肾移植与血液透析患者生活质量对比

Quality of life in renal transplant patients versus hemodialysis patients

背景：终末期肾病患者需要进行。肾脏替代治疗，血液透析与。肾移植均是治疗终末期肾病常用的有效方法。目的：应用世界卫生组织生活质量测定量表简表，比较分析。肾移植患者与血液透析患者的生活质量及其影响因素。设计、时间及地点；问卷调查于2005—01／2006-01在首都医科大学附属北京友谊医院泌尿科完成。对象：选择在首都医科大学附属北京友谊医院门诊接受维持性血液透析治疗的患者及门诊随访的。肾移植患者各60例，均自愿参加问卷调查。方法；应用以下2个量表：①一般情况问卷：包括人口学资料、治疗干预措施及并发症发生情况等。②世界卫生组织生活质量测定量表简表：包括生理领域、心理领域，社会关系领域及环境领域4个因子及自评总分，各个领域得分越高，代表该领域的生活质量越好。主要观察指标；计算患者量表各领域得分，并与常模进行比较。分析患者一般情况与生活质量各领域得分的相关性。结果：120例患者全部进入结果分析。①血液透析患者的生活质量自评总分低于。肾移植患者（P=0．001）。②血液透析患者在生理领域、社会关系领域的生活质量评分低于常模（P〈0．01）；肾移植患者在生理领域的生活质量评分低于常模（P〈0．01）。③血液透析患者生活质量的各因子中，心理领域评分与受教育程度有关（P〈0．05）；社会关系领域评分与婚姻状况及家庭收入相关（P〈0，05）；环境领域评分与受教育程度、家庭收入、医疗付费方式及医疗费用对家庭的影响相关（P〈0．05-0．01）；患者生活质量的自评总分与家庭收入相关（P〈0．05）。肾移植患者生活质量的各因子中，环境领域评分与家庭收入、医疗付费方式有关（P〈0．05），自评总分与肾移植时间有关（P〈0．05）。结论；血液透析患者对生活质量的总体感觉低于肾移植患者；与肾移植患者比较，血液透析患者的生活质量受更多因素的影响。

BACKGROUND： Renal replacement is a therapy for patients with nephropathy at final stage. Hemodialysis and renal transplantation are two effective treatments for nephropathy at final stage. OBJECTIVE： Using Brief Form of World Health Organization Quality of Life Questionnaire （WHOQOL-BREF） to compare and analyze the quality of life （QOL） and the factors influencing QOL in hemodialysis and renal transplant patients. DESIGN, TIME AND SETTING： The survey was performed at the Department of Urology, Beijing Friendship Hospital, Capital Medical University from January 2005 to January 2006. PARTICIPANTS： Sixty hemodialysis outpatients and 60 renal transplant patients from Beijing Friendship Hospital of Capital Medical University were enrolled. All patients were voluntary to participate in the questionnaire investigation. METHODS： There were two scales： ①General condition scale that evaluated the demographic data, clinical specifications, and complication conditions. ②WHOQOL-BREF involved four domains of physical capacity, psychological state, social function and environment, as well as the self-rating total scores by patients. A higher score indicated a better QOL. MAIN OUTCOME MEASURES： All patients were scored by each scale, and compared with the norms. The correlation between general condition of patients and the scores for each domain of QOL was analyzed. RESULTS： A total of 120 patients were all included in the final analysis. The overall score of QOL in hemodialysis patients was significantly lower than that in renal transplant patients （P=0.001）. The score of physical capacity in hemodialysis patients was significantly lower than that of the norm （P 〈 0.01）. In hemodialysis patients, the score of psychological state was correlated with education （P 〈 0.05）; the score of social function was correlated with marital status and family income （P 〈 0.05）; the score of environment was correlated with education, family income, medical payment and the influence of medical fare （P 〈 0.05-0.01）; the overall score of QOL was correlated with family income （P 〈 0.05）. In renal transplant patients, the score of environment was correlated with family income and medical payment （P 〈 0.05）; the overall score of QOL was correlated with the duration after transplantation （P 〈 0.05）. CONCLUSION： The self-feeling of QOL in hemodialysis patients is worse than that in renal transplant patients. The QOL of hemodialysis patients is easily influenced by various factors compared with renal transplant patients.