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.     

老年维持性血液透析患者衰弱发生情况及其影响因素

目的 调查老年维持性血液透析(MHD)患者衰弱发生情况并分析其影响因素。方法 采用横断面研究,选择2021年10月至2022年4月于安徽医科大学第二附属医院住院或门诊行MHD治疗的130例老年患者为研究对象。收集患者一般资料、实验室指标及人体学指标,采用Fried衰弱表型量表评估患者衰弱状况。比较2组患者一般资料、实验室指标、跌倒风险、日常生活活动能力、营养状况得分及人体测量指标的差异。采用SPSS 26.0统计软件进行数据分析。根据数据类型,分别采用t检验、Mann-Whitney U检验或χ²检验进行组间比较。采用偏相关分析评估衰弱评分与各指标的相关性,采用多因素logistic逐步回归分析老年MHD患者衰弱的影响因素。结果 老年MHD患者衰弱发生率为40.0%(52/130)。相关性分析显示衰弱与营养不良-炎症得分(MIS)、Morse跌倒风险评估(MFS)、C反应蛋白(CRP)呈正相关(r＝0.521,0.330,0.236;P＜0.05);与Barthel指数(BI)、中臂肌围(MAMC)、血清白蛋白(Alb)、血红蛋白(Hb)呈负相关(r＝-0.424,-0.438,-0.478,-0.332;P＜0.001)。多因素logistic逐步回归分析显示:MIS评分、Alb、BI、年龄是MHD患者发生衰弱的影响因素(MIS评分:OR=1.156,95%CI 1.002~1.333,P=0.047;Alb:OR=0.851,95%CI 0.687~0.931,P=0.013;BI:OR=0.972,95%CI 0.947~0.988,P=0.032;年龄:OR=1.107,95%CI 1.018~1.204,P=0.017)。结论 衰弱在老年MHD患者中发生率高,MFS、MIS、CRP水平与老年MHD患者衰弱得分呈正相关,而BI、Hb、Alb、MAMC与衰弱得分呈负相关。Alb水平和BI是衰弱发生的保护因素,而年龄和MIS评分是衰弱发生的危险因素。     

Increased hemoglobin concentration and related factors in maintenance hemodialysis patients in Anhui,China

To investigate the hemoglobin (Hb) concentration and related factors among maintenance hemodialysis (MHD) patients in Anhui province in 2020, so as to compare with the results in 2014. The cases of 3025 MHD patients were investigated in 27 hemodialysis centers of Anhui province from January 2020 to December 2020. The data of age, sex, primary disease, dialysis age, dialysis mode, drug use and laboratory tests were collected and analyzed. Compared with the survey in 2014, the average Hb level of MHD patients in Anhui province was increased (107.41 ± 20.40 g/L vs 100.2 ± 28.1 g/L), the anemia prevalence was decreased (65.9% vs 82.4%), and the percentage of patients with standard Hb level was increased significantly (47.1% vs 32.9%). Compared with low-Hb patients (Hb < 110 g/L), patients with Hb ≥ 110 g/L had lower age, higher proportion of males, longer dialysis age, higher levels of serum Alb, creatinine, total cholesterol, triglyceride, low density lipoprotein, calcium, phosphorus, magnesium, and lower high-density lipoprotein (P < .05). The multivariate logistic regression analysis results showed that male, longer duration of dialysis therapy, treatment with iron, higher triglyceride and albumin were protective factors of anemia, but older age was independent risk factors. The anemia treatment in MHD patients in Anhui province was significantly improved. Male, long dialysis age, use of iron, high serum albumin and triglyceride levels may be protective factors for Hb reaching standard level, and old age may be an independent risk factor.     

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。     

老年维持性血液透析患者第1年内的生存状况影响因素分析

目的分析老年维持性血液透析(MHD)患者在开始透析第1年的生存状况,并探讨其影响因素。方法选取2010年6月1日至2013年12月31日新入北京老年医院血液净化中心开始血液透析治疗的老年终末期肾病患者56例,所有患者随访观察1年,并收集其临床资料。根据是否死亡分为死亡组和存活组,先进行组间比较,再采用多因素logistic回归分析死亡危险因素。结果随访观察1年后,56例患者中死亡22例,我院继续透析30例,分别归入死亡组和存活组,第1年内死亡率达39.3%,前3个月死亡率达17.9%;两组患者在合并糖尿病、合并充血性心力衰竭、C-G公式的估算肾小球滤过率、血清白蛋白、C-反应蛋白、主观全面评估(SGA)法评分等比较,差异均有统计学意义(P0.05);多因素logistic回归分析显示,原发病为糖尿病肾病、进入透析时合并充血性心力衰竭、透始肾小球滤过率、透始血清白蛋白、透始C-反应蛋白、透始SGA评分为老年MHD患者进入透析第1年内死亡的危险因素,透始合并心力衰竭为最危险因素;死亡原因主要为心血管疾病(54.5%)和脑血管病(22.7%)。结论老年终末期肾病患者是新入MHD患者的主要人群,其开始透析后1年内特别是3个月内死亡风险最高,心血管疾病为死亡的首要原因。关注并积极控制患者的死亡危险因素可能有助于提高老年MHD患者的早期生存率。     

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...     

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 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.     

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.

     

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,...     

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。     

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.