潍坊市尿毒症脑病患者危险因素分析与生活质量调查

Analysis of Risk Factors and Quality of Life in Patients with Uremia Encephalopathy in Weifang

目的探讨维持性透析患者发生尿毒症脑病（UE）的危险因素及其对生活质量的影响。方法以2009年6月-2013年12月潍坊市二级及以上医院就诊的尿毒症透析患者为研究对象，对比发生UE（42例）及随机选取无尿毒症脑病患者（NUE组，85例）的年龄、性别、吸烟史、饮酒史、原发病、血压情况、血液透析时间、血液透析频率、是否定期血液滤过或血液灌流治疗及实验室检查等情况，以Logistic多因素逐步回归分析确立UE的独立危险因素，进一步关注UE患者的生活质量，应用终末期肾脏疾病透析患者调查表（KDQOL-SF^TM1．3）对UE及非UE患者进行SF-36的8个维度及透析相关生存质量（KDTA）维度得分比较。结果UE组患者年龄、原发病、血液透析频率、是否定期血液滤过或血液灌流、临床依从性、头孢类药物应用、血红蛋白（HGB）、甲状旁腺激素（PTH）、CLU、二氧化碳结合力（CO2CP）与NUE组比较差异有显著性（P〈0．05或P〈0．01）。Logistic逐步回归分析显示血肼H浓度、原发病（糖尿病）、临床依从性、透析频率、HGB、头孢类药物应用史、C02CP是UE的独立危险因素，风险比值和95％可信限分别为0．938-6．256，2．334～3．376，0．827～2．862，1．873～2．593，1．182～4．048，1．253～3．741，1．435～2．534．UE患者SF-36的8个维度得分及KDTA维度得分均较低。结论血PTH浓度、原发病（糖尿病）、临床依从性、透析频率、HGB、头孢类药物应用史、CO2CP是UE的独立危险因素，UE患者生活质量明显降低。

Objective To explore the risk factors in maintenance hemodialysis patients with uremic enceph- alopathy and its influences on the quality of life. Methods From June 2009 to December 2013,uremic hemodialysis pa- tients in two and above hospitals of Weifang were enrolled as the research object,uremic encephalopathy（42 cases） and non uremic encephalopathy patients （ control group, n = 85 ） were randomly selected and compared their age, gender, smoking history, drinking history, primary disease, blood pressure, blood dialysis lime, frequency of hemodialysis, hemofil- tration or regular hemoperfusion treatment and laboratory tests by using multivariate stepwise Logistic regression analysis to establish the independent risk factors of uremic encephalopathy, for paying further attention to the quality of life in pa- tients with uremia encephalopathy. KDQOL-SFTM1.3 was used to compare with SF-36 of the 8 dimensions and the com- parison of the scores of KDTA between uremic encephalopathy and non ueremic encephalopathy patients. Results Age, primary disease, frequency of hemodialysis,periodic hemofiltration or blood perfusion flow, clinical compliance, cephalo- sporin drugs,blood HGB, PTH, CLU, CO2CP values in uremic encephalopathy group were significantly different than those in the control group （P 〈 0.05 or P 〈 0.01 ）. Logistic stepwise regression analysis showed that serum PTH concen- tration, primary disease （ diabetes）, clinical compliance, dialysis frequency, HGB, cephalosporins, history of drug use, car- bon dioxide binding capacity（ CO2CP） is one of the independent risk factors of uremic encephalopathy, and the risk rati- os and 95% confidence limit were respectively 0.938 - 6. 256,2. 334 - 3. 376,0. 827 - 2. 862,1. 873 - 2. 593,1. 182 - 4. 048,1. 253 - 3. 741,1. 435 - 2. 534. The 8 dimension scores of SF-36 and KDTA dimension scores in uremic enceph- alopathy patients were all lower than those in the NUE group. Conclusion Serum PTH concentration, primary disease （ diabetes） , clinical compliance, dialysis frequency, hemoglobin （ HGB ） , cephalosporins, history of drug use, CO2CP are the independent risk factors of uremic encephalopathy, and the quality of life in patients with uremic encephalopathy re- duced significantly.