中青年维持性血液透析患者社会回归情况调查及进入透析前后社会功能退化程度的影响因素分析

Investigation on the social rehabilitation in young and middle-aged maintenance hemodialysis patients and analysis on the influencing factors for social function degradation before and after dialysis

目的调查中青年维持性血液透析(maintenance hemodialysis,MHD)患者社会回归现状,并探讨其进入透析前后社会功能退化程度的影响因素。方法对2023年6月于山西医科大学第二医院接受MHD的中青年患者,采用横断面及回顾性调查方法收集资料,采集生活质量简表(the kidney disease quality of life questionnaire,short-form version 1.3,KDQOL-SFtm 1.3)、社会功能缺陷筛选量表(social disability screening schedule,SDSS),以透析前后SDSS评分差值的中位数为界将患者分为社会功能退化不明显组和退化明显组。采用单因素分析、二元Logistic回归分析探讨中青年MHD患者社会功能退化的影响因素。结果本研究共纳入MHD患者112例,其中社会回归3级42例(37.50%)、4级70例(62.50%);社会回归4级患者生活质量评分高于3级患者(t=-2.554,P=0.012),而仅在肾病影响(t=2.185,P=0.031)、工作状态(t=3.203,P=0.002)、社交质量(t=2.117,P=0.037)、情感职能(t=2.700,P=0.008)、社会功能(t=2.349,P=0.021)方面有统计学差异。短透析龄(OR=3.031,95%CI:1.192~7.706,P=0.020)、有疲乏症状(OR=7.574,95%CI:1.829~31.367,P=0.005)、合并焦虑和(或)抑郁(OR=3.765,95%CI:1.120~12.658,P=0.032)、较高的社会影响量表得分(OR=1.303,95%CI:1.104~1.537,P=0.002)是中青年MHD患者社会功能退化的独立危险因素。结论中青年MHD患者社会回归及生活质量水平较高;透析龄短、伴有疲乏、有焦虑和/或抑郁状态、病耻感得分高的MHD患者社会功能减退更明显。应高度重视中青年MHD患者的心理和情绪问题。

Objective This study aims to investigate the current status of social rehabilitation and the quality of life,and to explore the factors influencing the degree of social function degradation after dialysis in young and middle-aged maintenance hemodialysis(MHD)patients.Methods The young and middle-aged MHD patients treated in the Second Hospital of Shanxi Medical University were taken as the study subjects.Cross-sectional and retrospective survey methods were used to collect patients'data.The Kidney Disease Quality of Life Scale(KDQOL-SFTM 1.3)and Social Disability Screening Schedule(SDSS)were used for evaluation of the patients.Patients were divided into the group with insignificant social function degradation and the group with significant social function degradation based on the median value of SDSS score difference before and after MHD.Univariate analysis and binary logistic regression analysis were used to investigate the influencing factors for social function deterioration in young and middle-aged MHD patients.Results①In the 112 MHD cases included in this study,42 cases(37.50%)were at the social rehabilitation level 3 and 70 cases(62.50%)at the social rehabilitation level 4.The quality of life score was higher in the patients at the social rehabilitation level 4 than those at the social rehabilitation level 3(t=-2.554,P=0.012),but statistical differences were only in the domains of impact of kidney disease(t=2.185,P=0.031),work status(t=3.203,P=0.002),social quality(t=2.117,P=0.037),emotional function(t=2.700,P=0.008)and social function(t=2.349,P=0.021).②Shorter dialysis age(OR=3.031,95%CI:1.192~7.706,P=0.020),fatigue symptom(OR=7.574,95%CI:1.829~31.367,P=0.005),comorbid anxiety and(or)depression problems(OR=3.765,95%CI:1.120~12.658,P=0.032),and higher morbidity stigma score(OR=1.303,95%CI:1.104~1.537,P=0.002)were the independent risk factors for social function deterioration in young and middle-aged MHD patients.Conclusions①Higher levels of social rehabilitation and quality of life were found in young and middle-aged MHD patients;②Patients with shorter dialysis age,comorbid symptoms of fatigue,anxiety and(or)depression,and high morbid stigma score were prone to have significant social dysfunction.The psychological and emotional problems should be emphasized clinically in young and middle-aged MHD patients.