尿毒症肾脏替代治疗患儿生存质量的横断面调查

Quality of life in children with end-stage renal disease undergoing renal replacement therapy:a cross-sectional survey

目的 评估接受肾脏替代治疗的尿毒症患儿的生存质量,分析影响患儿生存质量的相关因素.方法 收集2016年11月至2017年10月在复旦大学附属儿科医院肾脏科住院并接受透析或肾移植治疗的尿毒症患儿的临床资料.按照肾脏替代治疗方式分为透析组和肾移植组.对所有患儿和家长发放生存质量测定量表(PedsQLTM)4.0简体中文版患儿自评量表和家长代评量表并回收,同时收集尿毒症患儿的临床资料.比较两组患儿自评量表得分与家长代评量表得分的差异.多重线性回归法分析影响患儿生存质量的相关因素.结果共纳入肾脏替代治疗患儿79例,其中透析组48例,肾移植组31例.肾移植组患儿自评及家长代评量表总得分均高于透析组(均P<0.05).肾移植组患儿自评量表总得分与家长代评量表总得分的差异无统计学意义(P>0.05),透析组患儿自评与家长代评总得分的差异有统计学意义(P=0.05).身材矮小(身高低于第3百分位)及左心室质量指数增高是影响肾移植患儿自评及家长代评生存质量量表评分值的独立因素(分别 Β=12.162,t=2.681,P<0.05;Β=-0.240,t=-4.276,P<0.01).结论 肾移植患儿生存质量优于透析患儿.身材矮小及左心室质量指数增高是肾移植患儿生存质量的独立影响因素.

Objective To evaluate the quality of life(QOL)of children with uremia who underwent renal replacement therapy(RRT)and identify the influencing factors for QOL in order to improve the QOL of children with uremia.Methods Children with ESRD who underwent dialysis or kidney transplantation(KT)at Children's Hospital of Fudan University between November 2016 and October 2017 were enrolled.The children and/or their parents completed and returned the Pediatric QOL Inventory Measurement Models(PedsQLTM)4.0 questionnaire.Moreover,the clinical data of these children were collected.According to the way of RRT,children were divided into dialysis group and KT group.The differences of scores between two groups were compared.Multiple linear regression analysis was used to analyze the factors affecting the QOL of children.Results A total of 79children undergoing RRT were enrolled.Among them,48 cases in the dialysis group and 31 cases in the KT group.For children in KT group,the total PedsQL scores of child-self and parent-proxy assessment were higher than those in dialysis group(P<0.05).The total scores for the QOL of child-self and parent-proxy assessment were roughly the same for KT children(P>0.05).The total scores for the QOL of child-self and parent-proxy assessment were different for dialysis children(P=0.05).Short stature(height<3th percentile)and elevated left ventricular mass index(LVMI)were the independent influencing factors for the QOL of child-self and parent-proxy assessment in children undergoing KT,respectively(B=12.162,t=2.681,P<0.05;B=-0.240,t=-4.276,P<0.01).Conclusions QOL was higher in children undergoing KT than those on dialysis.Short stature and elevated LVMI were the independent influencing factors for QOL in children undergoing KT.