维持性腹膜透析患者肺淤血与生活质量的关系

Relationship between pulmonary congestion and quality of life in maintenance peritoneal dialysis patients

目的观察维持性腹膜透析患者肺淤血及生活质量情况,并探讨两者的关系。方法收集105例维持性腹膜透析患者的相关临床资料,应用肺超声显示的B线数目评估肺淤血,采用简明健康调查问卷(SF-36)评估生活质量,计算躯体健康总分(PCS)与精神健康总分(MCS)。采用Spearman相关分析B线数目与PCS、MCS的相关性。按PCS、MCS的中位数值将患者分为高PCS者与低PCS者、高MCS者与低MCS者,并比较两者相关指标的差异,采用logistic回归分析确定生活质量的独立影响因素。结果 105例患者B线数目为4(0,17)条,存在肺淤血52例,PCS为52.8(44.8,59.8)分、MCS为54.5(46.8,60.8)分。B线数目与PCS、MCS呈负相关(r分别为-0.589、-0.464,P均<0.01)。与高PCS者相比,低PCS者B线数目、血B型尿钠肽、年龄、糖尿病肾病比例和心脑血管疾病史比例高(P均<0.05),血红蛋白、血白蛋白低(P均<0.01)。与高MCS者相比,低MCS者B线数目、血B型尿钠肽高(P均<0.01),血红蛋白、血白蛋白低(P均<0.01)。多因素分析结果显示,B线数目、血红蛋白水平、年龄及心脑血管疾病史是PCS的独立影响因素(P均<0.05),但仅前两者是MCS的独立影响因素(P均<0.05)。结论维持性腹膜透析患者肺淤血发生率较高且生活质量较低。肺淤血可能是患者生活质量下降的重要原因。

Objective To observe the pulmonary congestion（ PC） and quality of life（ QOL） in maintenance peritoneal dialysis（ MPD） patients and to investigate the relationship between them. Methods We collected the clinical data of105 MPD patients,evaluated PC with B-line number on pulmonary ultrasonography,evaluated QOL by concise health questionnaire（ SF-36）,and calculated the physical health score（ PCS） and mental health score（ MCS）. The association between B line number and PCS,MCS was examined by Spearman correlation analysis. Patients were respectively divided into two groups according to the median of PCS and MCS. Demographic data and clinical parameters were compared between the two groups,and then multivariate binary logistic regression analysis was applied to determine the independent risk factors for QOL. Results A total of 105 MPD patients were included. Median B line number was 4（ 0,17）. PC was detected in52 cases,PCS was 52. 8（ 44. 8,59. 8） points,and MCS was 54. 5（ 46. 8,60. 8） points. B line number was negatively correlated with PCS and MCS（ r =-0. 589,-0. 464,both P〈0. 01）. Compared with patients with high PCS,B lines number,serum B-type natriuretic peptide,average age,proportion of diabetic kidney disease and proportion of previous cardiocerebrovascular events were higher（ P〈0. 05）,while hemoglobin and serum albumin were lower in patients with low PCS（ both P〈0. 01）. Compared with patients with high MCS,B line number and serum B-type natriuretic peptide were higher（ both P〈0. 01）,but hemoglobin and serum albumin were lower in patients with low MCS（ both P〈0. 01）. Multivariate analysis showed that B line number,hemoglobin,age,and previous cardiocerebrovascular events were independent risk factors for PCS（ all P〈0. 01）,however,only B line number and hemoglobin were independent risk factors for MCS（ both P〈0. 05）. Conclusion MPD patients have high prevalence of PC and low level of QOL,and PC may be an important reason for the decline of QOL in these patients.