持续不卧床终末期肾病腹膜透析患者述情障碍及影响因素

Study on alexithymia and its affecting factors in continuous ambulatory peritoneal dialysis patients

目的 评估单中心持续不卧床腹膜透析患者的述情障碍的发生情况,探讨述情障碍发生的影响因素.方法 对进行持续不卧床腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）治疗的86例终末期肾病（ESRD）患者,依据多伦多述情障碍量表（TAS-20）评分分为2组,即总分≥61分为述情障碍组,≤51分为非述情障碍组.比较2组患者的各项资料,用Logistic回归分析述情障碍的危险因素.结果 （1） 86例CAPD患者TAS-20评分为（55.8±9.2）分,TAS-20总分≥61分（述情障碍者）38例（44.2％）,平均得分（64.5±4.4）分;TAS-20总分≤51分（无述情障碍者）30例（34.9％）,平均得分（48.9±5.3）分;两者差异有统计学意义（t=10.1,P＜0.01）.（2）2组一般资料中的付费方式及残余尿量方面差异有统计学意义（P＜0.01）,且与述情障碍的发生呈显著负相关（P＜0.05）.（3）述情障碍组CAPD患者血白蛋白水平显著低于与非述情障碍组（P＜0.01）;血清钙、血清磷、甲状旁腺激素水平显著高于非述情障碍组（P＜0.05）;血白蛋白与述情障碍显著负相关（P＜0.05）;血清钙、血清磷、甲状旁腺激素水平与述情障碍显著正相关（P＜0.05）.（4）述情障碍与非述情障碍患者相比,在SF-36总分、生理功能、躯体疼痛、总体健康、活力、社会功能、情感职能及精神健康方面差异有统计学意义（P＜0.01）;述情障碍与SF-36总分、生理能力、躯体疼痛、总体健康、活力、社会功能、情感只能和精神健康之间存在显著负相关性（P＜0.05）.（5）述情障碍组总尿素清除指数（Kt/v：1.65±0.47）与非述情障碍组患者（Kt/v：2.13±0.69）相比,两者之间差异有统计学意义（t=2.5,P=0.017）.Pearson相关分析Kt/v与述情障碍有显著负相关性（r=-0.417,P=0.007）.（6）用Logistic回归分析发现：血白蛋白水平,SF-36总分,残余尿量,付费方式及Kt/v均为CAPD患者是否发生述情障碍的危险因素.结论 CAPD患者述情障碍的发生率高.血白蛋白水平,SF-36总分,残余尿量,付费方式及Kt/v均为CAPD患者发生述情障碍的危险因素.

Objective To evaluate the alexithymia in the continuous ambulatory peritoneal dialysis （CAPD） patients in our peritoneal dialysis center,and determine the factors affecting alexithymia in CPAD patients.Methods The patients with end-stage renal disease treated by CAPD were divided into alexithymia group （total score≥61）and non-alexithymia group（total score≤51）,according to the Toronto Alexithymia Scale（TAS-20）.Risk factors for alexithymia were analyzed by Logistic regression statistical model.Results （1）The TAS-20 score was（55.8±9.2） in 86 cases of patients with CAPD.Among them,TAS-20 scores of 38 cases were ≥61 points with an average score （64.5 ±4.4）,and the scores of 30 cases were ≤ 51 points with an average score （48.9±5.3）,which had a significant difference（t=10.1,P〈0.01）.（2） There were significant differences in the pay-way and the residual urine volume between the two groups（P〈0.01）.There were significant correlations of alexithymia with the pay-way and the residual urine volume（P〈0.01）.（3） The level of serum albumin was significantly lower in alexithymia groups than that in non-alexithymia（P〈0.01）.The level of serum calcium,phosphorus and parathormone were significantly higher in alexithymia group than that in non-alexithymia group（P〈0.05）.There were significant negative correlations of alexithymia with the level of serum albumin（P〈0.01） and positive correlations of alexithymia with the level of serum calcium,phosphorus and parathormone（P〈0.05）.（4） There were significant differences score in SF-36 total score,Physical Function,Bodily Pain,General Health,Vitality,Social Function,Role-Emotional and Mental Health （P〈 0.01）;There were significant negative correlations of alexithymia with SF-36,Physical Function,Bodily Pain,General Health,Vitality,Social Function,Role-Emotional and Mental Health （P〈 0.05）.（5） The Kt/v was 1.65±0.47 in alexithymia group and 2.13±0.69 in non-alexithymia group.There were significant differences in the two groups（t=2.5,P=0.017）.There were significant negative correlations of alexithymia with Kt/v（r=-0.417,P=0.007）by Pearson correlation analysis.Logistic regression analysis showed that the level of serun albumin,SF-36 scores,residual urine volume,the pay-way and Kt/v were the risk factors for alexithymia.Conclusion The incidence rate of alexithymia is higher.The level of serum albumin,SF-36 scores,residual urine volume,the pay-way and Kt/v are the risk factors for alexithymia.