维持性血液透析患者失眠及影响因素分析:一项多中心、横断面、观察性研究

Influencing factors of eosinophilia in peripheral blood of maintenance hemodialysis patients and its relationship with prognosis

目的失眠是影响维持性血液透析(maintenance hemodialysis,MHD)患者生活质量的重要因素。本研究拟探讨MHD患者失眠状况和严重程度,并进一步分析其相关的危险因素。方法本研究为多中心、横断面、观察性研究,将2020年7月至2020年11月在珠三角地区共7个透析中心的MHD患者作为研究对象。根据《国际睡眠障碍分类-第三版》对患者进行分组并采用匹兹堡睡眠质量指数(pittsburgh sleep quality index,PSQI)计算得分,将其分为睡眠正常组和失眠组(轻度、中度、重度)。研究指标包括:PSQI问卷、瘙痒视觉模拟评分表(visual analogue scale,VAS)、患者一般资料如人口学特征、透析龄、合并疾病、用药情况及临床基线数据,分析MHD患者睡眠情况和失眠程度及相关因素。结果(1)本研究共入组555例MHD患者,年龄(55.37±13.95)岁,男性占55.2%,失眠的患病率是38.49%;(2)与睡眠正常组相比较,失眠组胱抑素C水平和瘙痒VAS评分更高。女性、不宁腿综合征患者、未曾服用铁剂、转铁蛋白饱和度低的患者更容易发生失眠(P<0.05);(3)简单线性回归分析提示,MHD患者睡眠质量指数与年龄、胱抑素C、瘙痒VAS评分、不宁腿综合征呈独立正相关,反之,MHD患者睡眠质量指数与性别(男)、铁剂使用呈独立负相关(P<0.05);(4)二元Logistic回归分析显示,瘙痒(OR=1.077,95%CI:1.012~1.146,P=0.020)、不宁腿综合征(OR=2.403,95%CI:1.225~4.713,P=0.011)、低转铁蛋白饱和度(OR=0.981,95%CI:0.967~0.996,P=0.013)是失眠发生的危险因素;(5)进一步有序Logistic回归分析,结果提示年龄(OR=1.023,95%CI:1.002~0.1.045,P=0.035)、不宁腿综合征(OR=2.573,95%CI:1.039~6.370,P=0.041)、女性(OR=0.573,95%CI:0.334~0.983,P=0.043)是失眠加重的危险因素。结论本研究结果提示瘙痒、不宁腿综合征、低转铁蛋白饱和度可能导致MHD患者失眠,同时,年龄增长、合并不宁腿综合征、女性患者失眠状况较严重。

Objective To explore the influencing factors of eosinophilia in peripheral blood of maintenance hemodialysis patients and examine its relationship with prognosis.Methods From January1 to January 31,2018,114 MHD patients at dialysis center of our hospital were retrospectively selected and divided into two groups of A(>5%)and B(<5%)according to the proportion of eosinophil.The inter-group differences in baseline profiles and laboratory tests were analyzed.They were followed up for45 months.Logistic model was utilized for examining the factors related to all-cause endpoint events and receiver operating characteristic(ROC)curve for analyzing the predictive efficacy of elevated eosinophil ratio on all-cause endpoint events.Results Significant inter-group differences existed in gender,coronary heart disease,cardiac function gradeⅢ/Ⅳ,high-sensitivity C-reactive protein,dialysis adequacy(Kt/V),pre-dialysis calcium(Ca),ferritin,parathyroid hormone(iPTH)and all-cause endpoints(P<0.05).After adjusting for various confounding factors,Logistic analysis revealed a significant correlation between all-cause endpoints and elevated proportion of eosinophils(P=0.03,95%CI 1.013-1.281).The area under the curve(AUC)of predicting all-cause endpoint was 68%with a sensitivity of 68%and a specificity of 74.6%.Conclusion Inflammatory status,iPTH and pre-dialysis calcium are the influencing factors of elevated eosinophil ratio.And elevated eosinophil ratio is an independent risk factor for allcause endpoint events in MHD patients.