宁夏地区不同人群腹膜透析患者生活质量及其影响因素

目的探讨宁夏地区不同人群腹膜透析患者生活质量及其影响因素,旨在为临床工作中如何提高透析患者的生存质量提供依据。方法①选择行规律持续非卧床腹膜透析（continuous ambulatory peritoneal dialysis,CAPD）治疗6个月以上的109例慢性肾衰竭患者。收集患者的民族、年龄、性别、原发病因、受教育程度、年均收入、透析时间、透析方案及体质量指数（body mass index,BMI）等资料。按民族分为回族组和汉族组。②采用肾脏疾病生活质量简表（Medical Outcomes Study Health Status ShortForm,SF-36）评估患者的生活质量。③采用肾脏病膳食改良实验（Modifi—cationofDietinRenalDisease,MDI①）方程估计算患者的肾小球滤过率,以评估患者的残余肾功能。④采用主观综合性营养评估（subjective global assessment,SGA）及白蛋白等指标评估患者营养状况。⑤采用Charlson合并症指数评估患者合并症情况。⑥检测患者血浆全段甲状旁腺素（intactparathy—roidhormone,iPTH）及血钙、血磷水平以评估患者的钙磷代谢状况。结果①回族组、汉族组患者在年龄、性别、原发病因、受教育程度、年均收入、透析时间、透析方案及Charlson合并症指数等均无统计学差异（P〉0．05）。②与汉族组比较,回族组患者血钙、白蛋白、三酰甘油、总胆固醇及肾小球滤过率明显降低,iPTH水平明显升高,差异有统计学意义（P〈0．05）。③与汉族组比较,回族组的SGA评估的营养不良的发生率亦明显升高（47．5Z比24．6％）,有统计学差异（P〈O．05）。④与汉族组比较,回族组在SF-36评分[（52．90±20．68）比（42．78±19．46）]、生理健康评分[（53．27±22．91）比（39．47±20．22）]、精神健康评分E（58．30±22．68）比（46．10±22．76）]均明显下降,有统计学差异（P〈0．05）。⑤与汉族组比较,回族组在情感与精神状况[-（65．29±19．85）比（54．65±21．60）]和疼痛[（72．54±27．88）比（47．19±30．85）]两个维度评分也明显下降,均有统计学差异（P〈0．05）。⑥将2组存在差异的指标进行单因素相关分析及多元线性回归发现,不同人群和白蛋白水平与SF-36相关。结论回族、汉族腹膜透析患者生活质量SF-36、生理健康及精神健康存在一定的差异,回族患者明显低于汉族;白蛋白水平是影响患者生活质量的因素。

Difference in quality of life and its influencing factors between Hui and Han ethnic peritoneal dialysis patients

Objective To explore the difference in quality of life （QOL） between Hui and Han ethnics in maintenance peritoneal dialysis patients, and analyze the factors influencing QOL. Methods （1） 109 patients treated with continuous ambulatory peritoneal dialysis （CAPD） for at least 6 months were enrolled in our study. We investigated patients＂ ethnic group, age, gender, causes of disease, education status, income, PD duration and dialysis prescription, etc. All patients were divided into two groups in terms of the nationality; （2） Patients QOL was evaluated by Medical Outcomes Study Health Status Short Form （SF-36） ; （3） Patients residual renal function was assessed by Modification of Diet in Renal Disease （MDRD） formulal （4）Patientg nutritional status was evaluated by Subjective Global Assessment （SGA） and serum albumim （5）The comorbidities were evaluated by Charlson Index~ （6） Serum intact parathyroid hormone （iPTH）, calcium and phosphorus were used to estimate the patients calcium and phosphorus metabolism status. Results （1） There were no significant differences in the age, gender, causes of disease, education status, income, PD duration, dialysis prescription, body mass index （BMI） and score of Charlson Index between Hut and Han nationalities （P〈0. 05） ; （2） As compared with Han nationality, the calcium, albumin, triglyceride, cholesterol and creatinine clearance rate in patients of Han nationality were significantly lower, and the level of iPTH was significantly higher （P〈0. 05） （3） There was significantly higher rate of malnutrition in the Hut＇s patients than in the Harts （47. 5% vs. 24. 6% ,〈 0. 05） ; （4） As compared with Han nationality, Hut had a significantly lower sore in SF-36 [-（52. 90 ± 20. 68） vs. （42. 78 ± 19. 46） 1, WS [, （54. 86 ± 22. 09） vs. （39. 47 ± 20. 22） 1, MGS [ （54. 93 ± 22. 45） vs. （46. 10 ± 22. 76）1, EWB [-（65. 29 ± 19. 85） vs. （54. 65 ± 21.60）] and pain [（72. 54 ± 27. 88） vs. （47. 19 ± 30. 85） ; P〈0. 05]（5） Single factor correlation analysis and multiple linear regression revealed that SF-36 scores were associated with race and albumin. Conclusiom PD patients of Hut and Han nationalities perceive dif- ferent scores in QOL, especially in SF-36 scores, mental and physical health. Ethnic and semrn albumin level were the main factors that affect QOL