残余肾功能与血液透析患者生活质量的相关性研究

Study on the correlation between the renal residual function and the quality of life among the patients with hemodialysis

目的:探讨残余肾功能(RRF)与维持性血液透析(MHD)患者生活质量的相关性。方法:对87名MHD患者发放肾脏疾病特异性调查表(KDQ),并记录患者平时血压、24 h尿量、透析频率、透析间期体重获得量(IDWG%)及最近3个月发生失衡综合征和心血管事件的情况。测定患者透析前血肌酐(Cr)、尿素氮(BUN)、白蛋白(Alb)、血红蛋白(Hgb)、甲状旁腺激素(PTH)及血清CystatinC。使用血清CystatinC浓度估算肾小球滤过率(eGFR),并根据24 h尿量将患者分成有RRF组和无RRF组。结果:生活质量调查共收回有效问卷76份,无RRF组患者在透析龄、透析频率I、DWG%、失衡综合征、心血管事件和血压异常发生率方面均高于有RRF组(P<0.05)。基于血清CystatinC浓度估算的eGFR为(4.56±0.51)ml/(min.1.73 m2),它与MHD患者血清BUN、Cr呈负相关,与Hgb、Alb、PTH正相关;与患者生活质量评估的各项指标均存在正相关关系,其中与总分相关系数r=0.797(P<0.01)。结论:RRF与MHD患者的生活质量密切相关,是影响患者生理心理健康的重要因素,应采取有效措施保护血透患者残余肾功能。

Objective： To study the correlation between the RRF and the quality of life among patients with hemodialysis. Methods： The kidney disease questionaire （KDQ） was distributed to 87 patients who received the maintein hemodialysis（MHD） therapy. The patients＇ blood pressure, 24 h-urea, frequency of the therapy, interdialytic weight gain （IDWG%）,tbe data of disequilibrium syndrome and the cardiovascular events were recorded. Their serum creatinine（Cr）,urea nitrogen （BUN）, albumin（Alb）, haemoglobin （Hgb）, parathyroid hormone （PTH） and CystatinC were detected before the start of the dialysis therapy. The glomerular filtration rate （eGFR） was estimated by Cystatin C levels and the cases were divided into two groups by the 24h-urea. Results： 76 portions of effective KDQ were collected .The group without RRF got the higher result at dialysis duration, frequency of the therapy, IDWG%, disequilibrium syndrome, cardiovascular events and the abnormal blood pressure incidence （P〈0.05）.The eGFR derived from the assay of Cystatin C was （4.56±0.51）ml/（min·1.73 m2）. It had negative correlation with BUN and Cr,and positive correlation with Hgb, Alb, PTH.The eGFR correlated with all five aspects of the KDQ （P〈0.01）. Conclusion：There is intimate correlationship between RRF and quality of life among MHD patients,RRF bas beneficial effect on both physiological and psychic health of patients with hemodialysis.Effective methods should be taken to protect the RRF of the MHD patients.