透析充分性、微炎症、营养状态对血液透析患者生存质量及长期生存率的影响

The Effect of Dialysis Adequacy, Microinflammation and Nutritional Status on the Quality of Life and Survival Rate in Maintenance Hemodialysis Patients

目的:探讨透析充分性、微炎症、营养状态对血液透析患者生存质量及长期生存率的影响。方法:随机选择我院血液透析中心维持透析每周3次,治疗6月以上的患者89例,观察并评估其入组时、入组后第3、6、12、18、24月的生存质量(KDTA、SF-36)、营养状况(MQSGA、MAMC)、微炎症(hCRP、IL-6)及透析充分性(iPTH、Kt/V、β2-MG),并分析透析充分性、营养状况、微炎症与生存质量、生存率的相关性。结果:89例患者有9例死亡,死亡率为10.1%;iPHT、MQSGA与KDTA、SF-36呈负相关(P<0.05),Kt/V与KDTA、SF-36呈正相关(P<0.05),β2-MG、胆固醇与KDTA、SF-36无明显相关(P>0.05);hCRP、IL-6分别与KDTA、SF-36呈负相关(P<0.05);HGS与KDTA呈正相关(P<0.05),与SF-36无明显相关(P>0.05),ALB、MAMC与KDTA、SF-36呈正相关(P<0.05);Kt/V、MQSGA、IL-6、iPTH均与KDAT及SF-36存回归关系(P<0.05);Cox回归模型发现Kt/V、ALB及开始透析年龄是导致血透患者死亡的危险因素(P<0.05)。结论:透析充分性、微炎症及营养状况均影响透析患者的生存质量及长期生存率;iPTH、Kt/V、MQSGA、IL-6是其生存质量的独立影响因素,Kt/V、ALB及开始透析年龄是血透患者的死亡独立危险因素。

Objective： To study the effect of dialysis adequacy, microinflammation and nutritional status on the quality of life（Qol） and survival rate in maintenance hemodialysis patients. Methods： This was a prospective study on 89 cases of long-term hemodialysis patients. The Qol（KDTA, SF-36）, survival rate, nutritional status（MQSGA, MAMC）, microinflammation（hCRP, IL-6） and dialysis adequacy（iPTH, Kt/V,β2-MG） were evaluated at beginning, the 3th, 6th, 12 th, 18 th and 24 th month, and then calculated the means and analyzed the correlation of dialysis adequacy, microinflammation and nutritional status with Qol and survival rate. Results： 9cases out of 89 died, mortality was 10.1 %; There was negative correlation between iPTH and KDTA, SF-36, while the correlation of Kt/V with KDTA and SF-36 was positive; There was no correlation of β2-MG with KDTA and SF-36; there were negative correlation of hCRP and IL-6 with KDTA and SF-36; There were negative correlation of MQSGA with KDTA and SF-36, and HGS had positive correlation with KDTA respectively, while no correltion with SF-36; ALB and MAMC had positive correlation with KDTA and SF-36,while there was no correlation of cholesterol with KDTA and SF-36; Kt/V, MQSGA, IL-6, iPTH had regressive association to KDTA and SF-36; The Cox regression analysis revealed that Kt/V, ALB and beginning dialysis age were significant determinants of mortality in long-term hemodialysis patients. Conclusions： The dialysis adequacy, microinflammation and nutritional status had effect on KDTA and SF-36; Kt/V, MQSGA, IL-6, iPTH were the independent factors of KDTA and SF-36; Kt/V, ALB and beginning dialysis age were the death risk factors of hemodialysis patients.