腹膜透析患者的生活质量与营养不良和慢性炎症的相关性研究

A correlation study on life quality with malnutrition and chronic inflammation in patients on continuous ambulatory peritoneal dialysis

目的了解持续不卧床腹膜透析(continuous ambulatory peritoneal dialysis,CAPD)患者的营养不良、慢性炎症对其生活质量的影响。方法本研究为横断面研究。调查2009年1月至5月在中山大学附属第一医院透析中心随访的CAPD患者的营养不良、慢性炎症和生活质量,并分析其相互关系。其中以主观综合性营养评估(subjective global assessment,SGA)作为营养状况的标准,血C反应蛋白(C-reactiveprotein,CRP)水平为慢性炎症的指标,健康相关的生命质量量表(SF-36)评分结果作为患者生活质量的指标。结果在CAPD患者的生活质量与营养不良、慢性炎症的相关性分析中,营养不良与生理机能、躯体疼痛、总体健康状况、精力、社会功能、精神健康相关,其相关系数分别为:0.287,0.225,0.344,0.348,0.286,0.227(P<0.01),而血CRP水平分别与生理机能、生理职能、躯体疼痛、总体健康状况、精力、社会功能负相关,相关系数分别为:-0.359,-0.178,-0.271,-0.253,0.236,-0.198(P<0.01)。结论营养不良和慢性炎症状态从生理机能、精力、和社会功能等方面影响CAPD患者的生活质量。要提高CAPD患者的生活质量,在改善患者的营养状态的同时要注意纠正慢性炎症状态。

Objective Patients on continuous ambulatory peritoneal dialysis （CAPD） often have lower quality of life level （QOL） than general population. Malnutrition status and inflammation make important impacts on their morbidity and mortality. However, the factors contributing to the lower QOL remain unclear. This study attempted to assess the correlation of QOL with malnutrition and inflammation. Methods In this cross-sectional study, we collected clinical data, sociodemographic information and laboratory findings from patients＇ monthly records in this hospital in the period from January to May, 2009. The SF-36 and Subjective Global Assessment （SGA） were used to assess QOL and nutrition status, respectively. Results A total of 212 CAPD patients were enrolled in this study. SGA score was positively correlated with physical functioning （PF）, bodily pain （BP）, general health （GH）, vitality （VT）, social function （SF） and mental health （r=0.287, 0.225, 0.344, 0.348, 0.286 and 0.227, respectively; P〈0.01）. C-reactive protein was negatively correlated with physical functioning （PF）, role physical （RP）, bodily pain （BP）, general health （GH）, vitality （VT） and social function （SF） （r=-0.359, -0.178, -0.271, -0.253, -0.236 and -0.198, respectively; P〈0.01）. Conclusion Malnutrition and inflammation play important roles in QOL. Further studies are necessary to explore the approaches to improve QOL in CAPD patients.