急性肺栓塞患者生活质量及其影响因素调查

目的 探讨急性肺栓塞患者生活质量（QOL）及其影响因素.方法 60例急性肺栓塞患者完成贝克抑郁量表、状态-特质焦虑量表及SF-36生活质量调查问卷;SF-36 调查问卷包括躯体评分（PCS）及精神评分（MCS）两部分.60例年龄、性别匹配的社区慢病患者作为对照组.以生活质量PCS及MCS作为因变量,肺栓塞生活质量影响因素作为自变量,进行多元线性回归法分析,评估肺栓塞患者QOL相关影响因素.结果 与社区对照患者比较,急性肺栓塞患者生活质量显著下降（P＜0.05）,抑郁水平（P＜0.05）和焦虑水平（P＜0.01）均明显升高,且PCS及MCS评分均与动脉血氧分压（PaO2）呈正相关（P＜0.01）,与抑郁评分呈负相关（P＜0.05）;PCS评分还与下肢深静脉血栓形成（DVT）史呈负相关（P＜0.05）.结论 急性肺栓塞患者生活质量明显下降.PaO2、抑郁评分、DVT史是影响患者生活质量的重要因素.     

老年大肠癌患者术前生存质量相关因素

目的 分析老年大肠癌(CRC)患者术前生存质量(QOL)相关因素,为进一步提高患者QOL提供依据.方法 选取CRC患者96例,均进行一般情况和SF-36健康量表问卷调查.结果 80岁以上年龄组患者SF-36总评分明显低于60岁组;高等文化程度患者SF-36总评分明显高于低等文化程度;有配偶和收入高的患者SF-36总评分明显高于同组其他患者(均P＜0.05).女性患者社会功能评分明显高于男性;70和80岁组患者活力明显低于60岁组;80岁组精神健康明显低于60岁组;有配偶患者除生理功能外其余7个方面评分均高于无配偶患者;中、高等学历患者生理职能和社会功能评分均高于低等学历;高收入患者生理职能、总体健康和精神健康均高于低收入患者(均P ＜0.05).Logistcs回归分析显示年龄越小、有配偶和收入高患者QOL高,其中以收入对QOL影响最大,其次为婚姻、年龄.结论 性别、年龄、婚姻、文化程度和收入对于SF-36均有不同程度影响,干预措施应首先从收入、婚姻和年龄3个方面入手.     

系统性红斑狼疮患者151例的生存质量及其影响因素

目的 使用健康状况调查问卷简表-36(SF-36)量表评价系统性红斑狼疮(SLE)患者的生存质量(QOL)及其影响因素。方法 选择不同病情的SLE患者151例进行SF-36量表调查问卷，分析量表各维度得分与疾病活动性指数(SLEDAI)、损伤指数(SLICC/ACR DI)、治疗方案等因素相关性。结果 SLE患者SF-36量表各维度得分和健康变化自评(HT)低于中国常模，部分维度得分高于国外SLE患者；活动期、合并肾、脑内脏损伤的患者QOL得分低于非活动期、无肾脑损伤者。影响QOL最主要的因素是SLEDAI和DI记分并呈明显负相关；QOL还受激素使用剂量、年龄、病程、文化程度等因素的影响。结论 SF-36量表适于评价SLE患者的QOL，患者的QOL受病情活动度、严重性及治疗方案的影响。     

老年糖尿病患者抑郁状况与不同量表测定生活质量之间的关系

目的调查老年糖尿病人群抑郁的患病情况,探讨不同生活质量量表所测生活质量结果与抑郁评分之间的关系。方法采用流调用抑郁自评量表(CES-D),36条简明健康状况调查量表(SF-36),WHO生存质量测定量表简表(WHOQOL-BREF)和欧洲五纬度健康量表(EQ-5D)对218例年龄≥60岁的糖尿病患者进行抑郁状况及生活质量评定;比较分析抑郁评分与三种生活质量量表评分的相关性。结果①此组患者抑郁的检出率高达42.7%(93例)。②3种量表测得的各个维度生活质量评分在糖尿病合并抑郁患者中明显低于无合并者(P0.01)。③Spearman相关分析提示CES-D评分与WHOQOL-BREF生活质量总评分相关性最强(r=-0.842),其次为SF-36评分中的心理方面综合评分(MCS,r=-0.758)及EQ-5D健康效用值评分(r=-0.604),均有统计学意义(P0.01)。结论抑郁为老年糖尿病患者常见心理障碍,WHOQOL-BREF评分与抑郁的相关性高于其他量表,临床应用WHOQOL-BREF量表能够更客观地评价老年糖尿病患者的生活质量且利于国际间的交流。     

老年冠心病患者抑郁与健康相关生活质量的相关性

目的 探讨冠心病患者抑郁与健康相关生活质量(HRQOL)的关系.方法 冠心病患者213例,应用HAMD17抑郁量表进行抑郁评分,SF-36简易生活量表进行HRQOL评分并分别收集患者的临床资料.结果 213例冠心病患者抑郁的发生率为27.7％,轻度抑郁为25.8％,中度抑郁为1.4％,重度抑郁为0.5％.未受过高等教育患者比例为83.1％,受过高等教育患者比例16.9％.抑郁患者SF-36的8个维度以及生理健康(PCS)、心理健康(MCS)评分明显低于无抑郁患者(P＜0.01).PCS得分组抑郁组明显低于非抑郁组(P＜0.01),MCS得分抑郁组明显低于非抑郁组(P＜0.01).是否受过高等教育分层分析显示:未受过高等教育较受过高等教育显示了更差的HRQOL.结论 冠心病患者抑郁对HRQOL的影响比非抑郁患者严重,特别是未受过高等教育患者.     

SF-36和EQ-5D-5L量表在晚期血吸虫病患者生命质量评价中的比较研究

目的比较健康状况调查表(SF-36)和五水平欧洲五维度健康量表(EQ-5D-5L)用于晚期血吸虫病患者生命质量评价的效果。方法选择2020年就诊于嘉兴市某两家医院的晚期血吸虫病患者为调查对象,收集患者一般情况相关信息,包括姓名、性别、年龄、晚期血吸虫病临床分型等。分别采用SF-36和EQ-5D-5L量表进行问卷调查,比较两种量表评价晚期血吸虫病患者生命质量的信度、效度以及对于不同健康程度晚期血吸虫病患者的区分程度,并对两种量表评价得分进行相关性分析,对影响晚期血吸虫病患者生命质量的影响因素进行分析。(36.80%),女性79例(63.20%);巨脾型54例(43.20%),腹水型71例(56.80%)。SF-36量表内部一致性信度Cronbach’sα系数为0.780,主成分分析法提取2个因子,累计贡献率为70.427%; EQ-5D-5L量表内部一致性信度Cronbach’sα系数为0.850,主成分分析法提取2个因子,累计贡献率为85.884%。SF-36量表各领域中,精神健康平均得分最高(66.82±7.90),生理职能和情感职能得分最低(均为0分);生理健康总测量(PCS)平均得分(33.85±8.92),心理健康总测量(MCS)平均得分(39.76±4.93); MCS得分较高的患者数为119例,多于PCS的81例。EQ-5D-5L量表中效用指数(UI)得分平均值为(0.801±0.214);"疼痛或不舒服"维度存在"中度困难、严重困难及极度困难"患者所占比例最高(占24.80%),"焦虑或抑郁"维度最低(占5.60%)。视觉模拟标尺(EQ-VAS)评分平均值为(66.64±7.85)。年龄对患者PCS、 MCS、 EQ-VAS评分影响均较大(P 0.01),不同性别、临床分型得分之间差异无统计学意义(P 0.05)。PCS、 MCS得分较高者UI得分、 EQ-VAS评分均高于PCS、 MCS得分较低者(P 0.01);在EQ-5D-5L中随着各维度严重程度的增加,患者PCS、 MCS得分降低(P 0.01)。PCS与UI得分、 EQ-VAS评分具有相关性(r=0.716、 0.689, P 0.01), MCS与UI得分、 EQ-VAS评分具有相关性(r=0.622、 0.544, P 0.01)。结论 SF-36和EQ-5D-5L量表均可用于评价晚期血吸虫病患者的生命质量,其评估效果具有可比性和互补性,但EQ-5D-5L量表因信度、效度更高且结构简单等优势,更适宜用于晚期血吸虫病患者生命质量的评估。     

老年冠心病患者抑郁患病率调查及抑郁对患者生活质量的影响

目的探讨老年冠心病(OHD)患者抑郁患病情况及其对患者生活质量的影响。方法 2013年6月至2014年8月该院心血管内科收治的老年CHD患者80例为研究组,同期于该院体检的健康老年人80例为对照组,采用汉密尔顿抑郁量表(HAMD17)评估患者抑郁情况,对比两组抑郁患病率;采用健康调查简表(SF-36)评价CHD患者生活质量,分析老年CHD伴抑郁对生活质量的影响。结果研究组抑郁患病率明显高于对照组(P0.05)。研究组中不同病种患者抑郁患病率无明显差异(P0.05),不同性别、文化程度抑郁患病率差异有统计学意义(P0.05)。SF-36调查结果显示伴抑郁患者生理健康、心理健康各维度评分明显低于不伴抑郁患者(P0.05)。结论老年CHD患者存在明显抑郁患病情况,受教育程度较低的女性患者可能抑郁情况更为显著,且抑郁会不同程度地加重CHD患者的生活质量损害,临床需引起重视,并给予重点关注。     

血液透析患者生活质量及相关因素

目的探讨血液透析患者生活质量(QOL)及其影响因素。方法采用SF-36量表评价血液透析患者210例和同期健康体检者200例的QOL,统计其年龄、性别、婚姻障碍、工作状况、文化程度、医疗费用来源、医疗负担、就诊方式、内瘘手术次数等。结果与对照组比较,血液透析组SF-36各项评分差异不显著(P>0.05);患者年龄、工作状况、医疗负担、内瘘手术次数在一定程度上影响血液透析患者QOL(P<0.05),而不同性别、婚姻障碍、文化程度、医疗费用来源、就诊方式、对血液透析患者SP-36的影响不显著(P>0.05)。相关因素分析结果显示,年龄、工作状况、医疗负担、内瘘手术次数与患者SF-36值均呈负相关。结论年龄、工作状况、医疗负担、内瘘手术次数对血液透析患者QOL的影响较大。     

北京市社区老年高血压合并抑郁患者生活质量及相关因素分析

目的:评估北京市社区老年高血压合并抑郁患者的生活质量,并且探索其相关因素,为社区管理老年高血压合并抑郁患者提供理论依据。方法:纳入于北京市朝阳区大屯社区服务中心就诊的65岁以上高血压患者503例,采用面对面方式调查基线资料和老年抑郁量表(GDS),自我完成生活质量问卷(SF-36问卷)。以GDS评分将患者分为抑郁组和无抑郁组,对比分析两组生活质量,并且探索影响抑郁组生活质量的相关因素。结果:488例患者完成所有问卷,无抑郁384例(78.7%),合并抑郁104例(21.3%)。抑郁组在躯体健康维度(PCS)和心理健康维度(MCS)明显低于无抑郁组(P<0.05)。多因素分析显示年龄越大、有睡眠问题和血压分级高的患者躯体健康更差。抑郁程度更重的患者心理健康更差。结论:合并抑郁的老年高血压患者生活质量明显低于无抑郁患者。与PCS相关的因素有年龄、睡眠和高血压分级,与MCS相关的因素主要是抑郁评分,为社区尽早针对性的干预和管理,提高这类人群生活质量具有指导性建议。     

认知功能障碍对肝癌患者生命质量的影响及护理对策

目的探讨认知功能障碍对肝癌患者生命质量的影响及护理对策。方法对127例原发性肝癌患者进行简易精神状态量表和SF-36健康调查量表测定,分为肝癌合并认知功能障碍组(观察组,n=36)和肝癌无合并认知功能障碍组(对照组,n=91),比较两组一般情况和SF-36健康调查量表评分的变化。结果观察组与对照组性别、年龄和体质指数等一般情况比较差异均无统计学意义(P0.05),而观察组的生理功能、生理机能、躯体疼痛、社会功能、心理健康、情感职能、活力和总体健康等8个维度评分均明显低于对照组(P0.05)。结论肝癌合并认知功能障碍患者的生命质量下降,临床工作中应采取积极的护理干预措施,减少认知功能障碍的发生,提高患者的生命质量。     

A comparison of the quality of life of patients with systemic lupus erythematosus with and without endstage renal disease

OBJECTIVE: To compare health related quality of life between patients with lupus nephritis who progressed to endstage renal disease (ESRD) and patients with systemic lupus erythematosus (SLE) with preserved renal function. METHODS: Patients with SLE undergoing maintenance renal dialysis and SLE patients with preserved renal function completed the Medical Outcomes Study Short Form-36 and social support questionnaires and the Center for Epidemiologic Studies Depression Scale. SLE disease activity and organ damage were measured by the SLE Disease Activity Index and Systemic Lupus International Collaborating Clinics/American College of Rheumatology damage index. RESULTS: We studied 104 patients with SLE: 22 undergoing maintenance renal dialysis and 82 with preserved renal function. Their scores in all 8 of the SF-36 scales were reduced compared to national norms. Patients with ESRD had significantly higher mental health scores (mean +/- standard error 71.3 +/-4.8 vs. 60.7+/-2.5; p = 0.05), but there were no significant differences between the 2 groups in the remaining SF-36 scales. Multivariate models adjusting for demographic, socioeconomic, and clinical characteristics and for symptoms of depression revealed that being on dialysis was associated with higher mental health scores (regression coefficient = 12.97, 95% confidence interval 2.72 to 23.22), but lower physical function [-11.28 (-22.43 to -0.12)] and general health [-10.94 (-21.31 to -0.57)]. CONCLUSION: Patients with lupus nephritis who progress to endstage renal disease have improved mental well being but reduced physical function and general health. Strategies to improve the quality of life of patients with SLE are needed.     

A pilot self-care hemodialysis program in a satellite dialysis center

ObjectiveTo study the feasibility and cost-effectiveness of the self-care hemodialysis program in a satellite dialysis center.Patients and methodsThe Ha Kwai Chung (HKC) Renal Dialysis Centre, a satellite dialysis unit of Princess Margaret Hospital, has been in operation since October 1996 providing chronic hemodialysis support to 24 end-stage renal disease (ESRD) patients. ESRD patients with a mean age of 47.3 were stabilized in Princess Margaret Hospital before transferring to the HKC Renal Dialysis Centre. All patients were trained for self-care hemodialysis procedures. Each patient initially received close supervision from the renal nurse. The acceptability and advantages of the self-care model were studied by a questionnaire survey. The socioprofessional rehabilitation status was analyzed. The cost of each hemodialysis session was compared with two other satellite dialysis centers practicing the hospital full supported-care model.Results67% (16/24) of patients could perform at least 80% of the self-care procedures. There was no complication during the dialysis procedures. Ability to learn self-care hemodialysis did not appear to correlate with intelligence but was closely related to motivation and learning environment. Second, survey showed that 90% (18/20) of patients were satisfied with the self-care program. This program helped them to gain more knowledge on dialysis and dialysis-related complications. Moreover, they had attained locus of control over dialysis treatment. Their self-confidence and self- esteem were strengthened. Third, socioprofessional rehabilitation showed that 66.6% of patients retained the full-time job or housekeeping, 16.6% was unemployed and 12.5% was disabled. Fourth, cost analysis showed that the cost of each hemodialysis treatment in HKC Renal Dialysis Center was 28.4% lower than that in two other satellite dialysis centers in Hong Kong.ConclusionsAll treatment modalities of ESRD are complementary to each other. Self-care hemodialysis is feasible and cost-effective. It promotes rehabilitation, increases self-esteem and the locus of disease control of ESRD patients. It provides an ideal support for the young continuous ambulatory peritoneal dialysis (CAPD) patients who have failed in peritoneal dialysis and who have already got used to self-care home dialysis treatment.     

Circadian profile of the prolactin concentration in the patients with end-stage renal failure

Determination of circadian of prolactine (PRL) profile and its relationship to selected clinical and laboratory indices in end-stage renal disease (ESRD) patients undergoing hemodialysis, peritoneal dialysis as well as those in predialysis period was the aim of the study. Investigations were carried out in 38 patients with ESRD aged 36 to 79 yr. (medium 59 +/- 11 yr.), (20 male, 18 female, 7 treated with peritoneal dialysis, 25 undergoing hemodialysis, 6 in predialysis period) and the control group consisting of 7 healthy volunteers (4 male and 3 female). Serum concentration of PRL was evaluated at 3:00, 7:00, 12:00, 18:00, 22:00. The influence of different dialysis methods, blood concentration of parathormone, hemoglobin, total protein, erytropoietin (EPO), C-reactive protein, EPO therapy and duration of dialysis therapy on the PRL profile was analyzed. Results were analyzed according to medium obtained values of daily PRL profiles and individual indexes of variation of the daily concentration. Impaired circadian PRL profile was found in the all of followed groups comparing to the control, which was based on flatting of the curve and decreasing of the nightly pick of secretion PRL. None of analyzed factors had normalized the PRL profile curve. Conclusions: The PRL profile in ESRD patients treated with hemodialysis, peritoneal dialysis and in predialysis period is changed. The PRL profile curve is flatted and there was no night pick of PRL secretion in the patients. PRL level was shown to increase with progress of the disease, and the highest levels were in hemodialysed patients. EPO treatment, general appearance improvement, increased hemoglobin level and any of studied different dialysis method did not normalize the altered PRL profile.     

Levocetirizine improves health-related quality of life and health status in persistent allergic rhinitis

BACKGROUND: Allergic rhinitis is a chronic respiratory disorder with a detrimental impact on health-related quality of life (HRQOL) and health status. Enhancement and maintenance of patient function and well-being are therefore considered as essential. OBJECTIVE: To determine whether long-term treatment with levocetirizine 5mg improves HRQOL and health status in persistent allergic rhinitis (PER) patients assessed with RQLQ and SF-36 scales over a 6-month period. METHODS: The Xyzal in PER Trial (XPERT) was a multi-center, double-blind, parallel-group study. A total of 551 patients were randomized to receive levocetirizine 5mg or placebo once daily for 6 months and assessed for symptoms, HRQOL (Rhinoconjunctivitis Quality of Life Questionnaire: RQLQ) and health status (SF-36). Sensitivity of the RQLQ and SF-36 to disease severity was tested to ensure their suitability for use in PER patients. Treatment effect was assessed by means of repeated measures analyses. RESULTS: Over the 6-month treatment period, levocetirizine showed statistically significant improvements over placebo in HRQOL (P < 0.001 for all RQLQ domains and overall scores) and health status (P < or = 0.004 for SF-36 physical and mental summary scores; P < 0.05 for all SF-36 scales). The relative improvement of levocetirizine over placebo exceeded the predefined clinically meaningful threshold of 30% for all RQLQ scores and the improvement from baseline was 3 times the established MID for RQLQ. CONCLUSION: The RQLQ and SF-36 could be used to measure HRQOL and health status in PER patients. Long-term treatment with levocetirizine provides sustained improvement of HRQOL and reduces disease burden in PER patients.     

The impact of irritable bowel syndrome on health-related quality of life

BACKGROUND & AIMS: Few data are available to evaluate health-related quality of life (HRQOL) of people with irritable bowel syndrome (IBS). We evaluated and compared the impact of IBS on HRQOL using previously reported HRQOL data for the U.S. general population and for people with selected chronic diseases. METHODS: Using the SF-36 Health Survey, we compared the HRQOL of IBS patients (n = 877) with previously reported SF-36 data for the general U.S. population and for patients with gastroesophageal reflux disease (GERD), diabetes mellitus, depression, and dialysis-dependent end-stage renal disease (ESRD). RESULTS: On all 8 SF-36 scales, IBS patients had significantly worse HRQOL than the U.S. general population (P < 0. 001). Compared with GERD patients, IBS patients scored significantly lower on all SF-36 scales (P < 0.001) except physical functioning. Similarly, IBS patients had significantly worse HRQOL on selected SF-36 scales than patients with diabetes mellitus and ESRD. IBS patients had significantly better mental health SF-36 scale scores than patients with depression (P < 0.001). CONCLUSIONS: IBS patients experience significant impairment in HRQOL. Decrements in HRQOL are most pronounced in energy/fatigue, role limitations caused by physical health problems, bodily pain, and general health perceptions. These data offer further insight into the impact of IBS on patient functional status and well-being.     

Diabetes: changing the fate of diabetics in the dialysis unit

The prevalence of diabetes mellitus (DM) is very high worldwide. According to the World Health Organization in 2000 the worldwide prevalence of DM was 171,000,000. Diabetic nephropathy is a major vascular complication of DM. If DM is not treated early and adequately, many diabetic patients may reach end-stage renal disease (ESRD) secondary to advanced irreversible diabetic nephropathy. In many countries diabetic nephropathy has become the single most frequent cause of prevalent ESRD patients undergoing maintenance hemodialysis (MHD). In the early era of renal replacement therapy (RRT) by means of intermittent hemodialysis the prognosis of diabetic patients undergoing MHD was extremely poor and disappointing. While the prognosis of patients suffering from diabetic ESRD and maintained by chronic intermittent dialysis has greatly improved, the rehabilitation rate and survival of these patients continue to be worse than those of non-diabetic patients. A preexisting severely compromised cardiovascular condition, vascular access problems, diabetic foot disease, interdialytic weight gain, and intradialytic hypotension explain most of the less favorable outcome. Despite improved techniques and more aggressive medical therapy in recent years, a review of the fate of diabetics in dialysis units since 1972 reveals that these patients have had significant morbidity and mortality. We still have a long way to go in order to achieve more ideal outcomes for our patients. Most of the diabetic ESRD patients are still maintained by MHD, but they can choose other modalities of RRT such as chronic ambulatory peritoneal dialysis (CAPD), kidney and kidney plus pancreas transplantation. The results of different studies and national registries on the mortality and morbidity of ESRD patients being maintained on different modalities of dialysis are conflicting. It can be concluded that the two modalities of dialysis (CAPD and MHD) are almost comparable in terms of survival. The recent suggestions for nocturnal daily hemodialysis, short daily hemodialysis, and an integrative care approach for the management of diabetics with ESRD provides better promise for these patients.     

The short form-36 is preferable to the SIP as a generic health status measure in patients undergoing elective total hip arthroplasty

Objective. To assess the comparative usefulness of the Short Form-36 (SF-36) and the Sickness Impact Profile (SIP) as generic health status measures in total hip arthroplasty. Methods. Analysis of preoperative and 3-month data of 54 consecutive patients undergoing total hip replacement for osteoarthritis or rheumatoid arthritis. Instruments were mailed to patients preoperatively and 3 months postoperatively. Results. In 10 of the 12 SIP subscales, but just 1 of the 8 SF-36 subscales, more than 40% of the patients had scores of zero. On α 100-point scale, the median global SIP was 12 (range 0–40) whereas the median global SF-36 was 50 (range 10–85). This indicates that many items of the SIP were not germane to patients undergoing joint arthroplasty. The global and, particularly, the physical dimensions of the SF-36 were more responsive than their SIP counterparts, as measured both by the standardized response mean (1.26 and 0.88, respectively) and the correlation with self-perceived improvement in quality of life (r = 0.37 and 0.26, respectively). The SF-36, but not the SIP, discriminated between patients with relatively good physical performance at 3 months with respect to their ability to work, to play sports, or to garden. Conclusion. The SF-36 is briefer, more relevant, and more responsive than the SIP and is preferable as a generic health status measure in patients undergoing elective hip arthroplasty. The SF-36 should be tested in other populations as well as other conditions to determine whether it is a superior generic health status instrument for evaluative research in orthopedic surgery.     

血液透析对新诊断终末期肾衰竭患者营养状况及体内水分布影响

目的探讨血液透析(HD)对新诊断终末期肾脏疾病(ESRD)患者营养状况及体内水分布的影响。方法选择2006年10月至2007年10月上海交通大学医学院附属新华医院血液净化中心进行HD的ESRD患者30例。HD前及后3、6个月使用生物电阻抗分析方法(BIA)评估体内水分布状况,应用BIA、人体测量、血液生化指标评估营养状况。结果新诊断ESRD患者总体液量、细胞外液、细胞内液、标化总体液量、标化细胞外液、标化细胞内液在HD后3、6个月较HD前明显下降(P<0.05),HD后3、6个月比较差异无统计学意义;机体蛋白质、无机盐、体脂肪、瘦体重、骨骼肌在HD后3个月较HD前明显增加(P<0.05),HD后6个月较3个月进一步增加(P<0.05),去脂体重、肱三头肌皮褶厚度在HD后3、6个月较HD前明显增加(P<0.05),HD后3、6个月比较差异无统计学意义,体重指数在HD后6个月较HD前明显增加(P<0.05),HD后3个月和HD前比较差异无统计学意义;血白蛋白、转铁蛋白在HD后3、6个月较HD前明显增加(P<0.05),HD后3、6个月比较差异无统计学意义,前白蛋白在HD后6个月较HD前和HD后3个月明显增加(P<0.05),血红蛋白在HD后3个月较HD前明显增加(P<0.05),HD后6个月较3个月进一步增加(P<0.05),超敏C-反应蛋白在HD后6个月较HD前明显增加(P<0.05)。结论及时HD可纠正新诊断ESRD患者体内水负荷过多,改善营养状况,提示有严重营养不良,体内水负荷过多的ESRD患者应尽早行HD。     

Possible maximal change in the SF-36 of outpatients with chronic obstructive pulmonary disease and asthma.

The purpose of the present study was to investigate the responsiveness of the Short Form-36 (SF-36) in patients with chronic obstructive pulmonary disease (COPD) and asthma. We studied patients with COPD and asthma who attended our outpatient clinic. In the first cross-sectional study, we compared the differences in the SF-36 scores between pretreatment patients (152 with COPD and 174 with asthma) who visited the clinic for the first time and in-treatment patients (123 with COPD and 151 with asthma) who had received treatment for > 6 months. The differences in each scale of the SF-36 ranged from 6.9 to 14.4 in COPD patients and from 7.0 to 28.3 in asthma patients. In the second longitudinal study, patients who visited for the first time were enrolled, and the initial, and, 3-, 6-, and 12-month evaluations of the SF-36 were studied. A total of 136 COPD patients and 136 asthma patients were enrolled consecutively, and 100 patients with COPD and 66 patients with asthma completed the year-long examinations. In COPD patients, except for bodily pain, the scores in all scales of the SF-36 improved significantly during the first 3 or 6 months. In patients with asthma, all scale scores of the SF-36 improved significantly during the first 3 months. Maximal changes in the SF-36 scores were observed at 6 or 12 months. Longitudinal maximal changes in each scale approached or exceeded the possible maximal changes, which were derived from the differences in the scores between pretreatment patients and in-treatment patients in the first cross-sectional study. Improvements in the SF-36 scores showed moderate to strong negative correlations with their baseline scores in patients with COPD and asthma. In conclusion, the SF-36 shows sufficient responsiveness in the assessment of the health status of patients with COPD and asthma, but these responses are strongly influenced by their baseline values.     

Factors associated with health related quality of life in patients undergoing renal replacement therapy

The aim of this study was to investigate the sociodemographic and clinical variables which influence health-relate quality of life (HRQOL) of patients on renal replacement therapy (RRT). A cross-sectional study was carried out with a sample including all patients on hemodialysis (n = 170) and transplant patients (n = 210) of our region. The HRQOL assessment instruments used in this study were: the Spanish versions of the sickness impact profile (SIP) and the SF-36 health survey (SF-36). Sociodemographic and clinical data (including age at start of RRT, age at the interview, gender, hospital, socioeconomic level, educational level, living conditions, inclusion in transplant waiting list, renal disease diagnosis, time in any RRT, hemoglobin, hematocrit, serum urea, creatinine, proteins and albumin, hospital admissions and length of hospital stay during last year), a comorbidity index and the Karnofsky performance scale score step. To investigate which studied variables had independent influence over the HRQOL measures, logistic regression method was employed in the case of the SF-36, and multiple regression, in the case of the SIP. A model was adjusted step by step in each RRT method (hemodialysis and transplantation) for each dimension of the PCE (physical dimension, psychosocial dimension and total score), and for each component summary score of the SF-36 (physical and mental component summary). In patients on hemodialysis, variables associated with better HRQOL were: higher age, female gender, higher educational level, and better functional status; and variables associated with worse HRQOL were: higher number of hospital admissions, and higher comorbidity index. In transplant patients, variables associated with better HRQOL were: higher age and higher functional status; and variables associated with worse HRQOL were: longer time on dialysis before transplant, longer time with functioning transplant, and higher comorbidity index. Despite the independent influence on the HRQOL demonstrated for some of the studied variables, it seems that HRQOL assessment instruments scores may mainly depend on other non-studied variables, and it may be that these instruments evaluate other aspects of the patients which have not been taken into account until now.