维持性腹膜透析患者胃肠道症状调查及相关因素分析

Gastrointestinal symptoms in patients with peritoneal dialysis:multivariate analysis of correlated factors

目的评估腹膜透析(PD)患者中的主观胃肠道症状的出现情况并筛选出其相关影响因素。方法采用胃肠道症状分级量表(Gastrointestinal Symptom Rating Scale,GSRS)对PD患者的主观胃肠道症状进行评估;同时通过询问和(或)回顾病例资料获取患者相关信息。采用多元逐步回归分析法筛选患者临床特征中与GSRS得分相关的因素。结果 PD患者各种胃肠道症状的总体发生率为61.6%;发生率较高的前3种胃肠道症状分别为进食功能障碍(43.8%)、胃食管反流症状(32.1%)以及消化不良(32.1%)。糖皮质激素服用史(B=0.51,P<0.001)、每日服用药片数(B=0.009,P=0.005)及年龄(B=0.006,P=0.027)与GSRS评分呈正相关,而残余肾Kt/V(B=-0.27,P=0.001)与GSRS评分呈负相关,性别(B=-0.15,P=0.033)与GSRS评分也呈一定的相关性,女性较男性胃肠道症状更突出。以上5个因素可以预测36%的GSRS评分。结论进食功能障碍、胃食管反流以及消化不良是PD患者中最常见的消化道功能障碍。老年、女性、有糖皮质激素服用史者和每日服用药片数多者胃肠道症状可能更重,而残余肾功能可能是腹透患者免于出现消化道症状的保护因素。

Objective To evaluate the gastrointestinal （GI） symptoms of peritoneal dialysis （PD） patients and to explore the related factors contributing to GI symptoms. Methods Gastrointestinal Symptom Rating Scale （GSRS） was used for subjective evaluation of GI symptoms in PD patients. The information of patients was obtained by inquiring patients or review of medical records. Multiple regression analysis with stepwise backward variable selection was used to identify factors correlated with GSRS scores. Results The prevalence rate of gastrointestinal symptoms was 61.6% in the PD patients. The prevalence rates of eating dysfunction, reflux and indigestion were 43.8%, 32.1%, and 32.1%, respectively. We found that age （B=0.006, P=0.027）, history of corticosteroid therapy （B=0.51,P〈0.001） and daily tablet number （B=0.009, P=0.005） were positively correlated to GSRS score; and residual renal Kt/V （B=-0.27, P=0.001） was negatively correlated with GSRS score. Moreover, females seemed to have more GI symptoms than males （B=-0.15, P=0.033）. The above five factors mentioned above could predict 36% of the GSRS score. Conclusion Eating dysfunction, reflux and indigestion are the most common disorders in PD patients. Old age, female sex, more daily tablet number and corticosteroid history are correlated with more severe GI symptoms, while residual renal function might be a preventing factor of GI symptom.