维持性血液透析患者不宁腿综合征的横断面研究

目的 了解维持性血液透析患者中不宁腿综合征(restless legs syndrome,RLS)的发病率及其影响因素.方法 入选2012年9月1-30日在广东省人民医院血液净化中心行维持性血液透析的375例患者,收集相关实验室和透析指标数据,应用多元logistic回归分析对相关危险因素进行统计分析.结果 RLS的发病率为13.3％,严重程度评分为(18.69±0.95)分,多元logistic回归分析显示无尿(OR0.292,95％ CI 0.114～0.750)和β2微球蛋白升高(OR 1.023,95％ CI 1.003～1.044)是维持性血液透析患者发生RLS的危险因素,而体重指数、血红蛋白、血清铁、甲状旁腺素等与RLS无相关性.结论 维持性血液透析患者RLS发病率高,其发生危险因素为无尿和β2微球蛋白升高,故保存残余肾功能,提高透析充分性,特别是清除中分子毒素,可降低不宁腿的发生率进而改善透析患者的生活质量.     

维持性血液透析患者代谢综合征流行病学调查

目的了解维持性血液透析（MHD）患者代谢综合征（MS）的发病率及特点。方法以2004年中国糖尿病学会提出的MS诊断标准对我院2000年至2006年维持性血液透析患者进行回顾性、横断面调查。结果386例患者原发病构成：糖尿病19.7％、高血压21.O％、慢性肾炎及其它疾病59.3％。MS总的发病率为39.9％；糖尿病、高血压、慢性肾炎及其它疾病MS发病率分别为94.7％。59.3％，14.8％；女性、男性发病率分别为42.3％和38.1％。整个群体MS相关异常组分：高血压97.4％，低高密度脂蛋白47.2％。高甘油三酯40.4％，高血糖295％，肥胖16.7％。结论维持性血透患者有较高MS发病率，大样本、前瞻性研究有助于阐明MS在MHD患者中的发病规律及对预后的影响。     

维持性血液透析患者生活质量及其影响因素探讨

目的探讨维持性血液透析(MHD)患者生活质量(QOL)及其影响因素。方法选取中国医科大学附属第一医院2007年12月至2008年1月MHD3个月以上并且愿意参加本项调查的血液净化中心102例患者作为调查对象。采用SF-36量表评估患者的生活质量,应用HAMD17抑郁量表评估患者的精神状态。分析MHD患者年龄、性别、文化程度、职业、精神状态、透析情况等与QOL的关系。结果MHD患者SF-36量表8个维度得分显著低于普通人群(P0.01)。抑郁、性别、职业、其他系统疾病对PCS、MCS有显著影响(P0.05);年龄与PF、VT、SF、MCS呈负相关(P0.05)。结论MHD患者QOL显著低于普通人群;精神抑郁、女性、无业、伴有其他系统疾病对患者的躯体健康及精神健康有显著影响;随着年龄的增加患者的生理功能、精力、社会功能、精神健康状况等明显下降。     

Epidemiological investigation on the prevalence of anemia and the standardized rate of hemoglobin in patients with maintenance hemodialysis in Anhui province

<正>Objective To explore the prevalence of anemia,percentage of patients with hemoglobin(Hb)reaching the guideline target,and its impact factors in maintenance hemodialysis(MHD)patients in Anhui Province.Methods Two thousand six hundred and one cases of MHD patients were investigated in hemodialysis centers of 26 hospitals in southern,northern and central Anhui Province     

血液灌流对老年血液透析患者不安腿综合征和睡眠质量的影响

目的 了解老年维持性血液透析(maintenance hemodialysis,MHD)患者不安腿综合征(restless legs syndrome,RLS)的患病率、危险因素及其对睡眠质量的影响,观察血液灌流改善对老年血液透析患者不安腿症状和睡眠质量的有效性和安全性.方法 以118例因慢性肾衰竭进行MHD治疗的老年患者为研究对象.不安腿综合征的诊断采用国际不安腿综合征研究小组制定的诊断标准量表,以匹兹堡睡眠质量指数(Pittsburgh sleep quality index,PSQI)进行睡眠质量评估.对伴有RLS老年MHD患者进行血液灌流治疗,疗程3个月,观察治疗前后患者RLS症状和PSQJ评分情况及不良反应.收集患者的临床和生化资料,进行t检验或x2检验,部分指标间进行相关分析和Logistic回归分析. 结果 (1)118例老年血液透析患者中,并存RLS者31例,患病率为26.3%,其中男性11例,女性20例;(2)RLS组患者透析龄(t=2.332,P=0.021)、性别比(女/男)(X2=15.343,P=0.000)、血磷(t=4.784,P=0.000)、β2-微球蛋白(t=13.124,P-0.000)和甲状旁腺激素水平(t=10.900,P=0.000)明显高于非RLS组,差异均有统计学意义.而在年龄(t=0.341,P=0.734)、干体质量(t=0.008,P=0.994)、透析器膜材料(X2=1.055,P=0.304)、血肌酐(t=0.051,P=0.960)、血尿素(t=0.899,P=0.370)、血红蛋白(t=0.912,P=0.364)、红细胞压积(t=0.601,P=0.549)、血钙(t=0.192,P=0.124)、铁蛋白(t=0.200,P=0.842)、转铁蛋白饱和度(t=1.094,P=0.276)等生化指标方面,两组差异均无统计学意义;Logistic回归分析结果 显示,血甲状旁腺激素和血β2-微球蛋白是老年MHD患者并发RLS的独立危险因素;(3)RLS组PSQI明显高于非RLS组,分别为10.7±2.7和4.9±2.5(t=10.948,P=0.000);睡眠差主要表现在主观睡眠质量、睡眠时间、习惯睡眠效应、日间功能等方面,且RLS严重程度与PSQI总分呈正相关(r=0.839,P<0.05);(4)经血液灌流治疗后,RLS患者血磷,血甲状旁腺激素、血β2-微球蛋白、RLS和PSQI评分均明显下降,与治疗前比较,差异有统计学意义;(5)患者在治疗过程中牛命体征平稳,无不良反应发生. 结论 老年MHD患者RLS的患病率较高,且普遍存在睡眠质量差等问题;血甲状旁腺激素和β2-微球蛋白是老年MHD患者并发RLS的独立危险因素,血液灌流能改善老年MHD患者的RLS和睡眠质量,且安全性好.     

影响维持性血液透析患者生存率的相关因素

慢性肾脏病的防治已成为全球性的重要公共卫生问题,全球大约有120万终末期肾脏病患者在接受血液透析治疗。在我国,维持性血液透析(MHD)是终末期肾脏病患者的主要治疗方式,随着血液透析技术的不断发展,MHD患者的预后明显改善,但长期生存率仍较低,该文对影响MHD患者生存率的相关因素进行阐述。     

Prevalence of restless legs syndrome in patients with irritable bowel syndrome

AIM:To determine the prevalence of restless legs syndrome(RLS)in patients with irritable bowel syndrome(IBS).METHODS:Patients with diarrhea-predominant IBS(n=30),constipation-predominant IBS(n=30),or mixed-symptom IBS(n=30)were recruited from the community between March 2008 and February 2009.Rifaximin 200 mg three times daily was administered empirically to alleviate small intestinal bowel over-growth in all patients.The presence of RLS was assessed via an RLS questionnaire and polysomnography.RESULTS:Twen...     

Prevalence of peptic ulcer in patients undergoing maintenance hemodialysis

Renal failure is said to be a risk factor for peptic ulceration, although most previous studies were small and utilized radiology rather than endoscopy for diagnosis. We endoscoped 114 of 126 patients with end-stage renal failure on maintenance hemodialysis and found peptic ulcer in two (2%);one other patient not endoscoped had previously undergone ulcer surgery. Erythema, petechial spots, or erosions were found in another 58 patients (51%). The ranges of gastric acid output and serum gastrin were wide and were inversely correlated. The prevalence of peptic ulcer among patients on hemodialysis therefore appeared to be no higher than that in the general population. Elevated serum gastrin levels may be a response to hypochlorhydria.     

维持性血液透析患者心血管钙化的发生率及分布特点

目的:探讨维持性血液透析(MHD)患者心血管钙化分布及相关因素。方法:选择MHD≥3月的患者144例,完善相关实验室检查,螺旋CT检测冠状动脉钙化评分(CACS,Agaston法),腹部侧位平片检测腹主动脉钙化评分(AACS,Kauppila法),心脏超声检测心脏瓣膜钙化情况,计算心血管钙化指数(CCI)。结果:本组患者影像学可见钙化的总发生率为70.83%,29.17%无钙化,普遍钙化者26.39%,选择性钙化者44.44%。冠脉钙化的患者中,CACS100的患者占50.67%,腹主动脉钙化的患者,AACS5者占48.48%,瓣膜钙化以二尖瓣为主(34.25%)。钙化总发生率无性别差异,随年龄和透析龄的增长而增加。AACS与CACS呈正相关(r=0.636),发生瓣膜钙化的患者CACS更高(P0.00 1)。比较普遍钙化与无钙化的患者,年龄、透析龄、体质量指数、腹围、踝臂指数、总胆固醇、低密度脂蛋白、超敏C反应蛋白、是否糖尿病存在差异(P0.05),而收缩压、舒张压、血钙、血磷、全段甲状旁腺激素、磷结合剂和活性维生素D的用药情况未见差异(P≥0.05)。高龄、高血钙、贫血、血脂异常是冠脉钙化的独立危险因素;高龄、血脂异常是腹主动脉钙化的独立危险因素;高龄和长透析龄是心脏瓣膜钙化的独立危险因素。CCI与CACS比较有良好的特异度和灵敏度。结论:本组患者心血管钙化部位不均衡,年龄、透析龄、血钙、血脂及部分传统心血管危险因素与钙化的发生有关。CCI可能是更优质的血管钙化评价指标。     

Prevalence,severity, and impact on quality of life of restless leg syndrome in patients with liver cirrhosis in India

Background and Aim

Restless leg syndrome (RLS) has recently been shown to be increased in patients with liver cirrhosis (LC). We prospectively studied the prevalence and severity of RLS, and the effect of its presence on the quality of life (QoL) in Indian patients with LC.

Methods

Adult patients with stable LC (n = 121; 98 male; median age 47 [range 18–68] years; Child-Pugh class A/B/C 59/39/23), were prospectively enrolled along with a group of healthy, adult controls (n = 121; 84 male; median age 42 [19–70] years). Patients with recent (<4 weeks) worsening were excluded. The subjects underwent an initial screening for RLS, followed by a re-evaluation to confirm the diagnosis, using the International RLS Diagnostic Criteria, and assessment of its severity. All participants underwent QoL assessment.

Results

RLS was commoner in LC patients (8/121; 6.6 %) than in controls (1/121; p?<?0.05; odds ratio?=?8.5 [1.1–69.0]). Presence of RLS showed no association with specific gender (male 7/98, female 1/23), Child-Pugh class (A 5/59, B 1/39 and C 2/23) or cause of liver disease (alcohol 3/32, hepatitis B 1/18, hepatitis C 3/28, and cryptogenic 1/25). RLS severity was moderate (5), severe (2), or very severe (1). Though QoL scores were lower in patients with LC than in controls, those in patients with and without RLS were similar.

Conclusion

RLS was commoner in patients with LC than in controls, but did not correlate with liver disease severity and did not adversely influence QoL in LC.

     

Relation of serum hepcidin levels and restless legs syndrome in chronic hemodialysis patients

Background

Iron deficiency anemia, pregnancy, and end-stage renal disease (ESRD) are common causes of secondary restless legs syndrome (RLS). Serum ferritin is considered the most specific test associated with the total amount of body iron stores. However, due to the increase of serum ferritin secondary to inflammation in chronic hemodialysis (HD) patients, serum ferritin test results do not fully reflect decreased iron stores in these patients. The present study evaluates the serum hepcidin levels, as the main regulator of iron metabolism, and its relationship with RLS in chronic HD patients.

Methods

The present cross-sectional study involved 72 patients (36 with and 36 without RLS) who received chronic HD treatment between April 2014 and April 2015. Demographic and biochemical data were evaluated in all patients, and statistical analyses were performed.

Results

The mean age and mean dialysis vintage of all patients (56% women) included in the study were 65.3?±?11.6 years and 41.5?±?36.5 months, respectively. Serum hepcidin, hemoglobin A1C (HbA1C), and ferritin levels were significantly higher in patients with RLS (p =?0.001, p?= 0.032, p?= 0.042, respectively). In addition, a positive correlation was found between International Restless Legs Syndrome Study Group severity scale score and serum hepcidin levels, HbA1C, and ferritin (r?= 0.387, p?= 0.001; r?= 0.426, p?= 0.034; r?= 0.240, p?= 0.046, respectively). A multivariate linear regression analysis revealed hepcidin and HbA1C to be independently associated with the presence of RLS.

Conclusion

A significant relationship was detected between RLS and increased serum hepcidin levels in chronic HD patients, and uncontrolled diabetes was noted to contribute to this association.

     

维持性血液透析患者透析过程相关高血压的影响因素

目的探讨维持性血液透析患者透析过程相关高血压(IDH)的影响因素。方法入选2010-01-01-2010-12-31福建医科大学附属第一医院肾内科行维持性血液透析的终末期肾脏病患者53例(1年内共进行6890次血液透析),探讨透析过程患者的尿素清除指数(Kt/v)、透析间期体质量增长量(IDWG)、超滤率、甲状旁腺素、促红细胞生成素、平均住院次数、心脑血管疾病并发症发生率等与IDH的关系。根据IDH发生次数分为≥3次(A组,n=19)和≤2次(B组,n=34)。结果与B组比较,A组的透析频率[(2.1±0.3)比(3.0±0.7)次/周]、Kt/v[(0.8±0.1)比(1.3±0.1)]、血红蛋白[(96.4±3.8)比(102.1±2.1)g/L]均较低(P<0.05),而透析前后收缩压和舒张压差值[收缩压(26.4±11.0)比(8.2±6.8)mmHg;舒张压(10.2±4.8)比(4.0±1.2)mmHg]、IDWG[(3.8±1.2)比(2.1±0.9)kg]、超滤率[(14.2±0.2)比(9.1±0.4)mL/(h·kg)]、甲状旁腺素[(564.5±68.7)比(365.9±46.9)ng/L]、促红细胞生成素治疗比例(100%比85.3%)及治疗剂量[(10000±1546)比(8856±1287)U/W]、平均住院次数[(0.7±0.2)比(0.3±0.3)次/年]、心脑血管疾病并发症发生率(64%比12%)均较高(P<0.05)。就单次透析而言,与发生IDH比较,未发生IDH患者的IDWG、超滤率、透析期间平均心率、透析前平均动脉压均较低(P<0.05)。多因素Logistic回归分析显示,IDH影响因素分别为IDWG、透析频率、透析期间平均心率、透析前平均动脉压、超滤率。结论 IDH与IDWG、透析前平均动脉压、透析期间平均心率、透析频率、超滤率相关。     

血液透析发生结核感染的影响因素分析

目的 分析维持性血液透析患者发生结核感染的影响因素及临床特点.方法 回顾性调查2018年5月-2019年8月北京清华长庚医院肾内科收治的长期规律血液透析患者共150例,收集患者的年龄、性别、合并疾病、血常规、生化、透析充分性等检验结果和影像学资料,归纳分析血液透析患者发生结核感染的影响因素.结果 150例血液透析患者,...     

Prevalence of restless legs syndrome in Japanese patients with chronic liver disease

Aim: Sleep disturbance is a major complication in patients with chronic liver disease, but causes are unclear. The aim of this study was to clarify the prevalence of restless legs syndrome (RLS) in Japanese chronic liver disease patients and investigate the influence on sleep and quality of life. Methods: The study included 149 consecutive outpatients with chronic liver disease at Nagasaki University Hospital between September 2008 and March 2010. The presence of RLS was evaluated by a written survey using the questionnaire for the epidemiological surveillance of the international RLS research group in 2003. In addition, 89 cases, including all RLS patients, were evaluated for sleep quality and health-related quality of life. Sleep quality was evaluated by using the Japanese version of the Pittsburgh Sleep Quality Index (PSQI), and health-related quality of life was evaluated by the Japanese SF-36 Health Survey. Result: Twenty-five of the 149 patients (16.8%) fulfilled the diagnostic criteria for RLS. The median global PSQI score of the RLS group was significantly higher than the non-RLS group (9 vs 5, P < 0.01). The number of poor sleepers (global PSQI score, >5) in the RLS group was significantly higher than in the non-RLS group (P < 0.05). In SF-36, the mental component summary score of the RLS group was 43.8 ± 10.8, which was significantly lower than the non-RSL group (49.8 ± 10.5; P < 0.05). Conclusion: This is the first report that clarifies the prevalence of RLS in Japanese chronic liver disease patients. RLS worsens quality of sleep and life in chronic liver disease patients.     

Prevalence and determinants of restless leg syndrome in type 2 diabetes mellitus (T2DM) in Pakistan

Background and aimsRestless legs syndromes (RLS) are intrinsic sleeping disorder and its prevalence rate is 10–15% in general population but it is observed that prevalence rate is different in diabetes patients. Current study aims to find prevalence and determinants of RLS in people living with type 2 diabetes mellitus in Pakistan.MethodA multicenter cross-sectional observational study was conducted in 388 diabetes patients attending daily diabetes clinics and teaching hospitals in Pakistan’s twin city between August 2019 and February 2020. The chi-square test and linear regression were used to detect RLS-related factors in type 2 diabetes mellitus.ResultsThe prevalence of RLS found was; 3.1% patients with diabetes were suffering from very severe RLS, 23.5% from severe RLS, 34% from moderate RLS, 21.1% from mild RLS and 18.3% from non-RLS. Gender, age, education, blood glucose fasting (BSF), blood glucose random (BSR) and HBA1c were found to be significant predictors of RLS in patients with diabetes.ConclusionPolicy makers can develop local interventions to curb the growing RLS prevalence by keeping in control the risk factors of RLS in people living with type 2 diabetes.     

维持性血液透析患者高血压影响因素的分析

目的:统计南京军区南京总医院解放军肾脏病研究所血液净化中心188例患者血压控制情况,分析影响高血压控制的因素.方法:维持性血液透析(MHD)超过3个月的患者188例进行回顾性分析.根据血压,将188例患者分为血压正常组(A组)、血压达标组(B组)、血压未达标组(C组),分析MHD患者透析高血压的影响因素.统计参数包括一般资料;实验室及透析相关参数:透析时间、透析剂量、超滤量、体重变化、血红蛋白(Hb)、电解质水平、尿素氮清除率(Kt/V)等.结果:(1)55.3％的血压控制未达标,其中单纯收缩压、舒张压升高者分别为47.1％、1.9％;(2)三组患者的年龄、性别构成、千体重无明显差异;C组的体重增长率、体重增长过多者的比例、促红细胞生成素(EPO)剂量、钙磷乘积明显较前两组高,透析龄、Hb、Kt/V较前两组低,差异有统计学意义(P＜0.05).经Logistic回归分析(step),透析前收缩压与Hb、Kt/V成负相关,与EPO剂量、钙磷乘积呈正相关.(3)体重增长率和血压的平稳性紧密相关,体重增长率＜0.03及体重增长率＞0.03的平均收缩压下降率分别为0.049±0.104和0.206±0.165,统计学差异显著(P＜0.05).结论:MHD患者合并高血压者较为常见,其中以收缩压升高为主;高血压的控制受多种因素影响,包括体重增长率、体重增长过多者的比例、EPO剂量、透析龄、Hb、Kt/V等.透析前收缩压与Hb、Kt/V及透析龄呈负相关,与EPO剂量呈正相关,未发现与年龄有明显相关性.     

老年维持性血液透析患者心血管钙化危险因素分析

目的:调查老年维持性血液透析(MHD)患者心血管钙化发生率,分析影响老年MHD患者心血管钙化的危险因素。方法:选取2014年1月至2015年1月,于四川省15家血液透析中心透析的老年MHD患者。收集患者相关临床及实验室资料,腹部侧位X线片,骨盆X线片及心脏彩色超声心动图评估患者心血管钙化情况。根据患者是否存在腹主动脉、髂股动脉或心脏瓣膜钙化分为钙化与非钙化组,比较两组间各项临床指标差异,并利用多因素Logistic回归分析影响老年MHD患者心血管钙化的危险因素。结果:共纳入79例老年MHD患者,男性41例,女性38例,平均年龄(68.61±6.72)岁,透析龄平均(61.95±44.83)个月,糖尿病肾病占老年MHD患者原发病因首位(25.3%);②老年MHD患者心血管钙化发生率高达81.0%;钙化组(n=64)年龄、脉压差、矫正钙高于无钙化组(n=15)(P0.05), HGB、TC水平低于无钙化组(P0.05);③Logistic回归分析显示钙、HGB和TC是老年MHD患者心血管钙化危险因素(P0.05);④Logistic回归分析显示年龄、高磷是老年MHD患者心脏瓣膜钙化的独立危险因素(P0.05)。结论:老年MHD患者的心血管钙化发生率高达81.0%;高钙、高磷、低HGB和低TC是老年MHD患者心血管钙化危险因素,改善上述指标,可能会降低老年MHD患者心血管钙化发生率,减少心血管事件发生率及病死率。