XY,Fu,SH,et al. Factors related to fatigue in Chinese patients with end-stage renal disease receiving maintenance hemodialysis: a multi-center cross-sectional study[J]. Ren Fail,2016. 38(3):442-450.DOI:10.3109/0886022X.2016.1138819
[30] 凌河,王小琴. 慢性肾脏病合并抑郁状态的研究进展[J].临床肾脏病杂志,2016.16(6):379-382.DOI:10.3969/j.issn.1671-2390.2016.06.013.
[31] Zhang N,Lai F,Guo Y, et al. Status of and Factors Influencing the Stigma of Chinese Young and Middle-Aged Maintenance Hemodialysis Patients: A Preliminary Study. Front Psychol,2022.13:873444.DOI:10.3389/fpsyg.2022.873444
[32] Li B,Liu D,Zhang Y, et al. Stigma and related factors among renal dialysis patients in China[J]. Front Psychiatry, 2023.14:1175179.DOI:10.3389/fpsyt.2023.1175179
[33] Zhang N, Lai F,Guo Y,et al. Status of and Factors Influencing the Stigma of Chinese Young and Middle-Aged Maintenance Hemodialysis Patients: A Preliminary Study[J]. Front Psychol, 2022.13: 873444.DOI:10.3389/fpsyg.2022.873444
