肾移植与血液透析患者生存质量比较及相关影响因素的研究

Comparison of Quality of Life and Its Related Factors in Hemodialysis and Kidney Transplantation

目的探讨肾移植与血液透析患者的生存质量及其相关影响因素。方法根据《慢性肾脏病及透析的临床实践指南》中终末期肾病的诊断标准,选择2011年3月—2012年7月在昆明医科大学第一附属医院和云南省肾脏病医院行维持性血液透析或肾移植3个月以上、年满18岁的终末期肾病患者302例,在观察期内均未发生严重感染及其他并发症,其中肾移植组患者142例、血液透析组患者160例,两组患者均行实验室检查,并采用肾病与生活质量简短版量表(KDQOL-SFTM1.2量表)进行问卷调查,评价其生存质量。结果肾移植组健康相关生存质量(SF-36)总评分及其8个分支领域评分均高于血液透析组,差异有统计学意义(P<0.05);肾移植组肾脏疾病相关生存质量(KDTA)总评分及其分支领域症状(SPL)、肾病的影响(EKD)、肾病带来的负担(BKD)、工作状况(WS)、性功能(SexF)评分均高于血液透析组,差异有统计学意义(P<0.05)。影响因素与生存质量的相关性分析表明:两组患者SF-36总评分和KDTA总评分均与年龄呈负相关(肾移植组:r=-0.29、-0.05,P=0.03、0.04;血液透析组:r=-0.19、-0.16,P=0.02、0.03),与血清清蛋白水平呈正相关(肾移植组:r=0.07、0.17,P=0.04、0.01;血液透析组:r=0.26、0.23,P=0.00、0.04),两组患者的SF-36总评分与文化程度呈正相关(肾移植组:r=0.10,P=0.03;血液透析组:r=0.18,P=0.02),与血红蛋白呈正相关(肾移植组:r=0.26,P=0.02;血液透析组:r=0.20,P=0.04)。结论肾移植患者在SF-36总评分及其各个分支领域评分、KDTA总评分及其多个分支领域评分均高于血液透析组,表明肾移植患者总体生存质量优于血液透析患者,两组患者的生存质量均与年龄、文化程度、血清清蛋白、血红蛋白等因素有关,临床中注意监测上述指标有助于提高患者的生存质量。

Objective To investigate the quality of life （QoL） in hemodialysis patients and patients with kidney trans- plantation and its related factors. Methods According to the diagnostic criteria of end stage renal disease in K/DOQI guide- lines, adult patients with end stage renal disease receiving hemodialysis or kidney transplantations for more than 3 months in our hospital and Yunnan Kidney Disease Hospital between March 2011 and July 2012 were included in this study, and during their hospital stay, all patients had no serious infections or other complications. There were 160 hemodialysis patients and 142 patients with kidney transplantation. Kidney Disease Quality of Life Short Form （ KDQOL - SFTM 1.2 ） [ composed of short - form 36 health survey （SF- 36） and kidney disease target areas （KDTA）] was used to evaluate the QoL. The demographic and clini- cal characteristics were also collected. Results The total score of SF - 36 and the scores of its eight dimensions were all signifi- cantly higher in kidney transplantation group than in hemodialysis group （ P 〈 0. 05 ） ; while the total score of KDTA and the scores of its several dimensions including SPL, EKD, BKD, WS and SexF in kidney transplantation group were significantly higher than those in hemodialysis group （ P 〈 0.05 ）. Correlation analysis showed that the scores of SF - 36 and KDTA in two groups were negatively correlated with age （ kidney transplantation group ： r = - 0. 29, P = 0. 03 ; r = - 0. 05, P = 0. 04 ; hemo- dialysis group： r = -0. 19, P = 0.02; r = -0. 16, P = 0. 03 ） , and positively correlated with the level of Alb （kidney trans- plantation group： r =0. 07, P =0.04; r =0. 17, P =0. 01 ; hemodialysis group： r =0. 26, P =0. 00; r =0. 23, P =0. 04）. The scores of SF - 36 in two groups were positively associated with education level （ kidney transplantation group ： r = 0. 10, P = 0. 03 ; hemodialysis group ： r = O. 18, P = O. 02） and the level of Hb （ kidney transplantation group ： r = 0. 26, P = 0. 02 ; he- modialysis group ： r = 0. 20, P = 0.04）. Conclusion The patients with kidney transplantation scored higher in the SF - 36 and its all dimensions and KDTA and its several dimensions than hemodialysis patients did. The overall QoL of patients with kidney transplantation is higher than that of hemodialysis patients. The QoL of patients in both groups is correlated with age, education level, serum albumin, hemoglobin and other factors. In order to improve the patient＇s QoL, we should pay more attention to these indicators in clinical work.