尿毒症继发不安腿综合征73例临床表现分析

Clinical analysis of 73 cases of restless legs syndrome in uremic patients

目的了解尿毒症继发不安腿综合征患者患病率、严重程度、危险因素、具体不适部位及临床表现。方法以2015年3~7月于首都医科大学附属北京友谊医院、北京第六医院、北京中兴医院、首都医科大学附属北京朝阳医院血液净化中心尿毒症持续性血液透析患者186例为研究对象,进行横断面研究,采用床旁问卷形式,以国际不安腿综合征研究小组(IRLSS)制定的4个基本标准进行诊断,以IRLSSG量表进行严重程度分级,对患者一般情况、生活习惯、治疗情况及相关实验室检查进行统计,详细记录患者不适部位及具体临床表现。结果入组患者186例,根据是否符合RLS诊断,将其分为RLS(+)组73例和RLS(-)组113例。RLS(+)组:患病率为39.25%,RLS严重程度评分为(16.44±7.36)分,中、重度占68.50%。与RLS(-)组相比,RLS(+)组患者中肾移植失败后透析人数多(42/31 vs.44/69),而应用铁剂及进行血滤治疗的人数少(28/45 vs.61/52,51/22 vs.96/17),差异均有统计学意义(P<0.05)。RLS(+)组患者双下肢受累者占89.04%,单侧下肢受累占5.48%,上肢受累占2.74%,四肢受累占2.74%。肌肉内部不适患者占所有患者的80.82%,肢体表面不适患者占8.22%。结论尿毒症患者继发RLS与肾移植失败、不应用铁剂及血液滤过相关。RLS主要累及双下肢,以肌肉内部不适为主。

Objective To investigate the prevalence,severity,risk factors,specific discomfort sites and clinical manifestations of restless leg syndrome(RLS)in uremic patients.Methods One hundred and eighty-six cases of continuous hemodialysis patients with uremia in Beijing Friendship Hospital,Capital Medical University,Beijing Sixth Hospital,Beijing Zhongxing Hospital,and Beijing Chaoyang Hospital Blood Purification Center from March to July 2015 were investigated by face-to-face interviews.The study subjects were used cross-sectional studies,bedside questionnaires,diagnosed according to the 4 basic criteria established by the International Restless Legs Syndrome Research Group(IRLSS),and graded according to the severity of the IRLSSG scale,and the patient's general condition,living habits,treatment status and related laboratory examinations were counted,and the patient's discomfort parts and specific clinical manifestations were recorded.Results 186 patients were enrolled,and they were divided into RLS(+)group of 73 cases and RLS(-)group of 113 cases according to whether they met the RLS diagnosis.RLS(+)group:the prevalence rate was 39.25%,the IRLSSG scores of the patients were(16.44±7.36)scores,68.50% patients were above moderate.Compared with the RLS(-)group,RLS(+)group had more kidney transplantation failure surgeries(42/31 vs.44/69),few Iron drugs(28/45 vs.61/52),and few hemofiltration therapies(51/22 vs.96/17),with significant differences(P<0.05).Among the patients with RLS(+)group,89.04% patients were involved in both lower limbs,5.48% in unilateral lower limbs,2.74% in both upper limbs,and 2.74% in limbs.Muscle discomfort accounted for 80.82% of all patients,and surface discomfort for 8.22%.Conclusion RLS in uremia patients is associated with kidney transplantation failure,no application of iron and hemofiltration.RLS mainly involved lower limbs,mainly involved internal muscle discomfort.