血液透析患者不宁腿综合征相关影响因素分析

Analysis of related factors for restless legs syndrome in hemodialysis patients

目的调查血液透析患者不宁腿综合征发病率并筛查其相关危险因素。方法共220例维持性血液透析患者和40例慢性肾脏病患者,采用国际不宁腿综合征研究组评价量表(IRLS)评价不宁腿综合征严重程度,Beck抑郁量表(BDI)评价抑郁症状,Epworth嗜睡量表评价白天过度嗜睡,失眠严重程度指数(ISI)评价失眠程度。采用单因素和多因素前进法Logistic回归分析筛查血液透析患者发生不宁腿综合征的相关危险因素。结果血液透析组病程(Z=-9.837,P=0.000)、血清铁蛋白(t=2.847,P=0.005)、合并不宁腿综合征比例(χ~2=10.918,P=0.001)、应用镇静催眠药比例(χ~2=7.669,P=0.006)、IRLS评分(t=2.322,P=0.020)和ISI评分(Z=4.117,P=0.001)均高于对照组。单因素和多因素前进法Logistic回归分析显示,糖尿病(OR=3.387,95%CI:1.538~7.461;P=0.002)、BDI评分>9分(OR=2.643,95%CI:1.457~4.795;P=0.001)和ISI评分>7分(OR=3.542,95%CI:1.939~6.468;P=0.000)是血液透析患者发生不宁腿综合征的独立危险因素。结论血液透析患者不宁腿综合征和失眠发病率较高,不宁腿综合征与失眠密切相关,抑郁症状在其中发挥重要作用。

Objective To investigate the incidence of restless legs syndrome（RLS） in hemodialysis patients and to analyze the related risk factors. Methods There were 220 cases of hemodialysis as hemodialysis group and 40 cases of chronic nephrosis as control group. The severity of RLS was measured by International Restless Legs Syndrome Study Group Rating Scale（IRLS）. Beck Depression Inventory（BDI） was used to evaluate the status of depression, Epworth Sleepiness Scale（ESS） was used to evaluate excessive daytime sleepiness（EDS）, and Insomnia Severity Index（ISI） was used to evaluate the status of insomnia. Univariate and multivariate forward Logistic regression analysis was used to analyze the related risk factors for RLS in hemodialysis patients. Results In hemodialysis group duration（Z =. 9.837, P =0.000）, serum ferritin（t = 2.847, P = 0.005）, incidence rate of RLS（χ~2 = 10.918, P = 0.001）, the proportion of using hypnotic drugs（χ~2 = 7.669, P = 0.006）, IRLS（t = 2.322, P = 0.020） and ISI（Z = 4.117, P = 0.001） were significantly higher than control group. Univariate and multivariate forward Logistic regression analysis showed diabetes（OR = 3.387, 95%CI： 1.538-7.461; P = 0.002）, BDI 9 score（OR = 2.643, 95%CI： 1.457-4.795; P = 0.001） and ISI 7 score（OR = 3.542, 95%CI： 1.939-6.468; P = 0.000） were independent risk factors for RLS in hemodialysis patients. Conclusions Hemodialysis patients have a high incidence of RLS and insomnia. RLS is closely related with insomnia. Depression plays an important role therein.