不安腿综合征的发生及对尿毒症隐性结核血液透析患者生活、睡眠质量的影响

目的探讨不安腿综合征(RLS)发病因素及对尿毒症隐性结核血液透析患者生活、睡眠质量的影响。方法采用匹兹堡睡眠质量指数(PSQI)以及简明健康状况调查量表(SF-36)对患者睡眠质量以及生活质量进行调查,分析RLS发病情况及其可能的影响因素,并比较RLS与非RLS患者生活质量、睡眠质量。结果经单因素、多因素Logistic回归分析显示,β2-微球蛋白、透析龄及甲状旁腺激素为影响尿毒症隐性结核血液透析患者RLS发生的独立危险因素;RLS组患者SF-36生理功能评分显著低于非RLS组(P0.05);RLS组患者主观睡眠质量、睡眠持续性、习惯睡眠效率以及日间功能障碍PSQI评分显著高于非RLS患者(P0.05)。结论尿毒症隐性结核维持性血液透析患者RLS患病率较高。     

维持性血液透析患者睡眠质量影响因素分析

目的：分析影响维持性血液透析（ MHD）患者睡眠质量的相关因素。方法选择MHD患者109例,根据匹兹堡睡眠质量指数问卷（ PSQI）评分将患者分为睡眠质量较差组（ PSQI评分＞5分）57例、睡眠质量较好组（ PSQI评分≤5分）52例。收集并比较两组的一般资料（包括性别、年龄、透析龄、透析时间等）、实验室检查资料（包括血尿素氮、肌酐、白蛋白、血红蛋白、钙磷、β2微球蛋白、全段甲状旁腺激素等）。采用Logistic回归分析上述指标与患者睡眠质量的关系。结果相关分析显示,年龄、透析时间是影响MHD患者睡眠质量的危险因素（ OR分别为1．047、1．261,95％CI分别为1．014～1．081、1．016～1．564,P均＜0．05）。结论年龄、透析时间与MHD患者的睡眠质量有相关性。     

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.     

血液灌流联合血液透析治疗尿毒症患者的疗效及缓解皮肤瘙痒效果分析

目的探讨血液灌流联合血液透析治疗尿毒症患者的疗效及缓解皮肤瘙痒的效果。方法选择2015年1~12月在我院接受血液透析治疗的尿毒症合并严重皮肤瘙痒患者68例作为研究对象,随机分为A组(35例)和B组(33例),A组患者采用血液透析联合血液灌流治疗,B组患者只给予血液透析治疗,比较两组患者的临床疗效及皮肤瘙痒情况,检测比较两组患者治疗前后血肌酐(SCr)、尿素氮(BUN),甲状旁腺激素(PTH)、β2-微球蛋白(β2-MG)水平。结果 A组治疗总有效率(94.29%)明显高于B组(75.76%),差异有统计学意义(P0.05)。治疗后A组患者皮肤瘙痒程度评分、瘙痒分布范围评分、皮肤瘙痒对夜间睡眠干扰评分改善程度均明显优于B组(P0.05);A组患者PTH、β2-MG水平改善程度明显优于B组(P0.05)。结论血液灌流联合血液透析能有效清除尿毒症患者血液中分子毒素,提高疗效,缓解皮肤瘙痒症状,改善生活质量。     

血液灌流联合血液透析滤过对甲状旁腺素清除效果的观察

<正>血液透析滤过是采用弥散与对流的方式清除血液中小分子毒素。血液灌流通过吸附作用来清除尿毒症患者的中分子毒素。本研究在规律血液透析基础上分别采用血液透析滤过、血液灌流联合血液透析滤过2种治疗方式,观察尿毒症患者血清甲状旁腺素的清除情况及皮肤瘙痒、骨痛、食欲减退、睡眠障碍、不安腿综合征的改善情况。     

睡眠质量对老年维持性血液透析患者认知功能的影响

目的探讨睡眠质量对维持性血液透析(MHD)患者认知功能的影响。方法 106例老年MHD患者采用横断面调查研究,应用自编设计的一般情况调查表、匹兹堡睡眠质量指数量表(PSQI)、蒙特利尔认知量表(MoCA)进行问卷调查。根据MoCA评分将患者分为认知功能正常组(39例)和认知功能损害组(67例),采用单因素分析及分层回归分析探讨睡眠质量对认知功能的影响。结果 78例(73.58%)存在睡眠障碍,67例(63.21%)存在认知功能损害。单因素分析显示年龄(χ~2=10.24,P0.001)、文化程度(χ~2=4.057,P=0.044),高血压(χ~2=4.699,P=0.03)及睡眠质量(χ~2=5.965,P=0.015)对认知功能有影响。分层回归分析发现认知功能损害与年龄(β=0.46,P=0.01)、高血压(β=0.18,P=0.041)、睡眠质量(β=0.38,P=0.02)有相关性。睡眠质量可解释认知功能损害总变异的18.8%。结论 MHD患者睡眠质量及认知功能损害发生率均高,两者之间关系密切,睡眠质量越差,认知功能损害越严重;睡眠质量可预测认知功能损害的严重程度。     

血液透析滤过联合血液灌流对治疗顽固性尿毒症患者皮肤瘙痒的临床探讨

目的探讨血液透析滤过联合血液灌流对治疗顽固性尿毒症患者皮肤瘙痒的临床效果。方法将维持性血液透析皮肤瘙痒患者60例随机分成治疗组与对照组各30例,治疗组采用血液透析滤过+血液灌流,每周2次普通血液透析,1次血液灌流+血液透析滤过,各2 h,共4 h;对照组为普通血液透析组,每周3次,4 h/次;共观察10周。比较两组治疗前后血清甲状旁腺激素(PTH)、β2微球蛋白(β2-MG)浓度及皮肤瘙痒程度。结果治疗组治疗结束后血清中PTH、β2-MG浓度较治疗前明显降低,皮肤瘙痒明显缓解(P0.05)。对照组无明显差异(P0.05)。结论血液透析滤过联合血液灌流可以明显缓解维持性血液透析患者皮肤瘙痒症,值得临床推广。     

血液透析滤过联合血液灌流治疗对维持性血透失眠患者睡眠质量及生活质量的影响

目的探讨血液透析滤过联合血液灌流治疗对维持性血液透析（HD）失眠患者睡眠质量及生活质量的影响。方法将103例维持性血透失眠患者随机分为观察组53例及对照组50例。对照组采用单纯血液透析（HD）治疗;观察组采用血液透析（HD）＋血液透析滤过（HDF）＋血液灌流（HP）治疗。治疗12周后,采用匹斯堡睡眠质量指数量表（PSQI）、SF-36量表调查,比较两组患者睡眠质量及生活质量;对两组患者治疗前后血Ca^2＋、P^3＋、PTH、β2-MG、ALB、Hb及CRP进行比较。结果观察组患者PSQI因子中除催眠药物得分外,其PSQI总分及其他因子评分明显降低,睡眠质量比对照组明显提高（P〈0．05或〈0．01）;SF-36量表中的生理功能、生理职能、总体健康、活动、社会功能评分观察组明显高于对照组（P〈0．05或〈0．01）,治疗后观察组患者低血钙、高血磷、高甲状旁腺激素的紊乱状况以及CRP、ALB、Hb均比治疗前显著改善（P〈0．05）。结论HDF4-HP治疗可改善维持性HD失眠患者的睡眠质量及生活质量。     

组合型人工肾治疗老年维持性血液透析患者皮肤瘙痒的疗效

目的探讨组合型人工肾(血液灌流联合血液透析)对治疗老年维持性血液透析患者皮肤瘙痒临床疗效的评价。方法 54例老年维持性血液透析患者随机分为组合型人工肾治疗组30例和对照组24例(血液透析治疗),共治疗8 w,比较两组患者治疗后皮肤瘙痒缓解率及治疗前后血清β2-微球蛋白(β2-MG)、甲状旁腺激素(PTH)、血磷、血钙、血肌酐、血白蛋白的变化。结果治疗8 w后组合型人工肾治疗组总的皮肤瘙痒缓解率为73.3%(22/30),显著高于对照组〔20.8%(5/24),P0.01〕;治疗8 w后组合型人工肾治疗组血清β2-MG、PTH水平明显低于对照组(P0.05),而血磷、血钙、血肌酐、血白蛋白水平无显著差异(P0.05);组合型人工肾治疗组血清β2-MG、PTH水平较治疗前明显下降(P0.05),而在对照组中其治疗前后无显著变化(P0.05)。结论组合型人工肾可以有效地清除血浆中β2-MG、PTH等中大分子毒素,是治疗老年维持性血液透析患者皮肤瘙痒的一种有效方法。     

血液透析血液灌流对继发甲状旁腺功能亢进的影响

目的观察血液灌流比较血液透析滤过对慢性肾衰竭维持血液透析患者继发性甲状旁腺功能亢进的影响。方法选取2004年8月至2005年11月河北大学第二医院维持性血液透析患者40例,分为2组,比较单次血液透析串联血液灌流(HD HP)治疗,及单次血液透析滤过(HDF)治疗前后,患者血甲状旁腺激素(PTH)和磷(P)的清除力和清除百分比。结果单次血液透析串联血液灌流后,慢性肾衰竭维持血液透析患者血PTH下降明显,血钙(Ca)增高。结论血液透析串联血液灌流后患者骨病的临床症状好转;血液灌流可以明显降低患者的PTH,能很好地改善维持性血液透析患者的继发性甲状旁腺功能亢进症状。     

以活性炭为吸附剂的血液灌流联合血液透析对中分子毒素的影响

目的 观察以活性炭为吸附剂的血液灌流联合血液透析对维持性血液透析（MHD）患者血清甲状旁腺激素（PTH）和β2-微球蛋白（β2-MG）的清除效果.方法 选择符合入选标准的MHD患者60例,并将60例患者随机分为血液灌流联合血液透析（HP＋ HD）组、血液透析滤过（HDF）组和血液透析（HD）组3组,每组均为20例.比较3组患者单次治疗前、后和治疗6个月后血清PTH和β2-MG水平的变化.结果 3组患者治疗前PTH和β2-MG水平比较差异无统计学意义（P＞0.05）.HP＋ HD组单次治疗后PTH水平下降（P＜0.01）,β2-MG水平无明显变化（P＞0.05）,治疗6个月后PTH和β2-MG水平均下降（P＜0.01）;HDF组单次治疗和治疗6个月后PTH和β2-MG水平均下降（P＜0.01）;HD组单次治疗和治疗6个月后PTH和β2-MG水平均无明显变化（P＞0.05）.治疗6个月后,HP＋ HD组PTH下降率大于HDF组和HD组（P＜0.05）.结论 长期应用以活性炭为吸附剂的血液灌流联合血液透析治疗,能够有效清除尿毒症患者的中分子毒素,特别是对PTH的清除优于常规血液透析和血液透析滤过.     

Relationships Between Malnutrition,Inflammation, Sleep Quality,and Restless Legs Syndrome in Hemodialysis Patients

Restless legs syndrome (RLS) is a common neurologic sensorimotor disorder. It is also seen in hemodialysis patients in whom the mechanism is not thoroughly understood. The aim of this study was to evaluate the association between malnutrition‐inflammation score (MIS), sleep quality, and RLS in chronic hemodialysis patients. This cross‐sectional study included 232 adult stable chronic hemodialysis patients (mean age 60.9 ± 14.1 years, 56.5% male). RLS frequency, MIS, Pittsburgh Sleep Quality Index (PSQI), laboratory data of patients as well as severity of RLS were evaluated. Thirty‐seven patients (15.9%) were diagnosed with RLS. Mean MIS of patients with or without RLS were similar. PSQI of patients with RLS was significantly higher than patients without RLS (P = 0.002). There was a significant positive correlation between RLS severity and PSQI (r = 0.445, P = 0.006). A significant positive correlation was also found between PSQI and MIS in patients with RLS (r = 0.419, P = 0.010). RLS severity was positively correlated with some inflammatory parameters such as white blood cell count and C‐reactive protein (r = 0.427, P = 0.008 and r = 0.418 P = 0.010). PSQI was found as an independent significant predictor of RLS (odds ratio [OR] = 1.15 (1.06–1.25), P = 0.001) in multivariate logistic regression analysis. Our study revealed that there was no significant relationship between RLS and MIS in chronic hemodialysis patients. However, RLS severity is correlated with inflammatory parameters. Also, sleep quality in chronic hemodialysis patients with RLS is negatively associated with MIS.     

Association between abnormal thalamic metabolites and sleep disturbance in patients with end-stage renal disease

Sleep disturbances are common in end-stage renal disease (ESRD) patients. However, the underlying neuropathological mechanisms are largely unclear. Previous studies have revealed the important role of the thalamus in the potential mechanisms of sleep disorders. We hypothesized that the sleep disturbances in ESRD patients may correspond to metabolic changes of thalamus and the uremic factors may have a vital contribution on these changes. We performed multi-voxel ¹H-MRS of bilateral thalami in 27 ESRD patients who currently receiving hemodialysis treatment and 21 age-matched healthy volunteers. ESRD patients underwent Pittsburgh Sleep Quality Index (PSQI) scale and restless legs syndrome (RLS) rating scale assessment. Laboratory blood tests including serum creatinine, serum urea, cystatin-C, serum parathyroid hormone (PTH), calcium and phosphorus levels, hemoglobin and hematocrit were performed in all ESRD patients close to the time of the MR examination. We found correlations among elevated PTH, higher PSQI score and RLS rating score in ESRD patients. ESRD patients displayed decreased N-acetylaspartate and creatine ratio (NAA/Cr) of thalami compared with controls. There were significantly negative correlation between NAA/Cr and serum PTH level or PSQI score. The metabolic changes of thalami played an important role in the neuropathological mechanisms of lower sleep quality in ESRD patients. Secondary hyperparathyroidism as one of the main uremia-related factors was closely related to abnormal metabolites of the thalamus in patients with ESRD, revealing the crosstalk procedure between renal impairment and brain function.

     

血液透析滤过与血液透析对维持性血液透析患者疗效的比较

目的比较联机血液透析滤过（OL-HDF）与常规血液透析（RHD）对维持性血液透析（MHD）患者的临床疗效。方法将入选的60例MHD患者按随机排列表法分为两组,HDF组30例行后稀释法OL-HDF,HD组30例行RHD治疗。观察治疗前后及组间并发症发生情况,以及甲状旁腺素（PTH）、β2-微球蛋白（β2-MG）、超敏C反应蛋白（hs-CRP）、Kt/V值的变化。结果 OL-HDF可减少MHD患者的顽固性皮肤瘙痒、周围神经病变、慢性骨痛等并发症;治疗6个月后HDF组血清PTH、β2-MG、hs-CRP水平较HD组显著降低,而Kt/V值变化差异无统计学意义。结论 OL-HDF能更好地清除尿毒症毒素,预防和减少透析相关并发症的发生,明显改善MHD患者微炎症状态,提高患者治疗效果及生活质量。     

成年血液透析患者矿物质及骨代谢紊乱调查

目的 调查江苏省昆山市第一人民医院维持性血液透析（maintenance hemodialysis,MHD）患者的慢性肾脏病矿物质及骨代谢异常（chronic kidney disease-mineral and bone disorders,CKD-MBD）情况,比较分析老年和非老年患者CKD-MBD的特点,为临床治疗提供依据.方法 调查234例MHD患者的透析龄、透前肌酐、血小板、白蛋白、血色素、血钙、血磷、ALP及iPTH的水平及临床资料,与指南比较分析老年组和非老年组血钙、血磷、ALP及iPTH的特点.结果 我院MHD患者非老年组患病率高于老年组（P＜0.05）;透析龄、干体重、透前肌酐、白蛋白水平等指标两组间差异无统计学意义（P＞0.05）;血清钙、磷、iPTH达标率分别为83.76％、19.66％、40.17％.两组比较,老年组血清钙、磷、iPTH、ALP均不同程度的低于非老年组,差异有统计学意义（P＜0.05）.结论 老年组MHD患者CKD-MBD指标低于非老年组,提示两组患者CKD-MBD发生机制存在差异,老年患者容易合并低转运骨病（akinesis bone disease,ABD）.     

不同血液净化方法对肾衰合并继发性甲状旁腺功能亢进患者血清甲状旁腺激素水平的影响

目的探讨不同血液净化方法对慢性肾衰竭（CRF）合并继发性甲状旁腺功能亢进（SHPT）患者血清甲状旁腺激素水平的影响。方法将53例CRF合并SHPT患者随机分为血液透析（HD）组16例,血液透析滤过（HDF）组22例,血液灌流＋血液透析（HP＋HD）组15例,比较治疗前及治疗后6个月血清甲状旁腺激素（PTH）和钙、磷水平的变化。结果治疗后6个月与治疗前比较,HDF组、HP＋HD组PTH水平明显下降（P均〈0.01）,HP＋HD组血磷水平明显下降（P〈0.05）;三组治疗后血钙水平无明显变化。结论HP＋HD与HDF均能够使CRF合并SHPT患者PTH水平下降。     

Prevalence of Restless Legs Syndrome and Its Effects on Sleep and Health-Related Quality of Life in Patients With Heart Failure

BackgroundRestless legs syndrome (RLS) is a neurological disorder characterized by leg restlessness and dysesthesia. Although the relationship between RLS and heart failure (HF) has been reported, the prevalence and clinical significance of RLS in patients with HF remain to be elucidated.Methods and ResultsWe enrolled consecutive patients with HF who were admitted to our institutions. RLS was diagnosed using the International Restless Legs Syndrome Study Group criteria. Subjective sleepiness, sleep quality, and quality of life (QoL) were assessed using the Epworth Sleepiness Scale (ESS), Pittsburgh Sleep Quality Index (PSQI), and 8-item Short Form (SF-8), respectively. Among the 133 patients, 18 (13.6%) had RLS and were younger than those without RLS (62.4±13.4 vs 70.0±12.2, P = .017). The RLS group had significantly disrupted sleep quality and QoL, with greater PSQI score (8.0±3.2 vs 5.9±3.3, P = .015) and lower SF-8 physical component summary (PCS) score (35.6±6.5 vs 40.7±9.5, P = .031), despite similar ESS and SF-8 mental component summary scores. In the multivariable regression analysis, RLS was associated with greater PSQI (β=0.211; P = .014) and lower PCS score (β=?0.177; P = .045).ConclusionIn the patients with HF, RLS was prevalent, and sleep quality and QoL may be disrupted by RLS.     

高通量血液透析对维持性血液透析患者β_2-微球蛋白和甲状旁腺激素及左心功能的影响

目的观察高通量血液透析(HFHD)对维持性血液透析患者β2-微球蛋白(β2-MG)、甲状旁腺激素(PTH)及左心功能的影响。方法选取2010年1月—2013年4月在我院血液净化中心行维持性血液透析患者70例,将其随机分为HFHD组38例和常规血液透析(HD)组32例,分别于治疗前及治疗6个月后检测两组患者生化指标(尿素氮、肌酐、钙、磷、PTH、β2-MG);并测量左室舒张末内径(LVEDd)、左心室射血分数(LVEF)、左房室瓣前向血流E峰与A峰比值(E/A)。结果治疗前后两组患者尿素氮、肌酐、钙比较,差异无统计学意义(P0.05);治疗后HFHD组血磷、PTH、β2-MG均低于HD组(P0.05)。治疗后两组LVEDd比较,差异无统计学意义(P0.05);HFHD组LVEF、E/A高于HD组(P0.05)。结论 HFHD对维持性血液透析患者的β2-MG、PTH有明显清除作用,并可改善左心功能,优于HD。