不同血液净化方式对维持性血液透析患者微炎症状况及生存质量的影响

目的：研究不同血液净化方式对维持性血液透析患者微炎症状况及生存质量的影响。方法：选取东莞市人民医院血液净化室维持性血液透析患者75例,将患者随机分为三组：低通量血液透析（HD）组、血液透析滤过（HDF）组和血液透析联合血液灌流（HD＋HP）组,连续治疗6个月后,检测治疗前后C反应蛋白（CRP）、白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、肿瘤坏死因子（TNF-α）及白蛋白（Ab）与血红蛋白（Hb）的含量,治疗前后进行两次SF-36问卷调查评估生存质量。结果：HDF组与HD＋HP组治疗后CRP、IL-6、IL-8、TNF-α的清除及Ab与Hb上升均优于HD组（P〈0.05）,HDF组与HD＋HP组两组间比较差异无统计学意义。治疗6个月前后三组患者行生存质量评分,在总体健康、躯体疼痛、躯体角色功能、社会功能、精力、心理健康方面,HDF组与HD＋HP组治疗均优于HD组（P〈0.05）,HDF组与HD＋HP组两组间比较差异无统计学意义,而情绪角色功能在治疗前后三组之间差异无统计学意义（P〉0.05）。结论：维持血液透析患者存在微炎症状态,HD＋HP及HDF能更好清除炎症因子,改善维持性血液透析患者微炎症状态,改善患者生存质量。     

高通量血液透析对老年尿毒症钙磷代谢异常的影响研究

目的探究高通量血液透析治疗老年尿毒症伴钙磷代谢异常的临床疗效。方法择取2017年5月—2019年3月期间在本院进行治疗的老年尿毒症伴钙磷代谢异常患者共82例,根据抛硬币方式进行随机分组,其中对照组41例,观察组41例。对照组行常规血液透析治疗,观察组行高通量血液透析治疗,比较两组患者治疗前后钙磷代谢水平,统计两组患者治疗有效率。结果治疗前两组患者血鳞、血钙水平差异无统计学意义(P>0.05),治疗后观察组患者血钙水平高于对照组,血鳞水平低于对照组,差异有统计学意义(P<0.05);观察组与对照组患者临床治疗有效率分别为95.12%和78.05%,差异有统计学意义(P<0.05)。结论针对老年尿毒症伴钙磷代谢异常患者开展高通量血透治疗效果显著优于常规血透疗法,可有效纠正患者代谢异常症状,提升患者临床疗效。     

尿毒症患者血液透析充分性与肺功能相关性研究

目的观察尿毒症患者血液透析充分性与肺功能相关性,为临床慢性肾脏病患者肺功能治疗提供方法。方法选择本院维持性血液透析患者79例,以血压、尿素氮清除指数(Kt/v)、血清白蛋白、血红蛋白、血清钙磷甲状旁腺素水平评估血液透析充分性,多次分别测定用力肺活量(FVC)、第1秒用力呼气容积(FEV1)、50%及25%用力肺活量的呼气流量(MEF50、MEF25)、一氧化碳弥散量(DLco)、一氧化碳弥散常数(DLco/VA)、一氧化碳弥散吸收率(DLco%)等肺功能指标,与慢性肾脏病(chronic kidney disease,CKD)5期患者肺功能比较。结果不充分透析组患者肺功能较CKD5期改善,差异具有统计学意义(P<0.05);充分透析组患者肺功能则显著改善,差异具有统计学意义(P<0.01);充分透析组较非充分透析组患者肺功能好转,差异具有统计学意义(P<0.05)。结论充分透析是改善尿毒症患者肺功能有效治疗手段,可作为维持性血液透析患者透析充分性评估指标之一。     

中国四大城市慢性肾功能衰竭血透患者微量营养元素铁缺乏调查

目的 了解目前国内慢性肾功能衰竭(慢性肾衰)尿毒症患者微量营养元素铁缺乏和补铁治疗状况。方法 对北京、上海、广州和成都4大城市35所三甲医院65名肾内科主任、副主任和资深主治医师进行问卷调查。对所有计数资料采用频数分析方法，描述频数的分布和百分比；用均数、标准差描述定量变量数据。结果 尿毒症透析患者中53．3％患有明显缺铁性贫血，87．25％的患者接受了补铁治疗，其中97．18％为口服补铁，主要原因是国内没有静脉制剂，少有肌注剂型。但100％的医师认为口服铁剂不能满足临床需求。曾给患者使用过注射制剂的医师，大多对静脉剂型表示满意，而肌注剂型发生不良反应的比例较高。结论 缺铁是尿毒症透析患者贫血的重要原因之一，目前国内急需引进开发安全有效的静脉注射补铁制剂。     

Psychosocial Factors and Health-Related Quality of Life in Hemodialysis Patients

Several sociodemographic and clinical variables are known to influence the health-related quality of life (HRQOL) of patients with kidney disease, yet the relationship between psychological factors and the HRQOL measured by the Kidney Disease Quality of Life Short-Form (KDQOL-SF) is incompletely understood. The objective of this study was to examine the relationship between psychosocial status (depressive symptoms, trait anxiety, and social support) and KDQOL-SF scales in hemodialysis (HD) patients by controlling the effects of sociodemographic and clinical variables. The HRQOL of 194 patients from 43 dialysis centers in Spain was assessed by completing the KDQOL-SF, and evaluating depressive symptoms (Cognitive Depression Index), trait anxiety (Trait Anxiety Inventory) and degree of social support (Scale of Perceived Social Support). We also recorded several sociodemographic and clinical variables. Two regression models were estimated for each of the 19 scales in the KDQOL-SF. In the first model, we only included sociodemographic and clinical-factors, while the second model also took into consideration psychosocial variables. These last factors (trait anxiety and depressive symptoms, not social support) were found to increase the proportion of explained variability, with highest standardized regression coefficients observed for most KDQOL-SF scales. Depressive symptoms were related to a poor HRQOL when there was a strong physical component, while trait anxiety was mainly related to emotional upset and social relationships. We were able to conclude that trait anxiety and depressive symptoms are strongly associated with the HRQOL assessed by the KDQOL-SF in HD patients. The effects of these factors should therefore be considered when evaluating the quality of life of this type of patient.     

不同静脉补铁方法治疗血液透析患者肾性贫血的对照研究

目的：比较不同静脉补铁方法治疗血液透析患者肾性贫血的临床效果。方法：选取本院收治的90例慢性肾功能衰竭维持性血透的肾性贫血患者,按照随机数字表法均分为A、B、C三组,A组患者给予周期性补铁治疗,B组患者给予维持性补铁治疗,C组患者给予周期性补铁＋维持性补铁治疗,比较三组患者治疗前后血清Hb、ACT、SF、TSAT、CRP水平变化情况以及不良反应发生情况。结果：三组治疗12、24周后Hb、HCT、SF、TSAT水平均显著升高,与治疗前比较,差异均有统计学意义（P〈0.05）;A组治疗12、24周后Hb、HCT、SF、TSAT水平均显著高于B组,差异具有统计学意义（P〈0.05）;C组治疗12、24周后Hb、HCT、SF、TSAT水平均显著高于A组和B组,差异具有统计学意义（P〈0.05）;三组治疗12周与24周的Hb、HCT、SF、TSAT水平比较差异均无统计学意义（P〉0.05）;三组治疗前后血清CRP水平均无明显变化,差异无统计学意义（P〉0.05）。三组治疗期间未发生明显不良反应。结论：周期性补铁＋维持性补铁为治疗血液透析患者肾性贫血的最佳补铁方案,能够快速有效为患者提供储存铁和功能铁。     

Association of Malnutrition Inflammation Score With Anthropometric Parameters,Depression, and Quality of Life in Hemodialysis Patients

Objective: Hemodialysis patients may be at risk for malnutrition due to catabolic effects caused by dialysis, loss of amino acids, inadequate nutrient intake, acidosis, and inflammation. Malnutrition may have negative effects on quality of life, mortality, and disease prognosis. This study was conducted to determine the relationship between anthropometric parameters, depression, and quality of life with Malnutrition Inflammation Score (MIS) on 55 patients aged between 18 and 65 years (36 males and 19 females) who have dialysis treatment for 3?days per week for at least 3?months due to end-stage renal disease.

Methods: Patients were evaluated with MIS, Subjective Global Assessment (SGA), Beck Depression Inventory (BDI), and Satisfaction with Life Scale (SWLS). In addition, anthropometric (body weight, height, mid-upper arm circumference [MUAC]) and body composition measurements of patients were taken, body mass index (BMI) values were calculated, and biochemical parameters (albumin, C-reactive protein [CRP], and total iron binding capacity [TIBC]) were analyzed.

Results: At the end of the study, 14.5% of the patients according to SGA, were classified as malnourished. There was a statistically significant positive correlation of BDI, duration of dialysis, and CRP with MIS. However, MIS had a statistically significant negative correlation with SWLS, body weight, and MUAC (p?<?0.05).

Conclusion: MIS is an effective screening tool for assessing malnutrition and quality of life in hemodialysis patients. However, there is a need for studies to identify cutoff points of MIS.     

Hepcidin-25, Mean Corpuscular Volume,and Ferritin as Predictors of Response to Oral Iron Supplementation in Hemodialysis Patients

The benefit of oral iron therapy (OIT) and factors predictive of OIT response are not established in hemodialysis (HD) patients with iron deficiency anemia (IDA). We examined the values of hepcidin-25, mean corpuscular volume (MCV), and ferritin as predictors of OIT response. Oral ferrous fumarate (50 mg/day, 8 weeks) was given to 51 HD patients with IDA (hemoglobin (Hb) < 12 g/dL, ferritin < 100 ng/mL) treated with an erythropoietin activator. Sixteen patients were responders (improvement of Hb (ΔHb) ≥ 2 g/dL) and 35 were non-responders (ΔHb < 2g/dL). Baseline Hb, MCV, serum hepcidin-25, ferritin, iron parameters, and C-reactive protein (CRP) before and ΔHb after OIT were compared between groups. Hepcidin-25, MCV, ferritin, and transferrin saturation were lower in the responders than in the non-responders. Hepcidin-25 positively correlated with ferritin. Hepcidin-25, MCV, and ferritin positively correlated with baseline Hb and negatively correlated with ΔHb. Despite normal CRP levels in all patients, CRP correlated positively with hepcidin-25 and ferritin. Stepwise multiple linear regression analysis and receiver operating characteristics curve analysis revealed that hepcidin-25, MCV, and ferritin could predict OIT response. We conclude that hepcidin-25, MCV, and ferritin could be useful markers of iron storage status and may help predict OIT response in HD patients.     

血浆置换联合维持性血液透析治疗在重症尿毒症患者中的应用与护理

目的：探讨血浆置换（PE）联合维持性血液透析（MH）治疗和护理对重症尿毒症患者的影响。方法：选取2008年4月-2013年12月本院确诊治疗的重症尿毒症患者45例,依据随机数字表法分为维持性血液透析组（MH组）、维持性血液滤过组（MF组）和血浆置换联合维持性血液透析组（PEMH组）,每组15例患者。所有患者均给予常规护理、营养支持等综合治疗,MH组患者给予MH治疗,MF组患者给予MF治疗,PEMH组患者给予PEMH治疗及相应的护理,统计分析所有患者治疗前后血清中β2-微球蛋白（β2-MG）、总胆固醇（TC）水平和治疗后并发症发生情况以及生活质量。结果：治疗后,MH组血清中β2-MG、TC水平明均显高于MF组,MF组均明显高于PEMH组,差异均有统计学意义（P〈0.05）;治疗后,MH组总并发症发生率明显高于MF组,MF组均明显高于PEMH组,差异均有统计学意义（P〈0.05）;MH组躯体、认知、社会功能和健康状态评分明均显低于MF组,MF组均低于PEMH组,差异均有统计学意义（P〈0.05）。结论：PEMH治疗和护理可有效提高重症尿毒症患者酸碱、电解质的改善作用,有助于提高疗效,降低治疗后不良情况的发生,改善患者生活质量,值得临床作进一步推广。     

Preference-Based Quality of Life of Patients on Renal Replacement Therapy: A Systematic Review and Meta-Analysis

Objectives:  Various utility measures have been used to assess preference-based quality of life of patients with end-stage renal disease (ESRD). The purposes of this study were to summarize the literature on utilities of hemodialysis (HD), peritoneal dialysis (PD), and renal transplantation (RTx) patients, to compare utilities between these patient groups, and to obtain estimates for quality-of-life adjustment in economic analyses.
Methods:  We searched the English literature for studies that reported visual analog scale (VAS), time trade-off (TTO), standard gamble (SG), EuroQol-5D (EQ-5D), and health utilities index (HUI) values of ESRD patients. We extracted patient characteristics and utilities and calculated mean utilities and 95% confidence intervals (CIs) for categories defined by utility measure and treatment modality using random-effects models.
Results:  We identified 27 articles that met the inclusion criteria. VAS articles were too heterogeneous to summarize quantitatively and we found only one study reporting HUI values. Thus, we summarized utilities from TTO, SG, and EQ-5D studies. Mean TTO and EQ-5D-index values were lower for dialysis compared to RTx patients, though not statistically significant for TTO values (TTO values: HD 0.61, 95% CI 0.54–0.68; PD 0.73, 95% CI 0.61–0.85; RTx 0.78, 95% CI 0.63–0.93; EQ-5D-index values: HD 0.56, 95% CI 0.49–0.62; PD 0.58, 95% CI 0.50–0.67; RTx 0.81, 95% CI 0.72–0.90). Mean HD versus PD associated TTO, EQ-5D-index and EQ-VAS values were not statistically significantly different.
Conclusion:  RTx patients tended to have a higher utility than dialysis patients. Among HD and PD patients, there were no statistically significant differences in utility.     

Effect of Intradialytic Oral Nutritional Supplementation with or without Exercise Improves Muscle Mass Quality and Physical Function in Hemodialysis Patients: A Pilot Study

Background: Oral nutritional supplementation (ONS) with or without exercise (EX) could improve muscle mass (MM) in chronic kidney disease. Methods: Patients were randomized into two groups: (1) ONS and (2) ONS + EX. Thigh muscle area (cm²) and intramuscular lipid content via attenuation were evaluated at baseline and 6 months with computed tomography (CT) to measure MM quantity and quality. Physical function was measured by six-minute walk test (6 MWT), gait speed, handgrip strength (HGS), and Time Up and Go test (TUG) at baseline and 3 and 6 months. Results: The ONS group (n= 14) showed statistically significant improvement in gait speed and HGS; ONS + EX group (n = 10) showed differences in gait speed, in 6 MWT, and HGS. In the ANOVA (3 times × 2 groups), no differences were observed between groups. Greater effect sizes in favor to ONS + EX group were observed in the 6 MWT (d = 1.02) and TUG test (d = 0.63). Muscle quality at six months revealed a significant trend in favor of the EX-group (p = 0.054). Conclusions: Both groups had improved physical function, and greater effect sizes were seen in the ONS + EX group for the 6 MWT and TUG test. Neither MM quantity or quality was improved in either group.     

两种治疗方式的肝癌患者生命质量状况比较

目的 比较手术切除与经皮穿刺的微波凝固消融(Percutaneous Puncture of Microwave Coagulation Therapy,PMCT)治疗肿瘤直径≤5 cm的原发性小肝癌患者生命质量.方法 应用肝癌患者生命质量测定量表(2.0版)(Quality of Life With Liver Cancer,QOL-LC-V2.0)于治疗前确诊时、治疗后2周、1月、3月、6月、9月时分别测量评价手术切除、PMCT两组患者(直径≤5 cm)的生命质量状况.结果 两组患者生命质量评分均有所降低;手术切除组生命质量的降幅较PMCT组大,各时点的生命质量评分也较PMCT组低;两组间患者治疗前的躯体功能比较差异无统计学意义(P＞0.05),其余时点各功能纬度比较差异均有统计学意义(P≤0.05);时间与组别对患者生命质量具有交互作用.结论 手术切除、PMCT均对患者生命质量造成不良影响,而PMCT不良影响程度较手术切除小,患者恢复时间短,生命质量恢复也较快.     

Quality of Life Related to Oral versus Subcutaneous Iron Chelation: A Time Trade-off Study

ObjectiveTo investigate the utility associated with subcutaneous infusion (deferoxamine) compared with once-daily oral administration (deferasirox) of iron chelation therapy.MethodsInterviews using the time trade-off technique were used to estimate preferences (utility) for health states by finding the point at which respondents were indifferent between a longer but lower quality of life (QoL) and a shorter time in full health. Participants (n = 110) were community-based, 51% women, median age 35 years, from four regions in Sydney, Australia. Respondents rated three health states involving equal outcomes for people with thalassemia but with different treatment modalities for iron chelation; an “anchor state” describing a patient receiving iron chelation without administration mode specified, anchor state plus iron chelation via subcutaneous infusion, and anchor state plus iron chelation through once-daily oral medication.ResultsOn an interval scale between 0 (death) and 1 (full health), median (interquartile range) utility of 0.80 (0.65–0.95) for the anchor state, 0.66 (0.45–0.87) for subcutaneous infusion, and 0.93 (0.80–0.97) for once-daily oral administration was obtained. The mean (median) difference of 0.23 (0.27) between the two treatments was statistically significant (Wilcoxon-signed rank test, P < 0.001). Subcutaneous infusion was associated with a mean (median) utility 0.13 (0.14) lower than the anchor state (P < 0.001), and once-daily oral treatment had a utility 0.10 (0.13) higher (P < 0.001).ConclusionCommunity respondents associate oral administration of an iron chelator such as deferasirox with enhanced QoL compared with subcutaneous treatment. Assuming equal safety and efficacy, QoL gains from once-daily oral treatment compared with subcutaneous infusion are significant.     

精神康复治疗对精神分裂症患者生活质量的影响探讨

目的探讨并研究精神康复治疗对精神分裂症患者生活质量的影响。方法抽取本院2018年1月—12月接收的440例精神分裂症患者作为研究对象,440例患者均接受精神康复治疗,分析精神康复治疗对精神分裂症患者生活质量的影响。结果治疗后,患者精神康复作业治疗效果评分高于治疗前;精神康复松弛治疗效果评分高于治疗前;简单精神状态检查量表(mini-mental state examination,MMSE)评分高于治疗前;社会功能缺陷筛选量表(sloan digital sky survey,SDSS)评分均低于治疗前;治疗前后各项指标比较差异有统计学意义(P<0.05)。结论精神康复治疗能提高精神康复作业治疗效果和精神康复松弛治疗效果,改善患者的精神状态与社会功能,进而有效改善患者的生活质量。     

采用血液透析联合血液灌流治疗尿毒症的临床效果观察

目的 分析血液透析联合血液灌流治疗尿毒症的临床疗效.方法 选取2018年3月—2019年9月本科室治疗的72例尿毒症患者作为研究对象,随机分为对照组(n=36,血液透析治疗)和观察组(n=36,血液透析联合血液灌流治疗).结果 两组治疗前的Scr、β2-MG、iPTH水平差异无统计学意义(P＞0.05),治疗后均有所降...     

The Effect of Different Nutritional Education Models on Reducing Cardiovascular Disease Risk Factors by Improving Dietary Fat Quality in Hemodialysis Patients

Cardiovascular disease (CVD) is the most common complication in hemodialysis patients. Nutritional education provided by dietitians could improve overall dietary quality and dietary fat quality to reduce the risk of CVD. However, no studies have investigated the relationship between dietary fat quality (using the hypocholesterolemic/hypercholesterolemic ratio, or the h/H) and CVD risk factors in hemodialysis patients. The aim of this study was to examine the association between the h/H and CVD risk factors, and further explore how nutritional education intervention models could improve dietary fat quality and CVD risk factors in hemodialysis patients. A quasi-experimental design was conducted from May 2019 to April 2021 on four groups, including ‘no course for patients and nurses’ as the non-C group, a “course for nurses” as the CN group, a “course for patients” as the CP group, and a “course for patients and nurses” as the CPN group. Nutritional education booklets based on a healthy eating index for hemodialysis patients were developed and provided to patients and nurses. Data of 119 patients were collected at baseline, intervention, and follow-up periods, including patients’ basic information, blood biochemical data, dietary content, and calculated h/H. The results showed that the h/H was negatively correlated with body mass index (BMI) and positively correlated with high-density lipoprotein cholesterol (HDL-C). Compared with the non-C group, the CPN group was significantly higher in the h/H as well as HDL-C, and significantly lower in serum total cholesterol. In conclusion, the h/H was found to predict CVD risk factors, which helps in improving dyslipidemia. Nutritional education for both patients and nurses showed a beneficial impact on reducing CVD risks in hemodialysis patients.     

Prevalence of Iron Deficiency and Health-related Quality of Life among Female Students

Objective: To investigate prevalence of iron deficiency and examine the relationship between iron status and Health-related Quality of Life among female students.

Design: Cross-sectional study.

Subjects and Setting: Data were collected from 543 female students, aged 17 to 38 years, attending University or secondary schools in Clermont-Ferrand (France) and its metropolitan area. Three groups were defined, according to the rate of serum ferritin: iron deficient (serum ferritin <15μg/L), iron depletion borderline (serum ferritin 15–20 μg/L), and iron replete (serum ferritin > 20 μg/L). Those 3 groups of menstruating female students were compared in terms of health-related quality of life using univariate analysis.

Measures of Outcome: Health-related Quality of Life based on SF-36 questionnaire, and iron status measured by serum ferritin.

Results: The prevalence of iron deficiency was 19.3 %, the prevalence of borderline iron status was 11.4 %. Regarding the SF-36 questionnaire, the only significant difference between iron deficient and iron replete female students concerned the dimension reflecting ‘general health', which was significantly lower in iron deficient group (p = 0.015).

Conclusion: Iron deficiency seems to impair the perceived general health in female students. Further research should be conducted on this little known subject.     

优质护理对老年支气管哮喘患者生活质量影响分析研究

目的 探讨优质护理对老年支气管哮喘患者生活质量的影响.方法 摘选2018年9月—2019年9月期间,医院接收的老年支气管哮喘病例78例,依据随机化分组,获对照组(共39例)、试验组(共39例).对照组先予常规性护理,而试验组在常规性护理中应用优质护理,比较两组所得的结果.结果 对照组的满意度为82.05％,试验组患者满...     

Quality of Life of Post-stroke Patients

IntroductionStroke is a disease whose consequences have a considerable impact on the quality of the patient’s life. It is a widespread disease that has a disabling impact on life and, in addition to physical changes, brings about a number of psychological and cognitive processes.GoalThe goal of the study was to identify and describe the quality of life of post-stroke patients.MethodologyThe study design was quantitative. A questionnaire of the authors’ own design and the SF-36 questionnaire were used to obtain the data.ResultsSignificant differences in patient quality of life were identified in relation to patient gender. Moreover, the quality of life in all individual SF-36 dimensions, except for mental health, deteriorated with age. With regard to occupational placement, employed respondents gave the highest evaluation of quality of life according to SF-36 and old-age pensioners the lowest. The analysis shows that quality of life in individual dimensions is positively influenced by respondents’ higher education. The evaluation in individual dimensions improves with the time that has passed since the stroke.ConclusionThe quality of life of post-stroke patients deteriorates with age. The deteriorating level of patient quality of life in older age requires programmes that include assessments and interventions that lead to the treatment of these patients.     

前列腺癌患者的生命质量研究

根据欧洲肿瘤研治组织制定的前列腺癌生活质量量表，对１０２例前列腺癌患者进行了病例－对照研究。应用因子分析将量表分成日常生活起居、家庭社会生活、主观症状、不适和困倦、心理失衡和障碍、性生活等六个方面，结果表明病例和对照各指标之间的差异均有极显著性意义，该量表可以较好地评价前列腺癌患者的生活质量。