摘要
目的探讨残余肾功能（RRF）对持续性非卧床式腹膜透析（CAPD）患者生活质量的影响，并对CAPD患者生活质量的相关因素进行分析。方法选取本院腹膜透析中心行规律CAPD治疗3个月以上的成年患者118例，按残余肾小球滤过率（rGFR）将其分为RRF组[rGFR1ml·min^-1·（1．73m2）^-1]和无RRF组[rGFR〈1ml·min^-1·（1．73my]。收集患者的人口学资料，检测血生化指标、心胸比、透析充分性及残余肾功能，记录患者的血压、尿量、超滤量及透析剂量，采用肾脏疾病生活质量简表（SF-36）评估患者的生活质量。比较不同RRF状态腹透患者的临床指标及生活质量，并分析影响患者生活质量的相关因素。结果RRF组与无RRF组在年龄、性别、原发病因、并发症、体重指数、收缩压、舒张压、血红蛋白、胆固醇、三酰甘油、高密度脂蛋白、低密度脂蛋白、标准蛋白分解率（nPCR）及心胸比方面差异均无统计学意义（均P〉0．05）。与RRF组比较，无RRF组患者腹透龄长，尿量减少，腹透超滤量和透析剂量增加，血清白蛋白、血钾、总尿素清除率（Kt／V）降低，血肌酐、血钙、血磷、C反应蛋白、甲状旁腺素升高（均P〈0．05）。与RRF组比较，无RRF组在躯体健康总测量及生理功能评分明显降低（均P〈0．05）。两组患者在生理职能、躯体疼痛、总体健康、活力、社会功能、情感职能、精神健康7个维度，心理健康总测量及sF。36总体评分差异均无统计学意义（均P〉0．05）。单因素线性回归分析显示rGFR与sF．36总体评分相关性无统计学意义（β=1．330，P=O．070）。多重线性回归分析显示C反应蛋白（β=0．477，P〈0．001）、血肌酐（卢=0．020，P〈0．001）、心胸比（β=57．823，P=O．004）、血清白蛋白（β=0．772，P=0．016）、腹透超滤量（β=0．006，P=0．031）与sF-36总体评分相关，rGFR与sF．36总体评分无相关性（口=O．099，P=0．302）。结论无RRF的CAPD患者生理健康低于RRF患者，但两组患者精神健康及总体生活质量差异无统计学意义。RRF与CAPD患者的生活质量无相关性。慢性炎性反应、容量负荷增加和营养不良可能影响CAPD患者的生活质量。
Objective To explore the effects of residual renal function （RRF） on quality of life （QOL） in patients with continuous ambulatory peritoneal dialysis （CAPD）, and analyze the factors influencing QOL. Methods One hundred and eighteen patients treated with CAPD for at least 3 months in No.455 Hospital of People＇s Liberation Army were enrolled. All patients were divided into two groups according to residual glomerular filtration rate （rGFR）： the group with RRF [rGFR≥1 ml.min^-1（1.73 m^2）^-1], and the group without RRF [rGFR 〈 1ml·min^-1 （1.73 m^2）^-1]. The demographic characteristics, laboratory data, cardiothoracic ratio, dialysis adequacy parameters, rGFR, blood pressure, urine volume, uhrafihration volume and dialysis prescription were investigated. Patient＇s QOL was evaluated by Medical Outcomes Study 36- Item Short-Form Health Survey （SF- 36）. Results There was no significant differences between the groups with and without RRF in the age, gender, causes of disease, complication, body mass index （BMI）, systolic blood pressure （SBP）, diastolic blood pressure （DBP）, haemoglobin （Hb）, cholesterol, triglyceride, high- density lipoprotein, low-density lipoprotein, normalized protein catabolic rate （nPCR） and cardiothoracic ratio （all P 〉 0.05）. Compared with the patients with RRF, PD duration, uhrafihration volume, serum creatinine （Scr）, calcium, phosphorus, C-reactive protein （CRP）, parathyroid hormone （PTH） and peritoneal dialysis dose in the patients without RRF were significantly higher, and urine volume, serum albumin （Alb）, potassium, and urea total Kt/V were significantly lower （all P 〈 0.05）. The patients without RRF had a significantly lower score in physical function and physical component summary as compared to the patients with RRF （all P 〈 0.05）. There was no significant differences in role physical, bodily pain, general health, vitality, social function, role emotional, mental health, mental component summary and SF-36 scores （all P 〉 0.05）. Simple linear regression showed that there was no correlation between rGFR and SF-36 scores （β=1.330, P=0.070）. Multiple linear regression revealed that SF-36 scores were correlated with CRP （β=-0.477, P〈0.001）, Scr （/3=0.020, P 〈 0.001）, cardiothoracic ratio （β=-57.823, P=0.004）, Alb （β=0.772, P=O.016） and uhrafihration volume （β=-0.006, P=0.031）, but not correlated with rGFR （β= 0.099, P=0.302）. Conclusions PD patients without and with RRF perceived different scores in physical health, but their scores were similar in mental health and QOL. RRF was no related to QOL in PD patients. Chronic inflammation, fluid overload and malnutrition were the main factors that affect QOL.
出处
《中华肾脏病杂志》
CAS
CSCD
北大核心
2016年第5期327-333,共7页
Chinese Journal of Nephrology
基金
百特肾科研究基金（CHN-RENAL-IIS-2011-046）
上海市卫生局局级课题（2010097）
关键词
腹膜透析
生活质量
残余肾功能
Peritoneal dialysis
Quality of life
Residual renal function
