残余肾功能对维持性血液透析患者营养状况及生活质量的影响

The impact of residual renal function on nutritional status and quality of life in maintenance hemodialysis patients

目的分析残余肾功能(residual renal function,RRF)对血液透析患者营养状况及生活质量的影响。方法选取血液透析患者67例,将患者透析前24h内尿量≥200 ml/d分为有RRF组、尿量<200ml/d为无RRF组,收集患者临床资料,比较血浆白蛋白、前白蛋白、骨骼肌指数等营养指标;按年龄将2组患者进一步分为青年组(18~<45岁)、中年组(45~<60岁)和老年组(≥60岁)亚组,利用简明健康调查量表(the MOS 36 item short form health survey,SF-36)评估对应亚组患者的生活质量。结果①有RRF组(n=27)患者血浆前白蛋白水平(t=2.167,P=0.034)及骨骼肌指数(t=4.131,P<0.001)优于无RRF组(n=40);②具有RRF的青年组(n=8)及老年组(n=7)生理职能(青年组:t=4.781,P<0.001,老年组:t=2.306,P=0.036)、情感功能(青年组:t=3.606,P=0.005,老年组:t=2.542,P=0.023)、精神健康(青年组:t=2.621,P=0.026,老年组:t=2.518,P=0.024)、精力(青年组:t=4.111,P=0.002,老年组:t=2.165,P=0.047)和社会功能(青年组:t=3.308,P=0.008,老年组:t=2.136,P=0.049)等5个维度SF-36评分均高于无RRF组青年组(n=9)及老年组(n=19),躯体疼痛评分(青年组:t=3.400,P=0.007,老年组:t=2.439,P=0.028)低于无RRF组;而有RRF的中年组(n=12)较无RRF的中年组(n=12)患者精神健康(t=2.513,P=0.027)、精力(t=2.521,P=0.034)和社会功能(t=4.781,P=0.031)等3个维度SF-36评分更高,躯体疼痛评分(t=2.449,P=0.025)较低。结论具有RRF血液透析患者营养状况更好;RRF可全方位提高青年人群及老年人群生活质量,而对中年人群生活质量的影响有限。

Objective To analyze the effects of residual renal function(RRF)on nutritional status and quality of life in maintenance hemodialysis(MHD)patients.Methods A total of 67 MHD patients were selected and divided into RRF group with urine volume≥200 ml/d within 24h before dialysis and non-RRF group without urine volume<200 ml/d.The clinical data of the two groups were collected and analyzed.Plasma albumin,prealbumin and skeletal muscle index were compared between the two groups.Patients in the two groups were further subdivided into young subgroup(18~<45 years old),middle-age subgroup(45~60 years old)and elderly subgroup(≥60 years old).The MOS 36 item Short Form Health Survey(SF-36)was used to evaluate the quality of life of the subgroups.Results①The plasma prealbumin level(t=2.167,P=0.034)and skeletal muscle index(t=4.131,P<0.001)were better in the RRF group than in the non-RRF group.②The SF-36 scores of physiological function(t=4.781,P<0.001 for young subgroups;t=2.306,P=0.036 for elderly subgroups),emotional function(t=3.606,P=0.005 for young subgroups;t=2.542,P=0.023 for elderly subgroups),mental health(t=2.621,P=0.026 for young subgroups;t=2.518,P=0.024 for elderly subgroups),energy(t=4.111,P=0.002 for young subgroups;t=2.165,P=0.0473 for elderly subgroups)and social function(t=3.308,P=0.008 for young subgroups;t=2.136,P=0.049 for elderly subgroups)were higher,and the scores of physical pain(t=3.400,P=0.007 for young subgroups;t=2.439,P=0.028 for elderly subgroups)were lower in the young and elderly subgroups of the RRF group than in the young and elderly subgroups of the non-RRF group.The SF-36 scores of mental health(t=2.513,P=0.027),energy(t=2.521,P=0.034)and social functioning(t=4.781,P=0.031)were higher,and the physical pain scores(t=2.449,P=0.025)were lower in the middle-age subgroup of the RRF group than in the middle-age subgroup of the non-RRF group.Conclusion The nutritional status was better in MHD patients with RRF.RRF can elevate the quality of life of all aspects in young and elderly people,but has limited influence on the quality of life in middle-age people.