维持性血液透析患者蛋白质能量消耗及其与负性情绪、睡眠质量的关系

目的 探讨维持性血液透析(MHD)患者蛋白质能量消耗(PEW)发生状况及其与负性情绪、睡眠质量的关系。方法 选取2022年1月至2023年5月在安徽医科大学第三附属医院规律血液透析治疗的患者150例,使用国际肾脏营养与代谢学会(ISRNM)提出的蛋白质能量消耗诊断标准将患者分为蛋白质能量消耗组(n=52)和非蛋白质能量消耗组(n=98),分析两组患者一般资料、实验室指标及人体数据的水平差异,采用logistic回归分析探究PEW危险因素,通过焦虑自评量表(SAS)、抑郁自评量表(SDS)、匹兹堡睡眠质量指数(PSQI)评估两组患者的负性情绪、睡眠质量状况,采用logistic回归分析进一步探究PEW与负性情绪及睡眠质量的关系。结果 维持性透析患者PEW发生率34.7%;PEW组SAS、SDS、PSQI评分均高于非PEW组,差异有统计学意义(P<0.05);多因素logistic回归分析结果显示:C反应蛋白(OR=1.053,95%CI:1.013~1.096)为PEW危险因素,上臂中部周径(OR=0.556,95%CI:0.371~0.834)、高血红蛋白(OR=0.969,95%CI:0.944~0.995)为PEW保护因素。PEW与负性情绪、睡眠质量的发生风险相关,PEW组焦虑的发生风险是非PEW组的2.752倍(95%CI:1.307~5.795,P=0.008),PEW组抑郁的发生风险是非PEW组的3.387倍(95%CI:1.371~8.371,P=0.008),PEW组睡眠障碍的发生风险是非PEW组的2.939倍(95%CI:1.402~6.161,P=0.004)。结论 维持性血液透析患者PEW发生率较高,C反应蛋白为PEW危险因素,上臂中部周径、高血红蛋白为PEW保护因素,PEW增加维持性血液透析患者负性情绪、睡眠障碍的发生风险。

Protein-energy wasting and its relationship with negative mood and sleep quality in maintenance hemodialysis patients

Objective To investigate the incidence of protein-energy wasting(PEW) and its relationship with negative mood and sleep quality in maintenance hemodialysis(MHD) patients.Methods A total of 150 patients receiving regular hemodialysis treatment in The Third Affiliated Hospital of Anhui Medical University from January 2022 to May 2023 wereincluded. Patients were divided into PEW group(n=52)and non-PEW group(n=98) using the diagnostic criteria of protein-energy wasting proposed by the international society of renal nutrition and metabolism(ISRNM).The differences in general data, laboratory indexes and human body data between the two groups were analyzed. Logistic regression analysis was used to explore PEW incidence and risk factors, and self-rating anxiety scale(SAS), self-rating depression scale(SDS),Pittsburgh sleep quality index(PSQI) were employed to assess the anxiety, depression and sleep quality of patients in the two groups, and the relationship between PEW and negative emotion and sleep quality were further explored.Results The PEW incidence of maintenance dialysis patients was 34.7%; the scores of SAS, SDS and PSQI in the PEW group were higher than those in the non-Pew group, with statistical significance(P <0.05). Multivariate logistic regression analysis showed that C-reactive protein(OR=1.053, 95%CI:1.013~1.096) was PEW risk factor, while middle upper arm circumference(OR=0.556, 95%CI:0.371~0.834), high hemoglobin(OR=0.969, 95%CI:0.944~0.995) were PEW protective factors. PEW was associated with the risk of negative mood and sleep quality. The risk of anxiety in the PEW group was 2.752 times that of the non-Pew group(95%CI: 1.307~5.795, P=0.008), and the risk of depression in the PEW group was 3.387 times that of the non-Pew group(95%CI:1.371~8.371, P=0.008). The risk of sleep disorders in the PEW group was 2.939 times higher than that in the non-Pew group(95%CI:1.402~6.161, P=0.004).ConclusionThe incidence of PEW is higher in maintenance hemodialysis patients, C-reactive protein is PEW risk factor, while upper middle arm circumference and high hemoglobin are PEW protective factors, PEW increases the risk of negative mood and sleep disorders in maintenance hemodialysis patients.