维持性血液透析患者生活质量与蛋白质能量消耗和微炎症状态的相关性研究

Association between quality of life and protein energy wasting and micro inflammation state in maintenance hemodialysis patients

目的探讨维持性血液透析(MHD)患者生活质量(QOL)与蛋白质能量消耗(PEW)和微炎症状态(MIS)的关系。方法采用病例对照研究,观察2016年5月至2018年6月在桂平市人民医院行血液透析治疗的慢性肾脏病5期患者,按照是否合并PEW分为PEW组和非PEW组,按照是否存在MIS分为MIS组与非MIS组;分析患者的MIS、PEW状况和Q0L指标及其相互间的关系。结果①人选305例MHD患者,其中PEW发生率为33.77%(103/305).MIS发生率为30.49%(93/305),同时合并MIS和PEW者发生率为9.84%(30/305);②PEW组的透析龄、前白蛋白、血清白蛋白(ALB)、血红蛋白(Hb)、血清尿素氮、铁蛋白、血磷、全段甲状旁腺激素(iPTH)水平和Q0L的8个维度水平均低于非PEW组,但C反应蛋白(CRP)水平高于非PEW组,差异均有统计学意义(P<0.05),多因素回归分析显示:ALB Hb和Q0L是PEW的独立危险因素(P<0.05);③MIS组Q0L的8个维度水平和iPTH水平均低于非MIS组,CRP.血磷水平均高于非MIS组,差异均有统计学意义(P<0.05),多因素回归分析显示:CRP和Q0L是MIS的独立危险因素(P<0.05);④Spearman相关分析显示,PEW,CRP与SF-36量表评分均呈负相关(β=-0.565,P=0.000.r=-0.547,P=0.000)。结论PEW和MIS在MIHD患者中的发生率分别为33.77%和30.49%,合并PEW或MIS的MHD患者Q0L.水平显著降低。

Objective To investigate the relationship between quality of life and protein energy wasting(PEW)and micro inflammation state(M IS)in maintenance hemodialysis(MHD)patients.Methods The nutritional status and quality of life were evaluated by laboratory tests.They were divided into PEW group and non-PEW group,MIS group and non-MIS group and their clinical data was analyzed from May 2016 to June 2018.Results Three hundred and five mainte-nancehemodialysis patients were enrolled in this study.The prevalence rate of PEW and MIS were respectively 33.77%and 30.49%.The prevalence rate of MHD patients combined MIS and PEW was 9.84%.The levels of dialysis age,serum albumin,hemo-globin,blood urea nitrogen,serum ferritin,blood phosphorus,intact parathyroid hormone and the eight dimensions of quality of life(physical functioning,role physical,bodily pain,general health,vitality,social function,role emotional and mental health)in PEW group were lower than those in non-PEW group(P<0.05).The level of C-reactive protein(CRP)in PEW group was higher than that non-PEW group(P<0.05).The iPTH and the eight dimensions of quality of life in MIS group were lower than those in non-MIS group.The levels of G-reactive protein,blood phosphorus in MIS group were higher than those in non MIS group,with significant difference(P<0.05).The PEW and CRP were positively correlated with SF-36 scale score,and the correlation coefficients were(p=-0.565,P=0.000)and(r=-0.547,P=0.000).Conclusions The incidence of PEW and MIS in MHD patients was 33.11%and 30.49%,respectively.The quality of life of MHD patients with PEW or MIS was significantly reduced.