不宁腿综合征在维持性腹膜透析患者中的危险因素分析

The risk factors of restless legs syndrome in maintenance peritoneal dialysis

目的调查安徽医科大学第二附属医院腹膜透析患者不宁腿综合征(restless legs syndrome,RLS)的发生率,分析RLS的影响因素。方法选取在2013年3月1日~2013年11月31日在安徽医科大学第二附属医院腹膜透析中心规律随访的稳定透析≥3个月、年龄≥18岁且≤75岁的患者,收集其人口学数据、实验室指标,采用Zung’s抑郁自评量表评估是否存在抑郁,采用国际不宁腿综合征研究组(the international restless legs syndrome study group,IRLSSG)评定量表评价RLS严重程度。对于在2015年3月~2015年11月的在透析患者,再次收集数据,对其是否存在RLS再次评估。结果共纳入研究对象71例。31例患者(43.7%)在基线时被诊断存在RLS(RLS+组)。RLS+组抑郁人数、血磷及甲状旁腺激素水平高于RLS-组(χ^2=9.291,P=0.002;t=-2.668,P=0.010;Z=-2.274,P=0.023)。相关分析提示抑郁、血磷及甲状旁腺激素与基线RLS呈正相关(r=0.362,P=0.002;r=0.322,P=0.006;r=0.276,P=0.022)。Logistic回归分析提示抑郁及高血磷是RLS危险因素(OR=5.465,95%CI:1.712~17.439,P=0.004;OR=3.597,95%CI:1.190~10.867,P=0.023)。根据IRLSSG评分量表评估RLS的严重程度,35.5%患者存在轻度RLS,29.0%患者存在中度RLS,35.5%患者存在严重及非常严重RLS。较严重RLS的患者的透析龄更长(Z=-3.711,P<0.001),体质量指数(body mass index,BMI)更高(t=-2.244,P=0.038),超敏C反应蛋白(high-sensitive C-reactive protein,hs-CRP)水平更高(Z=-2.595,P=0.009),碱性磷酸酶水平更低(t=2.106,P=0.049)。完成二次随访的患者有55例,其中35例(63.6%)患者诊断为RLS,与基线不宁腿发生率相比无显著升高(χ^2=2.981,P=0.108)。Logistic回归分析提示基线甲状旁腺激素是二次随访时RLS的危险因素(OR=1.003,95%CI:1.000~1.006,P=0.027),也是RLS持续存在的危险因素(OR=1.005,95%CI:1.000~1.009,P=0.030)。结论安徽医科大学第二附属医院腹膜透析中心维持性腹膜透析患者的RLS检出率为43.7%。RLS患者更容易抑郁,其血磷、甲状旁腺激素水平更高。抑郁、血磷及甲状旁腺激素的升高是腹膜透析患者RLS的危险因素。

Purpose To investigate the prevalence and risk factors for restless legs syndrome(RLS)in maintenance peritoneal dialysis(PD)patients.Methods The maintenance PD patients treated in The Second Hospital of Anhui Medical University between Mar 1,2013 and Nov 31,2013,regularly followed-up for over 3 months,and with the age of ≥18 to ≤75 years old were enrolled in this study.Demographic information,laboratory indicators,depression and RLS assessment data were collected.We measured the severity of RLS by using the rating scale from the International Restless Legs Syndrome Study Group(IRLSSG).For patients continuing to use PD between Mar 1,2015 and Nov 31,2015,their data were collected again and the relationship between the indicators and the occurrence of RLS was re-evaluated.Results There were 71 PD cases in the study.At baseline,31(43.7%)were diagnosed with RLS(RLS+group).Compare to the RLS-group,the incidence of depression and the levels of serum phosphorus and parathyroid hormone were significantly higher in the RLS+group(χ^2=9.291,P=0.002;t=-2.668,P=0.010;Z=-2.274,P=0.023).Correlation analysis suggested depression,serum phosphorus and parathyroid hormone were positively correlated with RLS(r=0.362,P=0.002;r=0.322,P=0.006;r=0.276,P=0.022).Logistic regression analysis showed that depression and higher serum phosphorus were the risk factors for RLS at baseline(OR=5.465,95%CI=1.712~17.439,P=0.004;OR=3.597,95%CI=1.190~10.867,P=0.023).According to the rating scale of IRLSSG in the RLS+group,35.5% were mild RLS,29.0% were moderate RLS,and 35.5% were severe or very severe RLS.Patients with severer RLS had longer dialysis duration(Z=-3.711,P<0.001),higher body mass index(t=-2.244,P=0.038),higher sensitive C-reactive protein(Z=-2.595,P=0.009),and lower alkaline phosphatase(t=2.106,P=0.049).Of the 55 patients who completed the second assessment,35(63.6%)were diagnosed with RLS,similar to the incidence at baseline(χ^2=2.981,P=0.108).Logistic regression model indicated that parathyroid hormone at baseline was the risk factors for RLS in the follow-up period(OR=1.003,95%CI=1.000~1.006,P=0.027)and for persistent RLS(OR=1.005,95%CI=1.000~1.009,P=0.030).Conclusion The prevalence of RLS in this series of maintenance PD patients was 43.7%.Patients with RLS were more likely to have depression and higher levels of serum phosphorus and parathyroid hormone.Depression,higher levels of serum phosphorus and parathyroid hormone were the risk factors for RLS.